Structural and cultural barriers to patient education from the perspective of Iranian nurses: a qualitative study

This study examines the structural and cultural barriers that hinder patient education (PE) among nurses in Iranian public hospitals, focusing on the unique challenges in Hamadan's healthcare system.

A qualitative study using conventional content analysis.

We conducted semi-structured interviews with 11 nurses (8 female, 3 male) from five public hospitals in western Iran between September 2023 and July 2025. Participants, selected purposively for diverse clinical experience, shared their views on PE barriers. Interviews were transcribed verbatim and analyzed using Graneheim and Lundman's content analysis approach.

Nurses identified four key barriers: organizational limitations, cultural resistance, patient-related challenges, and personal professional constraints. These barriers, captured under the theme "Culturally silenced care," reveal how hospital policies, such as mandatory PE requirements, often undermine quality education, while cultural attitudes and limited resources further marginalize nurses' educational roles.

To strengthen PE in Iranian hospitals, targeted reforms are needed, including better resource allocation, cultural sensitivity training, and dedicated spaces for education. These insights can guide nursing practice in Iran and similar resource-limited, hierarchical healthcare systems worldwide.