title: Contextual factors affecting autonomy for patients in Iranian hospitals: A qualitative study.
abstract: BACKGROUND
  Consideration of patient autonomy is an essential element in individualized, patient-centered, ethical care. Internal and external factors associated with patient autonomy are related to culture and it is not clear what they are in Iran. The aim of this study was to explore contextual factors affecting the autonomy of patients in Iranian hospitals.
  
  
  METHODS
  This was a qualitative study using conventional content analysis methods. Thirty-four participants (23 patients, 9 nurses, and 2 doctors) from three Iranian teaching hospitals, selected using purposive sampling, participated in semi-structured interviews. Unstructured observation and filed notes were other methods for data collection. The data were subjected to qualitative content analysis and analyzed using the MAXQDA-10 software.
  
  
  RESULTS
  Five categories and sixteen subcategories were identified. The five main categories related to patient autonomy were: Intrapersonal factors, physical health status, supportive family and friends, communication style, and organizational constraints.
  
  
  CONCLUSIONS
  In summary, this study uncovered contextual factors that the care team, managers, and planners in the health field should target in order to improve patient autonomy in Iranian hospitals.
authors.affiliation: Department of Psychiatric Nursing, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Ebrahimi
authors.affiliation: Chronic Diseases (Home Care) Research Center, Nursing Department, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Efat
authors.initials: E
authors.lastname: Sadeghian
authors.affiliation: Department of Psychiatric Nursing, Iran University of Medical Sciences, Iran, Tehran.
authors.forename: Naeimeh
authors.initials: N
authors.lastname: Seyedfatemi
authors.affiliation: Department of Nursing, Tarbiat Modares University, Tehran, Iran.
authors.forename: Eesa
authors.initials: E
authors.lastname: Mohammadi
authors.affiliation: University of the West Scotland, Crichton Campus, Dumfries, Scotland.
authors.forename: Maureen
authors.initials: M
authors.lastname: Crowley
keywords: Autonomy; Iran; chronic disease; hospitals; inpatients; nursing ethics; patient; personal autonomy; qualitative research; qualitative study