ArticleBMJ open2026
Barriers and facilitators in hospital-based physiotherapy services in Iran: a qualitative study using the theoretical domains framework.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHospital-based physiotherapy can play an important role in the multidisciplinary treatment of hospitalised patients by optimising their functional mobility as part of the patient's overall functional health condition. Considering that hospital-based physiotherapy services are structured differently among countries, providing hospital-based physiotherapy services may also face different barriers and facilitators.
objectiveThis study aimed to explore the potential barriers and facilitators in providing hospital-based physiotherapy services in Iran.
designBased on the Theoretical Domains Framework (TDF), individual semistructured interviews were conducted to identify barriers and facilitators in the delivery of physiotherapy services in hospital settings. Purposive and snowball sampling was conducted to gather information from clinical physiotherapists and physiotherapy professors.
settingThis study was conducted from September 2023 until October 2024 in Iran.
resultsInformation was obtained from 39 clinical physiotherapists and 4 physiotherapy professors. According to TDF, 64 barriers and 66 facilitators were determined in hospital-based physiotherapy in Iran which were categorised into 11 and 12 domains, respectively. The most frequent barriers were found in the 'environment context and resources' domain. Further, 'Social/professional role and identity', 'reinforcement' and 'emotion' were ranked, in order, as the next most frequent domains in which the constructs were categorised. Also, the most frequent codes, 'lack of interdisciplinary collaboration' and 'lack of proper equipment', belong to 'Social/professional role and identity' and 'environment context and resources' domains, respectively. Similarly, among facilitators, 'environment context and resources' is the most common domain that was addressed. After that, 'Social/professional role and identity', 'beliefs about consequences', 'knowledge', 'reinforcement' and 'intentions' were ranked respectively as frequent domains that were mentioned. Similar to barriers, the most frequent code, 'attention to infrastructures', belongs to the 'environment context and resources' domain. Then, with a negligible difference, 'professional interactions' in the 'Social/professional role and identity' domain were defined as the second most frequent code in this study.
conclusionThis study identified key facilitators and barriers to hospital-based physiotherapy in Iran across TDF domains. These findings highlight the need for strengthening professional identity, improving interprofessional collaboration, and addressing structural and motivational barriers. These insights offer a foundation for targeted strategies to enhance physiotherapy integration into hospital care and inform future approaches tailored to the Iranian healthcare context.
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