**Background:** Hypertension is the most important controllable risk factor for cardiovascular diseases, stroke, and chronic kidney disease. Globally, about 1.28 billion adults aged 30–79 have hypertension, and in Iran the prevalence was reported as 17% (WHO 2018) and up to 48% under newer ACC guidelines. Comprehensive health centers (CHCs) are at the front line of non-communicable disease prevention in Iran, but many hypertensive patients fail to attend regularly for care. The authors note that the literature lacks studies focused specifically on hypertensive patients' utilization of CHCs, and most prior work has not simultaneously examined both patient and staff perspectives. This qualitative study aimed to identify utilization obstacles to hypertension services provided at CHCs from the perspective of both patients and staff in Ahvaz, southwest Iran.
**Methods:** The study used a conventional content analysis approach and was conducted in 2022. Participants included 15 hypertensive patients (SBP ≥ 130 mmHg and DBP ≥ 80 mmHg, aged 30–60 years, diagnosed at least one year prior, taking antihypertensive medication) and 10 staff members (7 CHC personnel and 3 expert staff from Ahvaz Jundishapur University of Medical Sciences). Patients with serious physical or mental disabilities, anxiety, depression, or other psychological problems were excluded. Staff were required to have at least one year of work experience in hypertension-related care. Purposive sampling was used. Data were collected via individual face-to-face semi-structured interviews lasting 30–45 minutes. Interview guides were validated by eight faculty members and CHC experts. Interviews were audio-recorded with consent, transcribed verbatim, and analyzed manually using conventional content analysis by two independent coders. Data saturation was achieved after 25 interviews over approximately four months. Lincoln and Guba's four criteria (credibility, confirmability, dependability, transferability) were used to ensure scientific trustworthiness. The study was approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (Ref. ID: IR.AJUMS.REC.1401.003).
**Key Results:** Of the 25 participants, 15 (60%) were female and 10 (40%) were male. The majority (48%) were aged 46–60 years, 44% were 30–45, and 8% were under 30. Educational attainment was: 36% below associate degree, 40% bachelor's degree, and 24% master's degree or higher. Most participants (72%) were married. In total, 15 codes and 8 categories were extracted and organized under two main themes. Under 'individual problems' (5 codes, 3 categories), the categories were: attitudinal obstacles (not receiving expected results in the short term due to chronic/long-term treatment; cultural flaws and low sensitivity, e.g., underestimation by families, ignorance, fear of COVID-19; misconceptions such as self-medication, belief that CHCs are only for women and children, or that referral is only for free pills), occupational obstacles (busy schedules, work hours conflicting with service hours), and economic obstacles (inability to afford commuting or care costs). Under 'systemic problems' (10 codes, 5 categories), the categories were: educational obstacles (lack of comprehensive efficient staff training, frivolous in-service training, insufficient patient/family awareness of disease complications), motivational obstacles (low staff motivation due to lack of incentives), procedural obstacles (multiple staff activities limiting patient time, time-consuming information registration, long waiting lists/bureaucracy), structural obstacles (lack of amenities, disintegrated services, lack of specialized staff, long distance to CHCs, difficult access), and managerial obstacles (inexperienced physicians in executive roles, short-term physician placements, ignorance of hypertension management, therapeutic rather than preventive orientation, poor insurance supervision). Notable quotations illustrate patient and staff perspectives, including reluctance to attend due to COVID-19 fears, self-medication, time constraints from government employment, and dissatisfaction with dirty restrooms.
**Clinical Implications:** The authors propose that addressing individual problems requires motivational interviewing techniques and effective use of health liaisons and volunteers to increase awareness and change negative attitudes. For systemic problems, effective training courses for staff, appropriate reward systems to boost motivation, matching service volume to staff capacity, equipping CHCs with patient-appropriate facilities, and management training for CHC directors are recommended. The study highlights the potential for digital tools (smartphone applications, mHealth) to support self-management of hypertension, especially given barriers of distance, cost, and time. Limitations include the single-city setting (Ahvaz), which may affect generalizability due to unique socio-cultural and administrative factors. The authors suggest future research comparing motivational interviewing techniques, evaluating educational interventions, studying service resilience during crises, and examining health information system challenges.