Stakeholders’ perspectives on community health nursing practice in the healthcare system of Iran: a qualitative study

INTRODUCTION: Health policies shape how healthcare systems organize authority, allocate resources and define professional roles. In many healthcare systems, redefining the scope and positioning of community-based providers has emerged as a policy response to demographic transitions, increasing chronic disease burdens and resource constraints. In Iran, community health nursing practice (CHNP) has been formally endorsed but remains weakly institutionalized within healthcare system governance and implementation structures. This study aimed to explore stakeholders' perspectives on the roles and tasks of community health nurses to identify policy, governance and system-level factors that influence the practice of community health nurses within the healthcare system of Iran. METHODS: This is a descriptive qualitative study that was conducted between February 2024 and May 2025 using a conventional content analysis approach. The study is part of a broader research project with focus on community health nursing. Data were collected through semi-structured and in-depth individuals' interviews with 18 participants who were selected by purposive sampling. They included faculty members, nursing directors, health deputies, the director of a comprehensive health centre and healthcare workers. Data analysis was guided by Graneheim and Lundman framework. Rigour of the study was ensured using the four criteria of qualitative research, and reporting adhered to the COnsolidated criteria for REporting Qualitative Research (COREQ) guideline. RESULTS: Following iterative analysis cycles for extracting the meaning units, 385 initial codes were generated. These were organized into 11 subcategories and 3 main categories, consisting of "Establishing a job position," "Facilitating integrated care delivery" and "Activating community engagement to promote well-being." These three categories reflected the overarching theme of the study: "The gap between knowledge and practice of community health nurses." CONCLUSIONS: The findings showed a discrepancy between the existing knowledge and competencies of community health nurses and their actual roles within the healthcare system of Iran. Stakeholders described challenges related to role definition, integration into healthcare service delivery and participation in decision-making processes, which were perceived as influencing the implementation of CHNP within the primary healthcare network of the country.