Abstract:
Background:
Chronic low back pain (CLBP) remains a leading cause of disability worldwide, disproportionately
affecting populations in low-resource settings. Despite mounting evidence of its psychosocial
underpinnings, there is limited context-specific research from Sub-Saharan Africa, particularly
Uganda.
Objective:
To investigate the prevalence and influence of psychosocial and socio-cultural factors on the
experience and severity of CLBP among adult Ugandan patients attending the spine clinic at
Mulago National Referral Hospital.
Methods:
This cross-sectional mixed-methods study involved 422 adults with CLBP. Quantitative data were
collected using validated tools including the DASS-21, Pain Catastrophizing Scale (PCS), Fear
Avoidance Beliefs Questionnaire (FABQ), and the Oswestry Disability Index (ODI). Qualitative
data were obtained through semi-structured interviews and analyzed thematically. Statistical
analyses included descriptive summaries and Spearman correlation tests.
Results:
A high prevalence of severe to extremely severe anxiety (83.6%), depression (44.9%), and stress
(28.1%) was observed. Significant positive correlations were found between psychosocial
variables and disability severity (ODI scores): anxiety (ρ = 0.61), depression (ρ = 0.58), stress (ρ
= 0.55), PCS (ρ = 0.65), and FABQ (ρ = 0.57), all p < 0.001. Participants with high perceived
social support had significantly lower disability scores than those with low support (p < 0.001).
Qualitative findings revealed four core themes: anxiety-induced activity avoidance, medication
dependency, emotional instability, and sleep disruption. Cultural and spiritual beliefs also
influenced coping and treatment-seeking behavior.
Conclusion:
This study reinforces the importance of adopting a biopsychosocial approach to CLBP
management in Uganda. Psychological distress and limited social support significantly exacerbate
v
pain-related disability, while cultural beliefs shape health behaviors. Addressing these factors
through multidisciplinary, culturally responsive care models is essential for improving outcomes.
Keywords: Chronic low back pain, psychosocial factors, disability, Uganda, social support,
biopsychosocial model
