Understanding the multidimensional barriers to treatment adherence among Iranian patients with hypertension: a qualitative content analysis

Hypertension is a prevalent chronic condition requiring consistent adherence to medications and lifestyle modifications. Despite its clinical importance, many patients struggle with treatment adherence (TA), and in-depth qualitative insights into how adherence barriers are experienced and interconnected in patients’ daily lives remain limited. This study aimed to explore barriers to TA among Iranian patients with hypertension. A qualitative study was conducted in 2025 using conventional content analysis. Twenty-three outpatients with hypertension attending the outpatient clinic of Shahid Modarres Hospital, Saveh, Iran, were purposefully recruited to maximize variation in age, gender, education, and disease duration. Data were collected through in-depth semi-structured interviews and analyzed following Graneheim and Lundman’s approach using MAXQDA 10. Data saturation was achieved when no new codes or themes emerged. Trustworthiness was ensured through independent coding by two researchers, member checking, reflexive journaling, and comprehensive documentation of the analytic process. Five interconnected categories of barriers to treatment adherence emerged: mental burnout, lack of effective education and communication, sociocultural influences, financial constraints, and behavioral and lifestyle-related challenges. The analysis revealed that these barriers did not operate independently; rather, they formed an interconnected system in which mental burnout, communication gaps, sociocultural pressures, financial hardship, and behavioral challenges reinforced one another, collectively undermining long-term treatment adherence. Treatment adherence among Iranian patients with hypertension is shaped by an interconnected system of psychological, interpersonal, sociocultural, financial, and behavioral barriers rather than isolated individual factors. These findings provide a deeper understanding of patients’ lived experiences and may inform the development of culturally responsive, patient-centered strategies to support long-term treatment adherence.