Pathways to Patient-Provider Conflict in Nigeria: A Structural Equation Model of Expectations, Communication, Trust, and Organizational Constraints

Objective: This study empirically investigated the drivers of patient-provider conflict and tested a conceptual model linking treatment expectations, communication, trust, and organizational constraints to conflict intensity in Nigerian tertiary care. Methods: A cross-sectional survey of 400 patients (response rate 82.3%) and 150 healthcare providers (response rate 71.2%) from three Nigerian tertiary hospitals was conducted using stratified random sampling. Validated, culturally adapted scales measured unrealistic treatment expectations, communication barriers, organizational constraints, trust, and conflict intensity. Data were analyzed using Structural Equation Modeling (SEM) with maximum likelihood estimation and bootstrapping for mediation testing. Multi-group confirmatory factor analysis established measurement invariance across samples. Results: The model demonstrated good fit (CFI = .94, RMSEA = .05, SRMR = .04). Unrealistic expectations (β = 0.38, p < .001) and communication barriers (β = 0.32, p < .001) were direct, significant predictors of conflict. The effect of expectations on conflict was partially mediated by a decrease in patient trust (indirect β = 0.10, p < .01; total effect β = 0.48). Organizational constraints significantly moderated the relationship between communication barriers and conflict (β = 0.18, p < .01), with the relationship being stronger in high-constraint environments (simple slope β = 0.48 vs. 0.22). Conclusion: Patient-provider conflict is directly fueled by misaligned expectations and communication failures, with effects exacerbated by eroding trust and amplified by systemic resource constraints. Effect sizes exceed those reported in high-income settings, suggesting context-specific amplification. A multi-level intervention strategy targeting patient education, provider communication skills, and systemic bottlenecks is essential.