Challenges of community health nursing practice in the Primary Health Care network of Iran: a qualitative study

The Primary Health Care (PHC) network is the cornerstone of health service delivery in the healthcare system of Iran. However, despite the growing health needs due to population aging and the increasing burden of non-communicable diseases (NCD), the potential of Community Health Nursing Practice (CHNP) has not been adequately integrated into the PHC network. Thus, this qualitative study aimed to explore the challenges of CHNP in the Primary Health Care network of Iran. This study has a descriptive qualitative design. It was conducted using a conventional content analysis approach based on Graneheim and Lundman’s method. Data were collected between February 2024 and April 2025 through individual semi-structured interviews with 15 participants. The interviews were recorded, transcribed verbatim, and analyzed using MAXQDA 2018. Trustworthiness of analyzed data was assessed based on Lincoln and Guba’s evaluative criteria. Data reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist. Following iterative cycles on analyzed data, 319 initial codes were generated. They were organized into 21 subcategories, three categories, and one main theme. The main theme of the study was “structural and functional challenges in the CHNP” which included three categories of “Unclear professional position,” “Insufficient service integration into the PHC network,” and “Limited responsibilities in core public health.” The findings showed that the absence of defined position and specific framework for delivering healthcare services by community health nurses (CHNs) has hindered the integration of the CHNP into the PHC network of the country. Strengthening structural reforms, clarifying the roles of CHNs roles, and expanding their participation in community-based programs can improve their coordination of care and equity in access to the healthcare services. This study emphasizes the need for educational reforms and research to enhance leadership and health policymaking competencies and support sustainable, community-oriented healthcare systems.