Prioritizing Barriers and Facilitators of Traditional, Complementary, and Integrative Medicine Service Use: A Delphi...

Recognizing and prioritizing the factors that influence the selection of treatment options is essential for effective health service planning and an appropriate health care delivery system. This study aimed to identify and prioritize the barriers and facilitators to the use of Traditional, Complementary, and Integrative Medicine (TCIM) in Iran.

A two-phase, mixed-methods study was conducted. First, a two-round Delphi survey was conducted with a panel of 32 experts, including specialists in Persian medicine (PM) and health policymakers, to acheive consensus on a list of barriers and facilitators within the Iranian context. Subsequently, the Analytical Hierarchy Process (AHP) was applied with a 12-expert panel to determine the relative weight and priority of the agreed-upon criteria.

The Delphi process yielded consensus on 18 facilitators and nine barriers. The facilitators were categorized into two main dimensions (Cultural and social facilitators, and Systemic facilitators) and six sub-dimensions. In comparison, the barriers formed four main dimensions (service delivery barriers, policy challenges, financial barriers, and knowledge and attitudinal barriers). Quantitative AHP results revealed that among facilitators, "effects of health professionals" (Final Weight: 0.29) was the most critical dimension, with "Recommendation and referral by conventional physicians (CPs)" (Final Weight: 0.18) as its top factor. Conversely, among barriers, "Policy Challenges" (Final Weight: 0.50) was the most significant dimension, substantially outweighing others.

The findings highlight that the recommendation of TCIM by CPs are the strongest facilitator; yet, overarching policy challenges critically hamper its implementation. Addressing this disconnect requires integrated policy reforms and interdisciplinary collaboration to leverage TCIM within Iran's health care system effectively.