Unseen barriers to home healthcare: a qualitative study of providers’ perspectives from Saudi Arabia

OBJECTIVES: This study investigated the challenges of providing care in Home Health Care (HHC) settings in Saudi Arabia. DESIGN: We employed a qualitative design and used thematic analysis to identify patterns and themes in the data supplemented with selected techniques commonly associated with grounded theory such as constant comparison, memo writing, and open coding to support rigor and depth without aiming to generate a formal theory. SETTING AND PARTICIPANTS: Sixty home health care providers self-selected into the study following an open invitation distributed to home health care facilities in Saudi Arabia. Participants were healthcare professionals, primarily younger than 40 years. Men predominated in roles such as general practice, physiotherapy, and family medicine, especially in the Western region, whereas nurses showed a more balanced sex distribution and broader regional representation. METHODS: Data were collected through semi-structured interviews conducted between September 2023 and May 2024. Interviews lasted between 30 and 45 min and explored the complexities of delivering care to older adults in home settings. Thematic analysis was applied to identify key themes from the data. RESULTS: Thematic analysis of 60 semi-structured interviews with home healthcare providers across four major regions of Saudi Arabia (Western, Southern, Northern, and Central) - including general practitioners, family physicians, nurses, physiotherapists, social care workers, and psychologists - identified four overarching challenges in delivering care to older adults: disrupted caregiver-provider communication, system fragmentation and resource constraints, environmental and cultural barriers, and the emotional burden of care. Collectively, these challenges undermined continuity of care and weakened patient-provider relationships. CONCLUSIONS AND IMPLICATIONS: The findings highlight the need for comprehensive strategies to strengthen Saudi Arabia's home health care sector. Priorities include caregiver training, equitable resource allocation, and standardized referral processes. In addition, raising public and provider awareness will be essential to dispel misconceptions and support the delivery of high-quality, sustainable home health care.