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. 2025 Nov 21;25(1):1508.
doi: 10.1186/s12913-025-13674-w.

Health system barriers to cardiovascular disease prevention and control in Iran: a qualitative study

Asieh Mansouri  1 , Mostafa Amini-Rarani  2 , Saeide Bahrani  3 , Mahnaz Jozan  3 , Maryam Eghbali Babadi  4 , Ramesh Hoseinkhani  5 , Alireza Khosravi  3 , Hamzeh Ahmadi  1 , Fahimeh Bagherikholenjani  6
Affiliations

Health system barriers to cardiovascular disease prevention and control in Iran: a qualitative study

Asieh Mansouri et al. BMC Health Serv Res. .

Abstract

Background: Several years have passed since the start of the provincial program for the prevention and control of cardiovascular diseases in Isfahan, but little progress has been observed in its indicators. Therefore, we decided to identify the barriers to implementing these programs and provide corrective solutions.

Methods: This exploratory descriptive qualitative study employed directed content analysis guided by the World Health Organization's health system building blocks framework. Data were collected through 16 semi-structured face-to-face interviews with purposefully selected key informants-including managers, decision-makers, implementers, and service providers-using a maximum variation sampling approach. To ensure trustworthiness, we applied Lincoln and Guba's criteria: credibility was enhanced through member checking and prolonged engagement; dependability and confirmability were supported by audit trails and peer debriefing; and transferability was addressed by providing thick descriptions. Data were analyzed using MAXQDA 2020 software.

Results: Analysis of interviews with 16 participants revealed six main themes and 23 sub-themes, aligned with the health system building blocks: governance and leadership, human resources, service delivery, financing, health information systems, and access to essential supplies and medications. The findings point to critical policy-level barriers, such as ineffective inter- and extra-sectoral collaboration, insufficient prioritization of cardiovascular diseases in national agendas, and inadequate financial and human resource planning. These insights underscore the need for strategic policy reforms, including improved intersectoral governance, workforce stabilization, rational drug regulation, and enhanced community-based education initiatives to strengthen the implementation of cardiovascular prevention and control programs.

Conclusion: This study highlights systemic and policy-level barriers that hinder the success of cardiovascular disease prevention and control efforts in Isfahan. Addressing these challenges requires coordinated policy actions, including stronger governance mechanisms, strategic resource allocation, and culturally appropriate community engagement. The findings provide practical insights for health policymakers to design more responsive and sustainable interventions that improve cardiovascular health outcomes at the provincial and national levels.

Keywords: Cardiovascular disease; Directed content analysis; Health system building block framework; Qualitative research.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in compliance with the Declaration of Helsinki. The Ethics Committee of Isfahan University of Medical Sciences approved the study (proprietary ID, IR.ARI.MUI.REC.1401.303). All participant received detailed information about the purpose of the study and the voluntary nature of participation, before starting the study. The participants were assured that they could withdraw from the study at any time without any consequences. The right to refuse to answer specific questions, to maintain the confidentiality of their information and to be anonymous was explained. Personal information and research data were stored separately with strict access controls so that only the primary researcher had access to the complete data set. Personal data will be destroyed after study completion, while other research data will be stored securely for future research, in accordance with data protection regulations. Informed written consent was obtained from all study participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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