Table 2 Identified themes and sub-themes representing challenges to the utilization of HTA in Iran’s health system

Internal factors

Institutional

1.Lack of clear policies or guidelines

2.Inadequate institutional support

3.Bureaucratic constraints

Resource limitations

1.Insufficient financial resources

2.Human resource shortages

3.Technological infrastructure gaps

Knowledge and awareness gaps

1.Limited awareness among decision-makers

2.Insufficient training and education

3.Preference for traditional methods

Data and evidence gaps

1.Lack of reliable data

2.Limited local evidence base

3.Challenges in data sharing

External factors

Political and economic influences

1.Political instability and policy shifts

2.Economic pressures

3.Influence of interest groups

Ethical and equity concerns

1.Ethical issues in decision-making

2.Equity concerns

3.Public perception and acceptance