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 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.results: 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.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.