Reconceptualising leprosy self-care as a social practice: a qualitative study in North Central Nigeria

Leprosy self-care is essential for preventing disability and preserving dignity but remains challenging in resource-constrained settings like Nigeria. Traditional behavioural approaches often fail to address the broader social and material factors influencing self-care sustainability. This study employs Social Practice Theory (SPT) to reconceptualise leprosy self-care as a socially embedded practice, moving beyond individual-focused interventions. Conducted over four months in a leprosy-designated village in North Central Nigeria, the research utilised a qualitative methodology grounded in hermeneutic phenomenology. Data were collected through 20 in-depth interviews with individuals affected by leprosy, five key informant interviews, and 16 hours of non-participant observation. Thematic analysis, guided by SPT’s framework of competences, materials, and meanings, revealed that self-care is shaped by dynamic interactions among skills, resource availability, and cultural interpretations. Challenges included inadequate supplies, inconsistent healthcare support, and stigma, which often undermined engagement. Religious practices and daily routines, such as ablution, sometimes supported self-care, while competing activities like street begging posed barriers. The study distinguishes between replaceable and irreplaceable materials, highlighting their impact on practice sustainability. Family and peer involvement further influenced outcomes, either reinforcing or weakening self-care efforts. By framing self-care as a social practice, this research underscores the need for systemic, contextually sensitive interventions that integrate material provision, skill development, and stigma reduction. SPT offers a robust framework for designing multi-level strategies to enhance self-care for leprosy and other chronic conditions, promoting sustainable health outcomes in marginalised communities.