Qualitative study identifies barriers to empowering urban primary health providers in Iran

Health providers working in urban primary health service centers in Shiraz, Iran, face a set of interconnected obstacles to their professional empowerment, according to a qualitative study published in BMC Primary Care. The research, led by Marzieh Kargarjahromi and colleagues, used conventional content analysis to map the challenges that keep frontline providers from reaching their full capability in delivering primary care.

The study team recruited eighteen participants in total: fourteen health providers, two supervisors and two family physicians employed in the primary health service center. Participants were chosen through purposive sampling with maximal variation, and recruitment continued until data saturation was reached. All of the health providers involved were women, with an average age of 32.87 years and a standard deviation of 8.85; individual ages ranged from 24 to 42 years.

Data collection ran from April to September 2023 and drew on multiple methods rather than interviews alone. The researchers conducted individual in-depth semi-structured interviews and focus groups, complemented by unstructured observations and field notes. The resulting material was analyzed using a conventional content analysis approach with the support of MAXQDA 2020 software, allowing categories to emerge from the data rather than being imposed in advance.

From this analysis, the authors derived three main categories containing eleven subcategories. The first main category was labeled “Inadequacy of health providers training process,” pointing to gaps in how these workers are prepared for their roles. The second, “inefficient management of organization resources,” captured problems in how the centers manage the resources available to staff. The third, “weakness in professional performance,” described shortfalls in day-to-day professional practice.

The background to the study frames why these findings matter. Empowerment of health providers is widely recognized as a critical factor in enhancing healthcare quality and outcomes. The authors note that when the capabilities of health providers are not sufficient to the demands of their profession, the consequences include reduced motivation, creativity, productivity and organizational dedication, lower job satisfaction and increased burnout. Understanding the specific challenges to empowerment is therefore presented as an important step for health systems that rely on primary care staff.

The aim of the study, as stated by the authors, was to investigate challenges related to health providers’ empowerment working in the urban primary health service center in Shiraz, Iran. By grounding the investigation in the direct accounts and observed practice of providers, supervisors and family physicians, the qualitative design sought to capture the lived experience of empowerment barriers rather than measure them numerically.

On the basis of their findings, the researchers put forward a recommendation aimed at health policymakers: prioritize the development and implementation of continuous, up-to-date training programs tailored specifically to the evolving roles of primary health providers. This recommendation flows directly from the category concerning the inadequacy of the training process, which the analysis identified as one of the three principal obstacles.

The authors conclude that the research offered more profound insights into health providers’ challenges to empowerment at the primary health service center. As a qualitative, single-center study based on a predominantly female provider sample in one Iranian city, its findings describe the experiences of the participants studied rather than establishing prevalence or causal effects across other settings. Nevertheless, the identified categories provide a structured picture of where training, resource management and professional performance fall short in this context.

The article was published open access in BMC Primary Care on 21 October 2026 and is being shared early to provide faster access to peer-reviewed, accepted research; this version remains subject to further edits before the final Version of Record replaces it. The work was authored by Marzieh Kargarjahromi, Fatemeh Vizeshfar, Camellia Torabizadeh and Shahrzad Yektatalab.

Subject of Research: Barriers to the professional empowerment of health providers working in urban primary health service centers in Shiraz, Iran

Article Title: Challenges related to health provider’s empowerment working in the urban primary health service center: a qualitative content analysis study

Article References: Kargarjahromi, M., Vizeshfar, F., Torabizadeh, C., & Yektatalab, S. (2026). Challenges related to health provider’s empowerment working in the urban primary health service center: a qualitative content analysis study. BMC Primary Care. https://doi.org/10.1186/s12875-026-03595-w

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03595-w

Keywords: primary health care, empowerment, qualitative research, content analysis, Iran, health providers, training, burnout, health policy, Shiraz, BMC Primary Care, semi-structured interviews