ArticleBMC health services research2026
Bridging the implementation gap: a qualitative study of barriers to integrating psychological care into rheumatoid arthritis services in Iran.
Article in BMC health services research, 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
backgroundDespite robust evidence and explicit guideline recommendations, psychological care is rarely integrated into routine Rheumatoid Arthritis (RA) services in Iran. This study explored the multilevel barriers to this implementation gap.
methodsA qualitative study guided by the Consolidated Framework for Implementation Research (CFIR) was conducted. Semi-structured interviews were held with 34 stakeholders (12 patients, 8 rheumatologists, 7 nurses, 4 psychologists, 3 hospital managers) in Iranian rheumatology clinics. Data were analyzed using directed content analysis.
resultsBarriers interacted across CFIR domains, forming an interpretive model of a reinforcing cycle. Financial exclusion (Outer Setting) reinforced biomedical clinic culture (Inner Setting), which diminished professional self-efficacy (Characteristics of Individuals) and nullified implementation processes. Stigma and lack of structured pathways were key themes.
conclusionThe integration gap reflects systemic misalignment, not a lack of evidence. Closing it requires coordinated policy, organizational, and educational reforms, not isolated interventions.
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