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Table 1 Overview of included studies

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

First author /yearSettingObjectivesStudy designSampling/ participantsAnalysis approachKey emerged themesCASP score
Molayaghobi [18], 2019A specialized polyclinic-IsfahanTo implement, determine, and solve the challenges of executing the Chronic Care Model in diabetes managementAction research/ semi-structured interviews17 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], 2012A big university affiliated hospitals in Tehranto clarify the care process for Iranian patients with diabetes suffering from diabetic foot ulcer conditionGrounded Theory /semi-structured interviews11 diabetic patients with food ulcer, 4 physicians, one head nurse and one nurseTheoretical analysis* disease management
* disease experience
* continuity of care
Shakibazadeh [21], 2011A diabetes clinic in Tehranto exploreexperience of Iranian diabetic patients regarding barriers to and facilitatingfactors for diabetes self-carephenomenological study/ focus groups43 type 2 diabetic patientsFramework 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’ perspectivesdocuments review and face-to-face semi-structured interviewsProgram leaders and relevant executive managers of the local medical universitiesThematic analysis* program planning
* program implementation
* Program results
Abdoli, 2009 [17]Hospitals, diabetes clinics, physician offices, and health housesTo identify barriers to and facilitators of empowerment in people with diabetesgrounded theory/ in-depth unstructured interviews11 diabetic patientsThematic analysis* negative view about diabetes
* ineffective healthcare systems
* poverty and illiteracy
Nouhjah, 2014 [19]A diabetes clinic/ Ahwazto explore diabetic women’s views about the diabetes and its consequencesSemi-structured interview40 Diabetic Women’sThematic 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 Isfahanto describe the situation of training of general practitioners who provide diabetes careunstructured interviews8 diabetes management planners and six general practitioners workingin diabetes centerscontent 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 patientsgrounded theory/ Semi-structured in-depth interviews21 diabetic patients+ two members of families and healthcare providersCorbin 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 departmentsto identify the problems of Type 2 diabetes prevention and control program in IranThe semi-structured interview7 diabetes experts, and 10 diabetic patientsFramework analysis* Referral system issues
* human resources issues
* Infrastructure issues
* cultural problems issues
* access issues
* intersectoral coordination issues
Dehghani Tafti, 2015 [28]Health network/ Ardakanto explore the barriers and incentives for diabetes self-carefocus group discussions and interviewsDiabetic patients and health care providerscontent analysis* product issues
* place issues
* price issues
* promotion issues
Molayaghobi, 2019 [25]A specialized poly-clinic/ IsfahanTo identify diabetes management challenges in Iransemi-structured interviews4 members of clinic diabetesunit and 21 type 2 diabetic patientscontent analysis* weak care delivery system
* Defective diabetes self-care
Rezaei, 2019 [20]A diabetes unit / KurdistanTo identify barriers of medication adherence in Iranian patients with type-2 diabetesSemi-structured interviews12 patients with type-2 diabetesconventional content analysis* disbelief in medical explanatory/prescriptive knowledge
* lived experiences of the disease
* challenges of everyday life
* interactive/economic challenges