Making sense of chronic low back pain in later life: illness representations and coping among older adults in Ghana

Background Chronic low back pain (CLBP) is one of the most common musculoskeletal conditions affecting older adults and a leading cause of disability worldwide. Beyond physical discomfort, CLBP has profound physical, psychological, social and economic consequences. Although previous studies have documented the burden of CLBP, limited evidence exists on how older adults in sub-Saharan Africa make sense of their condition and regulate their responses to it. Guided by the Common-Sense Model of Self-Regulation (CSM), this study explored the illness representations, emotional responses and coping strategies of older adults living with CLBP in Ghana. Methods An interpretive qualitative design was employed. Sixteen older adults aged 60 years and above with chronic low back pain were purposively recruited from Komfo Anokye Teaching Hospital. Data were collected through semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The CSM informed both data interpretation and the organisation of findings by examining participants’ illness beliefs, perceived consequences, emotional representations and coping responses. Results Five interconnected themes emerged. (1) Constructing the Meaning of Chronic Low Back Pain captured participants' attempts to explain the causes of their condition. (2) When Pain Redefines Everyday Life illustrated how persistent pain disrupted mobility, independence, occupational roles, etc. resulting in diminished quality of life. (3) Emotional Responses to Living with Persistent Pain highlighted feelings of fear, sadness, frustration, anxiety and threatened identity. (4) Negotiating Control Over Chronic Low Back Pain described participants' efforts to regain control through medications, healthcare utilisation, activity modification, self-management strategies and reliance on family support. Finally, (5) Faith as the Anchor of Adaptation demonstrated that spirituality was central to participants' coping. Conclusion Among our participants, CLBP was described in relation to illness beliefs, emotional distress, functional limitations, social participation and spiritual coping. These accounts suggest areas for person-centred assessment in this hospital-based sample. The potential value of integrating education, rehabilitation, psychosocial support and patient-preferred spiritual support warrants further evaluation; this study did not assess their effectiveness.