Redesigning the model for providing primary healthcare in Iran: a grounded theory study in rural settings

This study aimed to redesign the model for providing primary healthcare (PHC) in rural Iran using a grounded theory approach.

Iran's PHC system, although historically successful, faces structural, managerial, and demographic challenges that limit its responsiveness to emerging population health needs. A context-sensitive redesign is therefore required.

This applied qualitative study used grounded theory methodology. Semi-structured interviews were conducted with 25 senior PHC managers, policymakers, and academic experts selected through purposive and theoretical sampling. Data collection and analysis proceeded concurrently using open, axial, and selective coding in MAXQDA 20. PCAT dimensions were used as sensitizing concepts, while allowing new categories to emerge inductively.

The core category identified was 'strengthening PHC through integrated service delivery and system enablement'. The redesigned model includes core service delivery components (utilization, access, continuity, coordination, comprehensiveness, and affiliation with place/provider) and enabling system components (evidence-based planning, managerial capacity strengthening, financing and payment management, effective surveillance and supervision). These enabling components function as structural supports sustaining effective PHC delivery in rural Iran.