Explaining social determinants of health in Iran: a qualitative exploration of challenges and strategies

Identifying challenges and strategies for explaining or clarifying the social determinants of health (SDH) is crucial for developing preventive programs that improve socio-economic status and public health. While previous Iranian studies have focused on SDH implementation barriers and research activities, this specific process of explanation has remained underexplored. The present study addresses this gap by investigating the challenges and strategies for SDH explanation within the context of Iran. This qualitative study employed conventional content analysis of semi-structured interviews with 10 directors and researchers from SDH research centers across Iran. Purposive sampling continued until data saturation was reached, with interviews conducted both in-person and virtually. The analysis identified four primary challenges in explaining SDH: (1) a lack of stakeholder awareness; (2) inefficiencies among policymakers; (3) challenges inherent to SDH's structure and performance; and (4) difficulties in its definition and components. Regarding strategies, seven key themes emerged, including (1) clarifying SDH's role, (2) engaging experts, (3) securing funding, (4) fostering collaboration, (5) implementing educational policy strategies, (6) developing research-oriented policies; and (7) popularizing the SDH concept. Overall, this study demonstrates that improving population health in Iran requires not only addressing structural and governance challenges but also systematically improving the ways in which SDH are explained and communicated. The findings provide actionable insights for policymakers, educators, and researchers, thereby supporting evidence-based reforms in education, governance, and intersectoral collaboration. By clarifying SDH concepts and strengthening institutional capacity, Iran can move toward more equitable and sustainable health outcomes.