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

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.

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).

A qualitative descriptive study was conducted using the purposeful sampling method to enroll 30 physicians from October 2016 to May 2018. 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.

This themes identified were: 1) macro- and meso-contextual factors, emphasizing that a) policies at all levels affect guideline adherence, and b) environmental-contextual factors affect guideline adherence, 2) 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.

The attitudes, awareness, knowledge, and capacity of clinicians, as well as a broader socio-cultural context should be taken into account for guideline implementation.