Conceptual framework of evidence-based decision-making among primary healthcare managers: a grounded theory study

Abstract Background Evidence-based decision-making (EBDM) is essential for effective primary healthcare (PHC) management, as it enables managers to integrate the best available evidence into organizational decisions. Despite its importance, there is limited understanding of the factors influencing EBDM among PHC managers. This study aimed to develop a conceptual framework for explaining EBDM among PHC managers. Methods A qualitative study was conducted using the Strauss and Corbin’s grounded theory approach. Semi-structured interviews were conducted with 17 PHC managers, experts, and specialists selected through purposive and theoretical sampling. Data were analyzed using open, axial, and selective coding to identify the relationships among categories and to construct the conceptual framework. Results Thirteen main categories were identified and organized within six grounded theory dimensions: causal, contextual, and intervening conditions; the core phenomenon; strategies; and consequences. The framework highlights the interactions among evidence characteristics, evidence demanders and suppliers, organizational structure and resources, legal requirements, organizational support, evidence utilization, training, monitoring, and resulting organizational and community outcomes. Conclusion This study developed a grounded theory-based conceptual framework that explains how organizational, contextual, and managerial factors interact to shape EBDM among PHC managers. The framework provides practical guidance for strengthening evidence-based management and policymaking within PHC systems.