This study explored the challenges of implementing family physician program in an urban community. An important challenge of the FPP was the indigenous norms of the society. Participants believed that adherence to indigenous norms impedes the recipients of the FPP to uptake lifestyle modifications. Due to the culture of the region, they adopted health risk behavior such as unhealthy eating habits like consumption of solid oil, reluctance to fish consumption and sedentary life.
Moreover, participation of men in the program due to the cultural norm that health services just are prepared for women and children, was low. In a similar qualitative study that described cultural barriers to men’s participation in perinatal care in Iran, a large part of resistance to men’s participation in perinatal care was due to the undesirable dominant socio-cultural climate of the society and the traditional patriarchy culture which is dominant in the Iranian families 17. Also another study that was conducted on the factors that preclude men to accessing health care have found that cultural factors, time, convenience, resources, embarrassment and lack of awareness of health care options play a significant role in men’s access to health care18.
Financial problems of the care receivers were another big challenge of the FPP. Various studies on the patients with diabetes and cardiovascular diseases have indicated financial problems as one of the main reasons for having difficulty in self-managing the disease. 19 20. Similarly, our study showed that financial challenges such as low income, unemployment, and recent inflation may lead to poor lifestyle management and lack of preventive medication use like, screening for women's cancers and dental care, which may consequently result in adverse outcomes among the individuals. As participants reported, poor interpersonal relationship was another barrier to successful implementation of the FPP. For instance, the distrust to the health care providers’ competencies made the healthcare recipients unwilling to participate in the FPP. In agreement with this finding, Hamidzadeh et al. reported the lack of trust in health educators’ competencies as one of the barriers revealed for implementing health education programs in rural settings 21. Lack of proper communication between health care providers and clients was another difficulty that may hinder their participation in the FFP. Various studies have indicated effective communication skills as a facilitator for efficient implementation of health care services 12 21 22. In this respect, Mannava et al. in a study on the behaviors and attitudes of health care providers, revealed that the negative interpersonal interactions between care providers and clients might affect clients’ well-being, recovery and follow-up care. They finally showed that the communication and counselling skills of healthcare providers are crucial in changing the health workers’ attitudes and behaviors regarding maternal healthcare provision 23.
Another challenge reported by the participants was the use of inefficient and temporary workforce in implementing the FPP, which leads to incomplete and inappropriate delivery of the program’s health care to the clients and thus reduces the effectiveness of the program. Insufficient capacity of specialists to provide the clients with quality care and support are among the barriers and challenges reported from low- and middle-income countries24 25. As participants believed, the inability of the government to hire permanent staff has led to lack of motivation due to job insecurity among temporary employees, and consequently lack of commitment in delivering high quality health care.
Poor announcement and notification were another managerial problem reported by the participants. Based on the findings, the people are not sufficiently aware of the FFP and its services, which has resulted in low levels of service use as mentioned in many other studies 26 27. In this respect, Kaniz et al. investigated that, exposure to mass media is positively associated with comprehensive maternal healthcare services in South Asia 28. Therefore, FFP services should be presented to the public in a planned manner through mass media campaigns and cyberspace to publicize FFP’s health messages and motivate people to receive healthcare services and increase public trust and public use of the services.
In a family physician program, the payment system plays a key role in both the quantity and quality of the health services 29. Nevertheless, the results of the present study explained that there were problems in the payment of salaries of health workers in the FFP, and payments were too low and paid with delay. Similarly, the weakness of payment mechanisms in health sector and its lack of clarity and notable income gap among the members of a health team are mentioned as main challenges of such programs in previous studies 27 29. Hence, in any countries that was implemented FFP, in order to avoid unnecessary visits and improving the quality of care and diagnosis have used different payment methods, including salaries, per capita, bonuses and fee for service30 considering regular payment system and fair approach to all healthcare providers in the team is essential for the success of family physician program.
According to the findings of our study, high pressure from the management system to raise the indicators and set a ceiling for daycare are among the reasons for caregivers to focus overwhelmingly on increasing the quantity of care provided. Such a situation bear about a huge decline the quality of health services. In a similar study in Turkey on the challenges of implementing primary health care reforms, performance-based indicators were only related to the quantity of care provided, and the quality was not measured. So, uncertainty about the quality of service provision was reported as a big challenge for the investigators30.
Further, in a study, Qi Feng et al. examined a ten-year health care reform program in Taiwan, they examined the quality indicators of care, namely the structure, process, and outcome, and concluded that after receiving the program, members made better use of preventive health services more than others 31.
It can be assumed that to improve the quality of care and the number of registrations in the system and quantity should not be considered as the basis for evaluating and judging employees, so that health care workers don’t worry about increasing the provision of poor-quality care.