Stakeholder analysis of tobacco control policy in Iran: a qualitative study

Tobacco control in low- and middle-income countries is a complex issue due to powerful economic and political bodies in the production and distribution of tobacco products. The urgent need for effective tobacco control measures is highlighted by the rising health burden associated with tobacco use in Iran, necessitating a comprehensive stakeholder analysis. The current study aimed to analyze the roles and characteristics of all stakeholders involved in tobacco control policymaking in Iran. Adhering to the theoretical framework introduced by Varvasovsky and Brugha, a qualitative stakeholder analysis was conducted based on five items of stakeholders’ roles, interests, positions, powers and influences. The actors included in the study encompassed governmental bodies, non-governmental organizations (NGOs), the tobacco industry, health organizations, and the international community. The data were collected using semi-structured interviews with 36 key informants. MAXQDA V.10 software was used to analyze interviews by content analysis, and PolicyMaker software V.4 was used to perform data analysis. Forty-two tobacco-related stakeholders were identified and classified into eight groups of governmental executives, legislative body, non-governmental organizations, mass media, universities, clerics and imitators, the tobacco industry, and international organizations. The Iranian Parliament and public sector stakeholders have the central role in all stages of the policymaking process. The state actors prevail in all stages of Iran’s tobacco control policymaking. The number of non-governmental organizations active in the field of tobacco control was limited. Notably, there exists a conflict of interest between the actors in the two areas of tobacco control and the tobacco industry. Health-related organizations in Iran exhibit a weak coalition for tobacco control, lacking influence over the tobacco industry and smuggling control actors, while various stakeholders have diverse interests impacting their relationships. Strengthening the government’s tobacco control capacity and developing a national tobacco control strategy, in which intersectoral collaboration between different actors is established, can reduce the conflict of interests between involved actors in Iran. This, in turn, leads to a reduction in the smoking rate and an improvement in public health in Iran.