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Table 1 Overview of included studies

From: Challenges of managing diabetes in Iran: meta-synthesis of qualitative studies

First author /year



Study design

Sampling/ participants

Analysis approach

Key emerged themes

CASP score

Molayaghobi [18], 2019

A specialized polyclinic-Isfahan

To implement, determine, and solve the challenges of executing the Chronic Care Model in diabetes management

Action research/ semi-structured interviews

17 patients with type 2 diabetes.

Content analysis

* lack of effective follow-up system

* insufficient acre providers

* incomplete medical records

* limited knowledge of healthcare providers

* lack of regular physician visit

* lack of commitment to ordered regime


Aliasgharpour [24], 2012

A big university affiliated hospitals in Tehran

to clarify the care process for Iranian patients with diabetes suffering from diabetic foot ulcer condition

Grounded Theory /semi-structured interviews

11 diabetic patients with food ulcer, 4 physicians, one head nurse and one nurse

Theoretical analysis

* disease management

* disease experience

* continuity of care


Shakibazadeh [21], 2011

A diabetes clinic in Tehran

to exploreexperience of Iranian diabetic patients regarding barriers to and facilitatingfactors for diabetes self-care

phenomenological study/ focus groups

43 type 2 diabetic patients

Framework analysis

* physical barriers

* psychological barriers

* educational barriers

* social barriers

* care system barriers


Ravaghi, 2014 [23]

General (health system)

To evaluate the planning and establishing of the specialized care program for diabetic’s patient from the healthcare providers’ perspectives

documents review and face-to-face semi-structured interviews

Program leaders and relevant executive managers of the local medical universities

Thematic analysis

* program planning

* program implementation

* Program results


Abdoli, 2009 [17]

Hospitals, diabetes clinics, physician offices, and health houses

To identify barriers to and facilitators of empowerment in people with diabetes

grounded theory/ in-depth unstructured interviews

11 diabetic patients

Thematic analysis

* negative view about diabetes

* ineffective healthcare systems

* poverty and illiteracy


Nouhjah, 2014 [19]

A diabetes clinic/ Ahwaz

to explore diabetic women’s views about the diabetes and its consequences

Semi-structured interview

40 Diabetic Women’s

Thematic analysis

* unavailability of drugs

* high treatment cost

* fear and embarrassment of insulin injection

* self-treatment


Abazari, 2012 [22]

Ministry of health, and officials of the health system in Isfahan

to describe the situation of training of general practitioners who provide diabetes care

unstructured interviews

8 diabetes management planners and six general practitioners workingin diabetes centers

content analysis

* unstructured education of healthcare provides

* inadequate physician’s competence

* ineffective education


Mousavizadeh, 2018 [26]

Hospitals, diabetes associations, physicians’ offices, patients’

to explore how adherence to diabetes treatment process occurs among Iranian patients

grounded theory/ Semi-structured in-depth interviews

21 diabetic patients+ two members of families and healthcare providers

Corbin and Strauss constant comparative analysis

* unperceived threat in diagnosis time

* bitter belief

* adaptation to treatment


Valizadeh, 2017 [27]

Diabetes centers, treatment and health deputies, and health departments

to identify the problems of Type 2 diabetes prevention and control program in Iran

The semi-structured interview

7 diabetes experts, and 10 diabetic patients

Framework analysis

* Referral system issues

* human resources issues

* Infrastructure issues

* cultural problems issues

* access issues

* intersectoral coordination issues


Dehghani Tafti, 2015 [28]

Health network/ Ardakan

to explore the barriers and incentives for diabetes self-care

focus group discussions and interviews

Diabetic patients and health care providers

content analysis

* product issues

* place issues

* price issues

* promotion issues


Molayaghobi, 2019 [25]

A specialized poly-clinic/ Isfahan

To identify diabetes management challenges in Iran

semi-structured interviews

4 members of clinic diabetesunit and 21 type 2 diabetic patients

content analysis

* weak care delivery system

* Defective diabetes self-care


Rezaei, 2019 [20]

A diabetes unit / Kurdistan

To identify barriers of medication adherence in Iranian patients with type-2 diabetes

Semi-structured interviews

12 patients with type-2 diabetes

conventional content analysis

* disbelief in medical explanatory/prescriptive knowledge

* lived experiences of the disease

* challenges of everyday life

* interactive/economic challenges