Iran Journal of Nursing

Introduction
Following the increase in the number of chronic diseases and the demand for treatment and rehabilitation services, the health care system and families have faced challenges such as increased hospitalization costs, the risk of hospital infections, decreased hospital bed productivity, and increased workload of caregivers and nurses. Recently, the home care plan has been implemented as an alternative or complementary method to solve the challenges in this field [1]. Home care is one of the community-based care methods. In this care method, a wide range of professional, specialized, supportive, and rehabilitation care are provided according to the needs of the patient at home by a doctor, nurse, or caregiver with the cooperation of family members [5]. 
Most of the previous studies in the field of home care in Iran are quantitative, and the contextual factors and diverse experiences of people (care providers and service recipients) have been neglected. In the existing qualitative studies, the home care plan has often been examined from the hospitalized patients’ point of view, and the perceptions of older adults and those unable to go to the hospital have been neglected. Therefore, this study aims to investigate the challenges of home care plans in Iran based on the viewpoints of service providers and recipients and provide solutions to improve their implementation.

Methods
This is a qualitative study. Participants were 28 people, including 15 service providers and 13 service recipients, who were selected using a purposive sampling method until reaching data saturation. The inclusion criteria for service providers were at least five years of clinical work experience and two years of work experience in the field of home care (for home care center managers), responsibility in developing the national home care plans, responsibility in inspecting home care centers (for policymakers), and scientific activity and interest in the field of home care (professors and experts).
 The inclusion criteria for service recipients were a history of receiving home care services for at least 6 months. The exclusion criterion was the unwillingness to continue participation. By reviewing the literature, the questions for semi-structured interview were selected for the research. Interviews were then conducted face-to-face. Each interview lasted 20-50 minutes. The recorded interviews were transcribed verbatim and read several times. Data analysis was done by the content analysis method in MAXQDA 2020 software. It should be noted that the codes were extracted by inductive coding (open coding), and there was no codebook. After extracting the codes and themes, they were sent to the experts and were confirmed based on their opinions.

Results
Four themes (challenges) were extracted with 12 sub-themes: Challenges of families with the service center (manpower, difficulty in providing care services, and costs), challenges of the service center with the families (Therapeutic/communication process, security), challenges of the service center with hospitals (Referral method and previous hospital treatments, hospital violation), and existing challenges in the field of policymaking (culturalization, statute, insurance, violation of the law, and license provision). The solutions were proposed in three categories: the services center, treatment system/law, and culturalization.

Conclusion
The results of this research showed that the home care plan in Iran is facing several challenges. These challenges were examined from two perspectives of service providers and service recipients In overall, these challenges included the challenges of families with the center, challenges of the center with the families and hospitals, and the challenges related to policymaking. Considering the important and key role of home care services for people discharged from the hospital or in need of care (older people or disabled patients), it is necessary to address these challenges and take steps according to the presented solutions. The home care plans in Iran should be revised, the service centers should be supported, and license provisions should be facilitated. Also, a culture of home care should be created in the society.

Ethical Considerations
Compliance with ethical guidelines
Before the study, general explanations were given to the participants about the study objectives, and the researcher answered their questions. Then, informed consent was obtained from them. They were assured that their information could be kept confidential. The study was approved by Islamic Azad University, Sari Branch (Code: IR.IAU.SARI.REC.1402.069). 

Funding
This article was extracted from the master’s thesis of Bahman Ahmadi in Healthcare Management at the Faculty of Medicine, Islamic Azad University, Sari Branch. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization and data analysis: Bahman Ahmadi; data analysis, supervision, and review: Azadeh Ahmadi Dashtian and Ghahraman Mahmoodi

Conflict of interest
The authors declare no conflicts of interest.

Acknowledgments
The authors would like to thank all participants for their cooperation in this study.


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