Physicians’ Perspectives of the Factors Influential in Implementing National Clinical Guidelines for Hypertension in Iran: A Qualitative Study

Background: Although clinical guidelines help in the prevention, diagnosis, and management of hypertension, individuals with hypertension often remain undiagnosed, or once diagnosed, may not receive adequate care and treatment. Objectives: In this study, we explored physicians’ perspectives of the factors influential in implementing the Iranian Recommendations on Prevention, Evaluation, and Management of Hypertension (IRPEM-HTN). Methods: A qualitative descriptive study was conducted using the purposeful sampling method to enroll ۳۰ physicians from October ۲۰۱۶ to May ۲۰۱۸. The physicians working in private offices or university-affiliated health centers/hospitals in the province of Isfahan, Iran, were included in this study one year after participating in the IRPEM-HTN program. The data were gathered through semi-structured interv iews. The transcribed data were thematically analyzed, and the rigor was ensured following the procedure outlined by Braun and Clark. Results:This themes identified were: ۱) macro- and meso-contextual factors, emphasizing that a) policies at all levels affect guideline adherence, and b) environmental-contextual factors affect guideline adherence, ۲) micro level factors, emphasizing that c) attributes of the guideline affect guideline adherence, and d) clinician- and patient-level factors affect guideline adherence. Micro-, meso- and macro-level factors influenced guideline implementation. Conclusion: The attitudes, awareness, knowledge, and capacity of clinicians, as well as a broader socio-cultural context should be taken into account for guideline implementation.

Keywords:

hypertension , preventive care , clinical practice guideline , facilitators , barriers , physicians