Barriers to the Development of Health Literacy in Iran's Health System: A Qualitative Study

BACKGROUND: Despite the significance of health literacy, studies show the inadequacy of health literacy in the health system of Iran. Inadequate health literacy is considered a warning for service providers. It needs to be integrated into educational programs that are administered within health and medical centers. OBJECTIVE: Therefore, the present study was conducted to explore the barriers to health literacy in Iran's health system. METHODS: The present qualitative study was conducted in 2023 using a conventional content analysis. To this aim, 18 participants were selected among urban health center staff, 21 from rural health centers, 10 health volunteers, and 8 trainees (people participating in training classes) for interviews and group discussions. After the first interview, continuous data analysis began and continued to saturation level. The data were collected through semi-structured interviews and focus group discussions and were simultaneously analysed using a conventional qualitative analysis. KEY RESULTS: Two main categories of internal and external barriers were detected. The data analysis led to the extraction of four main subcategories: (1) personal barriers (trainee's inadequate competence, lack of physical or mental health, low motivation and commitment of health staff, beliefs, contextual barriers); (2) interpersonal barriers (health care providers' misunderstanding of correct training, malcommunication or miscommunication in training sessions, the trainer's limited skill, underestimated role of education in behavior change); (3) organizational barriers (high workload of health care staff, inadequate human resources, poor management and distrust in the health system, low organizational motivation); and (4) social barriers (uninterest in learning about health issues, issues related to the internet and cyberspace, lack of interpectoral cooperation). CONCLUSION: Considering the multidimensional nature of barriers to health literacy, it is recommended to make and implement a comprehensive plan to integrate efforts by health authorities and institutions, mass media, experts, decision-makers, policymakers, and service providers to remove barriers.