Exploring Barriers to the Development of Home Health Care in Iran: A Qualitative Study

Abstract

Changes in society’s needs have increased individuals’ desire to be independent and receive health care at home. Home health care (HHC) is one of the main components of realizing these ambitions. However, there is a serious concern about the state of development of the HHC industry in Iran and the quality of its services. This study aims to explore the barriers to the development of HHC in Iran. This qualitative study with a conventional content analysis approach was conducted in Tabriz, Iran, from October 2019 to March 2020. Twenty-one key stakeholders including nurses, home health directors, physicians, policy-makers, patients, and their families participated in the study. Participants were selected using purposive sampling. Data were collected using a focus group discussion (FGD) and 18 semi-structured in-depth interviews and analyzed using Graneheim and Lundman’s techniques. Data collection continued until saturation was reached. Three main themes emerged from the analysis: quality management challenges, insufficient infrastructure and policy, and political issues. The findings show that applying standard strategies to monitor the quality of services, paying attention to infrastructure, and having a clear framework for policy-making are beneficial for the development of the HHC industry. Health managers can monitor and upgrade the quality of HHC services by defining standards and assessment indicators, as well as providing comprehensive data. It is suggested that legislators consider the principles of community-based accountability, justice, and accessibility their top priority. Moreover, policymakers need to develop a roadmap to reform policies to create the conditions for the development of this industry.

Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review)

“…Another challenge is the high cost of health service provision in the community in the form of home visits and the fact that they are not paid by insurance. Allocating less funds for providing community-based care than for treatment care and hospitalization is another challenge in the Iranian health system ( 16 , 17 , 31 , 33 ).…”

“…It is suggested that legislators prioritize accountability principles based on community, justice, and accessibility. In addition, policymakers need to develop a strategy to reform policies in order to lay the ground for the development of nursing at the community level ( 33 ).…”

“…Health and treatment managers should support community health nurses in establishing community health clinics ( 1 , 6 , 21 , 30 ). Nursing managers should also take action to set up home visit centers using a health promotion approach with the help of community health nurses ( 33 , 46 ). Nursing managers should take the necessary measures to explain and promote the concept of community health nurse and its capabilities ( 46 ).…”

“…A brief review shows that studies in Iran have mostly focused on the challenges of community health nursing education and barriers against home care (1,16,18,19,(32)(33)(34) and other aspects of community health nursing have rarely been studied. In addition, no study has been conducted to offer solutions for addressing the challenges of community health nursing.…”

Home care nurses’ perception of the challenges they faced during the COVID-19 pandemic: a qualitative study

“…It must be noted that home care is completely a new sector in Iran, and despite its remarkable improvements, there is still room for planning and improvement [ 39 ].…”