Community participation is a fundamental principle of primary health care (PHC), aiming to empower individuals and communities in their own health and well-being. However, the institutionalization of community participation has been hindered by various barriers. To shed light on this issue, a recent study was conducted in Divandareh city, Iran, to identify the barriers to community participation in primary health care from the perspectives of stakeholders.


The study, a qualitative case study, took place in 2021 within the district health network of Divandareh city. A purposive sampling method was used to select 23 specialists and experts experienced in community participation. The participants included nine health experts, six community health workers, four community members, and four health directors involved in primary health care programs. The sampling continued until data saturation was achieved. Semi-structured interviews were conducted, and qualitative content analysis was employed to analyze the collected data.


Upon analyzing the data, the research team identified 44 codes, which were then grouped into 14 sub-themes and five overarching themes representing the barriers to community participation in primary health care within the district health network.

The five themes that emerged from the analysis were as follows:

  1. Community trust in the healthcare system: Lack of trust in the healthcare system was found to be a significant barrier. This lack of trust can stem from past negative experiences, limited access to information, or perceived indifference of healthcare providers towards community needs.
  2. Status of community participation programs: The effectiveness and implementation of community participation programs were found to be inadequate. Insufficient resources, limited training opportunities, and the absence of meaningful engagement were identified as key barriers.
  3. Community and system’s perception of participation programs: Divergent perceptions between the community and the health system regarding the purpose and value of participation programs hindered effective collaboration. Bridging this gap requires effective communication and awareness-building efforts.
  4. Health system management approaches: Inadequate management practices, including top-down decision-making and lack of accountability, hindered community participation. Empowering local healthcare providers and adopting inclusive decision-making processes were identified as potential solutions.
  5. Cultural barriers and institutional obstacles: Cultural norms, beliefs, and societal expectations can act as barriers to community participation. Additionally, existing institutional structures and policies may not adequately support or prioritize community engagement.


The findings of this study highlight several crucial barriers to community participation in primary health care within the district health network. Addressing these barriers is essential to realize the potential benefits of community participation in the healthcare system.

Key areas for improvement include building community trust through transparent and patient-centered practices, enhancing the status and effectiveness of community participation programs, aligning the perceptions of the community and the health system, improving health system management approaches, and addressing cultural and institutional obstacles.

By recognizing and addressing these barriers, policymakers, healthcare providers, and communities can collaborate to foster meaningful community participation in primary healthcare, leading to improved health outcomes and a stronger, more inclusive healthcare system.

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