Volume 28, Issue 3 (12-2025)
jha 2025, 28(3): 60-87 |
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Alizadeh N, Gerivani H, Bazrafshan A, Sajadi H S. Barriers to accessing services for people with disabilities in Iran: insights from a scoping review and stakeholder dialogue. jha 2025; 28 (3) :60-87
URL: http://jha.iums.ac.ir/article-1-4687-en.html
URL: http://jha.iums.ac.ir/article-1-4687-en.html
1- Center for Academic and Health Policy, Tehran University of Medical Sciences, Tehran, Iran.
2- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
4- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran ,hsajjadi@tums.ac.ir
2- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
3- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
4- Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran ,
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Table 1. Barriers to service access for persons with disabilities in iran and corresponding solutions: findings from the review and stakeholder dialogue
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Introduction
With the growing population of people with disabilities (PWD), ensuring their access to services has become a priority for policymakers and service providers. According to the World Health Organization, about 16% of the global population lives with some form of disability [1]. This figure is rising due to population aging, noncommunicable diseases, crises, conflicts, and traffic-related injuries [2]. Around 80% of PWD live in low- and middle-income countries, where resources for providing adequate services are often limited [3-5]. Disabilities encompass physical and mental impairments, functional limitations, and restricted participation in social and individual activities [5, 6], placing this group among the most vulnerable people. Evidence shows that PWD have reduced access to health, education, employment, and social opportunities compared with the general population [6]. However, they are entitled to full citizenship rights and require targeted support to realize them. Many countries have enacted laws and implemented measures to safeguard the rights of PWD, including accessible public transport, awareness-raising campaigns, supportive social and health services, and employment quotas [2, 4, 7, 8]. In Iran, despite legislative efforts such as the Comprehensive Law on the Protection of the Rights of PWD, the adoption of the UN Convention on the Rights of PWD, free higher education, and employment quotas, significant gaps remain between service provision and actual needs [9]. Barriers include insufficient employment opportunities [10], inadequate insurance coverage [11-13], high healthcare costs [11, 13-16], limited physical and transport access [8, 17, 18], and low availability of digital and library services. Given the importance of ensuring equal rights, participation, and inclusion [18], careful planning, identifying key challenges, and developing evidence-informed solutions are essential. This study synthesized existing evidence on barriers to service access for PWD in Iran and propose practical strategies to address them.
Methods
This study synthesized evidence through a scoping review and a stakeholder dialogue session. The scoping review was conducted in 2025, using the Arksey and O'Malleyframework, to identify studies on barriers to service access for PWD in Iran. Six steps were followed: defining research questions, identifying relevant studies, selecting studies, charting key results, collating and summarizing findings, and reporting outcomes. Searches were conducted in five international databases (PubMed, Scopus, Web of Science, PsycINFO, Embase) and two Iranian databases (SID and Magiran) using both Persian and English keywords (Supplements). Grey literature was identified through Google searches, organizational websites, and reference lists of relevant studies. Studies were included if they were original or review articles in Persian or English, focused on barriers to access for PWD in Iran, and had full-text availability. Selection and data extraction were performed by one researcher using a structured excel form to capture study characteristics and main findings, including barriers, facilitators, and proposed solutions. Data were synthesized narratively by two researchers.
To complement and enrich the review findings, a stakeholder dialogue session was held with 14 purposively selected participants, including policymakers, service providers, researchers, and non-governmental organizations related to rehabilitation and disability. A two-hour session, conducted in person and online, was facilitated by a neutral moderator. Key review findings were presented, followed by a semi-structured group discussion to explore perspectives on feasibility, social acceptability, priorities, and potential barriers. With participants' informed consent, the session was audio-recorded and fully transcribed, and additional notes were collected. Data were analyzed using a deductive-inductive content analysis approach. Two researchers coded independently, resolving discrepancies through discussion, and preliminary findings were shared with participants for feedback to enhance credibility and transferability.
Results
The systematic search identified 7,985 records through electronic databases, five through reference list screening, and 16 documents from organizational websites. After removal of 2,605 duplicates, 5,401 records were screened at the title and abstract level, resulting in the exclusion of 5,016 records. A total of 385 full-text articles were assessed for eligibility; 15 were excluded due to the unavailability of the full text. Of the remaining 370 full-text articles, 288 were excluded for not meeting the inclusion criteria. Ultimately, 82 studies were included in the final review. Of the 82 included studies, 71 were published in English, and 11 were published in Persian. More than half (53%, n = 44) were published after 2021. The majority (81%, n = 67) aimed to identify barriers and propose solutions, and 41% (n = 34) of these studies were conducted in Tehran. Regarding scope, 23 studies covered national areas, and 25 covered provincial areas. Methodologically, 49 studies (60%) employed qualitative approaches, 28 (34%) used quantitative approaches, and 5 (6%) employed mixed-methods approaches. In terms of the service domain, 78% (n = 64) examined access to health services.
The review findings and stakeholder consultations identified 21 barriers and 19 proposed solutions, which were classified into seven categories: individual, cultural, communicational, financial, physical, institutional, and legal barriers (Table 1).
With the growing population of people with disabilities (PWD), ensuring their access to services has become a priority for policymakers and service providers. According to the World Health Organization, about 16% of the global population lives with some form of disability [1]. This figure is rising due to population aging, noncommunicable diseases, crises, conflicts, and traffic-related injuries [2]. Around 80% of PWD live in low- and middle-income countries, where resources for providing adequate services are often limited [3-5]. Disabilities encompass physical and mental impairments, functional limitations, and restricted participation in social and individual activities [5, 6], placing this group among the most vulnerable people. Evidence shows that PWD have reduced access to health, education, employment, and social opportunities compared with the general population [6]. However, they are entitled to full citizenship rights and require targeted support to realize them. Many countries have enacted laws and implemented measures to safeguard the rights of PWD, including accessible public transport, awareness-raising campaigns, supportive social and health services, and employment quotas [2, 4, 7, 8]. In Iran, despite legislative efforts such as the Comprehensive Law on the Protection of the Rights of PWD, the adoption of the UN Convention on the Rights of PWD, free higher education, and employment quotas, significant gaps remain between service provision and actual needs [9]. Barriers include insufficient employment opportunities [10], inadequate insurance coverage [11-13], high healthcare costs [11, 13-16], limited physical and transport access [8, 17, 18], and low availability of digital and library services. Given the importance of ensuring equal rights, participation, and inclusion [18], careful planning, identifying key challenges, and developing evidence-informed solutions are essential. This study synthesized existing evidence on barriers to service access for PWD in Iran and propose practical strategies to address them.
Methods
This study synthesized evidence through a scoping review and a stakeholder dialogue session. The scoping review was conducted in 2025, using the Arksey and O'Malleyframework, to identify studies on barriers to service access for PWD in Iran. Six steps were followed: defining research questions, identifying relevant studies, selecting studies, charting key results, collating and summarizing findings, and reporting outcomes. Searches were conducted in five international databases (PubMed, Scopus, Web of Science, PsycINFO, Embase) and two Iranian databases (SID and Magiran) using both Persian and English keywords (Supplements). Grey literature was identified through Google searches, organizational websites, and reference lists of relevant studies. Studies were included if they were original or review articles in Persian or English, focused on barriers to access for PWD in Iran, and had full-text availability. Selection and data extraction were performed by one researcher using a structured excel form to capture study characteristics and main findings, including barriers, facilitators, and proposed solutions. Data were synthesized narratively by two researchers.
To complement and enrich the review findings, a stakeholder dialogue session was held with 14 purposively selected participants, including policymakers, service providers, researchers, and non-governmental organizations related to rehabilitation and disability. A two-hour session, conducted in person and online, was facilitated by a neutral moderator. Key review findings were presented, followed by a semi-structured group discussion to explore perspectives on feasibility, social acceptability, priorities, and potential barriers. With participants' informed consent, the session was audio-recorded and fully transcribed, and additional notes were collected. Data were analyzed using a deductive-inductive content analysis approach. Two researchers coded independently, resolving discrepancies through discussion, and preliminary findings were shared with participants for feedback to enhance credibility and transferability.
Results
The systematic search identified 7,985 records through electronic databases, five through reference list screening, and 16 documents from organizational websites. After removal of 2,605 duplicates, 5,401 records were screened at the title and abstract level, resulting in the exclusion of 5,016 records. A total of 385 full-text articles were assessed for eligibility; 15 were excluded due to the unavailability of the full text. Of the remaining 370 full-text articles, 288 were excluded for not meeting the inclusion criteria. Ultimately, 82 studies were included in the final review. Of the 82 included studies, 71 were published in English, and 11 were published in Persian. More than half (53%, n = 44) were published after 2021. The majority (81%, n = 67) aimed to identify barriers and propose solutions, and 41% (n = 34) of these studies were conducted in Tehran. Regarding scope, 23 studies covered national areas, and 25 covered provincial areas. Methodologically, 49 studies (60%) employed qualitative approaches, 28 (34%) used quantitative approaches, and 5 (6%) employed mixed-methods approaches. In terms of the service domain, 78% (n = 64) examined access to health services.
The review findings and stakeholder consultations identified 21 barriers and 19 proposed solutions, which were classified into seven categories: individual, cultural, communicational, financial, physical, institutional, and legal barriers (Table 1).
Table 1. Barriers to service access for persons with disabilities in iran and corresponding solutions: findings from the review and stakeholder dialogue
Table 1.Continued
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Table 1. Continued
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Table 1. Continued
Discussion
This study aimed to identify barriers to service access for PWD in Iran and propose strategies for improvement through scoping review and stakeholder dialogue. Findings revealed seven main categories of barriers: individual, cultural, communicational, financial, physical, institutional, and legal barriers. Among these, institutional barriers—such as inadequate accountability, insufficiently trained personnel, limited service centers, and poorly organized service delivery—were the most frequently highlighted, which undermine the efficiency of service systems and limit access [19, 20]. Financial challenges, including high treatment costs, lack of financial support, and employment discrimination, were also significant, emphasizing the need for sustainable financial and social support systems to enhance equity and quality of life [20-24]. Legal obstacles, like insufficient enforcement of supportive laws and a lack of oversight mechanisms, further hindered the full realization of the rights of PWD [25-27].
Other frequently reported barriers included socio-cultural and communicational challenges, such as negative societal attitudes, insufficient cultural support, limited access to information, and weak awareness among stakeholders [28, 29]. Addressing these issues requires structural and cultural changes, public education, and improved technological infrastructure to facilitate inclusion and participation [11, 30-33]. Physical-environmental barriers—such as inaccessible urban spaces, buildings, and public transportation—remain significant despite recent improvements [32, 34, 35]. Individual-level barriers, although less reported, directly affect independence, quality of life, and social participation [36, 37], necessitating targeted interventions such as health literacy programs, PWD empowerment, and mental health support.
Limitations
A key strength of this study is its integrative approach in synthesizing existing evidence and validating findings through stakeholder dialogue. This approach not only enhanced the comprehensiveness of the analyses but also facilitated the reconciliation of the findings with field experience, thereby strengthening the external validity of the results. The present study also had some limitations. First, due to the lack of sufficient quantitative data, it was not possible to accurately measure the level of access PWDs have to services. Scientific prioritization of the identified barriers was not conducted, and repetition in studies and expert opinion were the primary factors in determining priorities. Additionally, sufficient evidence was not obtained to evaluate the effectiveness of the proposed solutions in the Iranian context, highlighting the need for intervention studies and prospective evaluations in this field.
Conclusion
Overall, a comparison of barriers to service access for PWD in Iran and other countries with similar income levels indicates that this population faces comparable challenges, including inadequate physical infrastructure, negative cultural attitudes, insufficient social support systems, and weak management and enforcement mechanisms. In many such countries, supportive laws are either absent or poorly implemented—a situation also evident in Iran. Although Iran has developed relatively comprehensive legal frameworks, their full and coordinated implementation remains problematic. Further research is required to explore the underlying causes of policy implementation failures and the limited achievement of intended policy objectives. At the same time, Iran exhibits certain distinctive characteristics. These include the strong and informal role of families in caregiving, the concentration of services in urban areas, and the existence of some insurance mechanisms, albeit insufficient in scope and coverage. Overall, while the pattern of barriers to service access for PWD is broadly similar across countries, structural, cultural, and economic differences highlight the need for context-sensitive policy solutions tailored to each nation's institutional and social realities.
Online supplement
Database search strategies
Sample quotes from a stakeholder dialogue session
Declarations
Ethical considerations: The approval for this study was granted by the Research Ethics Committees of Academy of Medical Sciences Islamic Republic of Iran (IR.AMS.REC.1404.009).
Funding: This study was conducted with financial support from the Rehabilitation Working Group of the Academy of Medical Sciences of the Islamic Republic of Iran.
Conflicts of interests: The authors declare that there is no conflict of interest.
Authors' contribution: N.A: Study design, data curation, data analysis, Writing– review & editing; H.G.: Study design, data curation; A.B.: Study design, data curation; HS.S.: Study design, Supervision, Writing– review & editing. All authors have read and approved the final version of the manuscript.
Consent for publication: Not applicable.
Data availability: Access to the data is available through the corresponding author upon reasonable request.
AI deceleration: The authors used ChatGPT artificial intelligence for editing the English section of this article. All AI-edited content was reviewed and approved by the authors.
Acknowledgements: The researchers would like to express their gratitude to the Rehabilitation Working Group of the Academy of Medical Sciences of the Islamic Republic of Iran, and especially to Dr. Marzieh Shirazikhah, for her guidance and assistance.
This study aimed to identify barriers to service access for PWD in Iran and propose strategies for improvement through scoping review and stakeholder dialogue. Findings revealed seven main categories of barriers: individual, cultural, communicational, financial, physical, institutional, and legal barriers. Among these, institutional barriers—such as inadequate accountability, insufficiently trained personnel, limited service centers, and poorly organized service delivery—were the most frequently highlighted, which undermine the efficiency of service systems and limit access [19, 20]. Financial challenges, including high treatment costs, lack of financial support, and employment discrimination, were also significant, emphasizing the need for sustainable financial and social support systems to enhance equity and quality of life [20-24]. Legal obstacles, like insufficient enforcement of supportive laws and a lack of oversight mechanisms, further hindered the full realization of the rights of PWD [25-27].
Other frequently reported barriers included socio-cultural and communicational challenges, such as negative societal attitudes, insufficient cultural support, limited access to information, and weak awareness among stakeholders [28, 29]. Addressing these issues requires structural and cultural changes, public education, and improved technological infrastructure to facilitate inclusion and participation [11, 30-33]. Physical-environmental barriers—such as inaccessible urban spaces, buildings, and public transportation—remain significant despite recent improvements [32, 34, 35]. Individual-level barriers, although less reported, directly affect independence, quality of life, and social participation [36, 37], necessitating targeted interventions such as health literacy programs, PWD empowerment, and mental health support.
Limitations
A key strength of this study is its integrative approach in synthesizing existing evidence and validating findings through stakeholder dialogue. This approach not only enhanced the comprehensiveness of the analyses but also facilitated the reconciliation of the findings with field experience, thereby strengthening the external validity of the results. The present study also had some limitations. First, due to the lack of sufficient quantitative data, it was not possible to accurately measure the level of access PWDs have to services. Scientific prioritization of the identified barriers was not conducted, and repetition in studies and expert opinion were the primary factors in determining priorities. Additionally, sufficient evidence was not obtained to evaluate the effectiveness of the proposed solutions in the Iranian context, highlighting the need for intervention studies and prospective evaluations in this field.
Conclusion
Overall, a comparison of barriers to service access for PWD in Iran and other countries with similar income levels indicates that this population faces comparable challenges, including inadequate physical infrastructure, negative cultural attitudes, insufficient social support systems, and weak management and enforcement mechanisms. In many such countries, supportive laws are either absent or poorly implemented—a situation also evident in Iran. Although Iran has developed relatively comprehensive legal frameworks, their full and coordinated implementation remains problematic. Further research is required to explore the underlying causes of policy implementation failures and the limited achievement of intended policy objectives. At the same time, Iran exhibits certain distinctive characteristics. These include the strong and informal role of families in caregiving, the concentration of services in urban areas, and the existence of some insurance mechanisms, albeit insufficient in scope and coverage. Overall, while the pattern of barriers to service access for PWD is broadly similar across countries, structural, cultural, and economic differences highlight the need for context-sensitive policy solutions tailored to each nation's institutional and social realities.
Online supplement
Database search strategies
Sample quotes from a stakeholder dialogue session
Declarations
Ethical considerations: The approval for this study was granted by the Research Ethics Committees of Academy of Medical Sciences Islamic Republic of Iran (IR.AMS.REC.1404.009).
Funding: This study was conducted with financial support from the Rehabilitation Working Group of the Academy of Medical Sciences of the Islamic Republic of Iran.
Conflicts of interests: The authors declare that there is no conflict of interest.
Authors' contribution: N.A: Study design, data curation, data analysis, Writing– review & editing; H.G.: Study design, data curation; A.B.: Study design, data curation; HS.S.: Study design, Supervision, Writing– review & editing. All authors have read and approved the final version of the manuscript.
Consent for publication: Not applicable.
Data availability: Access to the data is available through the corresponding author upon reasonable request.
AI deceleration: The authors used ChatGPT artificial intelligence for editing the English section of this article. All AI-edited content was reviewed and approved by the authors.
Acknowledgements: The researchers would like to express their gratitude to the Rehabilitation Working Group of the Academy of Medical Sciences of the Islamic Republic of Iran, and especially to Dr. Marzieh Shirazikhah, for her guidance and assistance.
Type of Study: Research |
Subject:
Health Services Management
Received: 2025/08/29 | Accepted: 2025/12/7 | Published: 2025/12/19
Received: 2025/08/29 | Accepted: 2025/12/7 | Published: 2025/12/19
Supplement [PDF 175 KB] (36 Download)
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