Social determinants of health among homeless women in border regions of Iran with Afghanistan: a qualitative study

Homeless women constitute one of the most vulnerable populations. The aim of the study was to identify the Social Determinants of Health (SDH), also known as social drivers of health among homeless women residing in Iran’s border regions adjacent to Afghanistan, characterized by socioeconomic and healthcare disparities. This qualitative study was carried out between September 2025 and January 2026. The research was conducted in government-operated shelters situated in a low-resource region of eastern Iran. Using Microsoft Office Word 2016, verbatim transcripts of audio-recorded data from 13 semi-structured, in-depth interviews with homeless women, recruited through convenience and purposive sampling, were subjected to a manual thematic analysis following Boyatzis’s methodological approach. The analysis was guided by the Healthy People 2030 framework as the study’s conceptual framework. The thematic analysis revealed 24 SDH under five overarching themes: Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context. The domains of economic stability, along with, social and community context, encompassed the highest number of determinants, presenting their influential role in the ultimate health outcome of homeless women. This study presented a comprehensive list of SDH for homeless women, highlighting the pivotal roles of governments in addressing the issue. The findings hold particular value for low-resource settings.