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J Caring Sci. 2013 Aug 28;2(3):229-36. doi: 10.5681/jcs.2013.028. eCollection 2013 Sep.

Barriers of referral system to health care provision in rural societies in iran.

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Department of Nursing and Midwifery, Islamic Azad University, Arsanjan Branch, Arsanjan, Iran.
Department of Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.



Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. This study aimed to describe barriers of health care process in rural societies in Iran.


In this qualitative study, 26 participants (21 rural health care providers and five rural patients) were selected through purposive sampling. The data was collected via semi-structured individual interviews and small focus group discussions. Data was analyzed with qualitative content analysis.


One category, "ineffective referral system", and five subcategories, i.e. being far from the ideal referral system, lack of adequate governmental referral system, lack of connection between different levels of the referral system, self-referential and bypassing the referral system, and insufficient knowledge about the referral system, were found.


Considering the obstacles to the referral system, improvements in its structure are necessary to promote the quality of health care in rural areas. Such changes require coordination between the three levels of the referral system, strengthening the public sector of the system, increasing public awareness about the referral system, and prevention of self-referential.


Health care; Referral; Rural communities

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