The spectrum of person-centered care: from luxury to necessity: a descriptive qualitative study

Abstract

Background

Person-centered care (PCC) constitutes a fundamental element of holistic nursing practice, emphasizing patient engagement and comprehensive understanding beyond pathology. This study sought to investigate nurses’ perceptions of PCC within the Iranian healthcare system. Given the aging population in Iran, ongoing challenges in implementing PCC in clinical practice, and the limited qualitative research on this topic, understanding nurses’ perspectives is crucial for improving care delivery.

Methods

A descriptive qualitative content analysis study was employed, conducted in 2024 at public hospitals in northern Iran. Sixteen nurses from diverse clinical departments were recruited via purposive sampling. Data collection utilized semi-structured interviews, with subsequent analysis performed through conventional content analysis using MAXQDA 10 software, adhering to Graneheim and Lundman’s analytical framework.

Results

Analysis yielded one overarching theme, “Luxurious or Necessary,” comprising two categories: “Luxurious care” and “Enriched nursing care.” Eight subcategories emerged: being supportive, being heard, being compassionate, individualized care, care with competence, care with commitment, care with conscience, and care with respect. These were derived from 850 initial codes.

Conclusion

Findings indicated a dichotomous perspective among nurses regarding PCC, with some considering it essential to quality care, while others perceived it as a superfluous formality. This divergence in viewpoints underscores the imperative for healthcare policymakers to formulate and implement strategies that enhance nurses’ comprehension and application of PCC principles, thereby fostering improved community health outcomes.

Clinical trial number

Not applicable.

Background

Person-centered care (PCC) transforms the traditional patient-provider dynamic by empowering patients as active partners in their healthcare journey [1]. This approach builds upon the concept of holistic care, which encompasses patients’ physical, emotional, social, and spiritual needs to promote overall health. Florence Nightingale first emphasized the importance of holistic care, advocating for a shift from disease-centric to patient-centric care, thereby underscoring the significance of person-centered approaches [2, 3].

The theoretical framework of PCC, as conceptualized by McCormack and McCance, includes four key concepts: prerequisites, care environment, person-centered processes, and person-centered outcomes [2, 4]. Prerequisites comprise professional competence, commitment to the job, clarity of beliefs and values, self-awareness, and advanced interpersonal skills. The care environment refers to a supportive therapeutic setting, including staff skills, effective relationships, shared decision-making, and innovation. Person-centered processes involve genuine participation, compassionate presence, and comprehensive care. These elements lead to person-centered outcomes, including positive care experiences, active participation, and a sense of well-being [2, 4].

Despite the growing desire of patients to actively participate in healthcare processes and clinical decision-making, PCC faces implementation challenges. These barriers include workload issues, difficulties in interprofessional relationships, and gaps in nurses’ advanced knowledge of patient care [5, 6]. Moreover, there remains a paucity of information on strategies to transform traditional care systems into person-centered models that prioritize patients’ goals and preferences [7, 8].

The importance of PCC in nursing practice necessitates a comprehensive understanding of this concept and the identification of factors influencing its promotion. While existing studies are predominantly quantitative and report factors affecting PCC implementation, they may not capture the full complexity of the concept. Iran, like many countries, faces healthcare delivery challenges due to an aging population, increased prevalence of chronic diseases, and resource constraints [9]. Factors such as nurses’ working hours, remuneration, workload, and work experience may affect PCC implementation [10, 11].

To enhance the quality of nursing care, a deeper understanding of nurses’ perceptions of PCC is crucial. However, few qualitative studies have explored nurses’ comprehension of PCC, with most existing research employing quantitative methodologies based on predetermined assumptions [12].Qualitative research methods are particularly suited to identifying human emotions and perceptions [13]. These studies offer valuable insights into how individuals experience and interpret social phenomena within their cultural and societal frameworks [14]. The in-depth and nuanced insights yielded by qualitative methods can complement the findings of other researchers in this field, especially when quantitative approaches fall short in capturing the complexity of social and cultural experiences [15].

Although person-centered care (PCC) has been widely promoted in global healthcare discourse, there remains a notable lack of qualitative research examining how this concept is understood and practiced by nurses within the unique sociocultural and organizational context of Iran. Most existing literature is grounded in Western healthcare systems, with limited exploration of how cultural norms, institutional structures, and systemic challenges in non-Western countries shape the meaning and implementation of PCC. Furthermore, the voices of frontline nurses, those most directly involved in patient care, are often underrepresented in defining what person-centered care truly means in everyday clinical settings. Conceptual ambiguity also persists, as PCC is frequently used as a broad ideal without consensus on its operational meaning across diverse environments. These gaps highlight the need for contextually grounded insights and locally relevant strategies to better understand and promote person-centered care in Iranian nursing practice.

Design

This descriptive qualitative content analysis study was conducted between July and October 2024 in three public teaching hospitals in Mazandaran Province, northern Iran. Inductive content analysis was employed to explore nurses’ perspectives [2, 4]. This method allowed themes and categories to emerge directly from the raw data, providing a deeper understanding of the participants’ views.

Inductive content analysis is particularly suited for examining complex phenomena in healthcare settings where little prior research exists [3, 16]. This approach enables researchers to collect and analyze data without relying on predefined categories or theories, supporting a more flexible and open-ended exploration of the subject [5, 6].

Participants and setting

The participants consisted of 16 nurses who worked in the ICU, CCU, Surgery, Emergency, Internal, Gynecology, Cardiac and Neurology wards of various hospitals in northern Iran. Participants were selected by purposive sampling and invited to participate in the study. Inclusion criteria were as follows: holding at least a bachelor’s degree in nursing, having a minimum of one year of work experience, the ability to provide rich information about the concept, and being in suitable mental and physical condition for the interview. Exclusion criteria included unwillingness to continue in subsequent sessions and experiencing poor mental and physical health.

Data collection

After obtaining written informed consent and permission to record the interviews, semi-structured, in-depth, face to face interviews were conducted face-to-face. Individual interviews were conducted by the first author (N.M) from July to October 2024 in northern Iran. Participants were interviewed in the staff room to maintain their safety and convenience and to allow them to freely express their experiences and thoughts. During the interviews, observations were also made, with attention paid to non-verbal cues and the interview environment. The interview guide included questions such as: “What is your understanding of person-centered care?“, “How do you define care?“, “What is quality care in your opinion?“, and “Can you describe a day at work as a nurse?” Follow-up questions were employed to further explore the participants’ responses. There were no restrictions on the number of participants, interviews, or data sources.

Efforts were made to ensure maximum diversity among participants regarding age, sex, and work experience. A familiarization meeting was held to explain the study objectives, general principles, and confidentiality measures. Participants completed a written consent form and a demographic questionnaire. Interviews lasted between 35 and 110 min, with a median duration of 43 min. All interviews were audio-recorded and transcribed verbatim. After fourteen interviews, all existing sub-categories properties were identified, and no new sub-categories was formed and we assumed that the data saturation had been achieved. After that two more interviews were conducted to ensure data saturation was reached.

Data analysis

Data analysis was conducted concurrently with data collection using the conventional content analysis method. First, the researcher transcribed the interviews verbatim immediately after each session, and then analyzed the transcriptions to gain a deeper comprehension of the participants’ experiences based on based on the five-stage Grenheim and Landman conventional content analysis method. the entire interview text was typed, and in the next phase, it was read several times to achieve a general perception of the content. Consequently, meaning units were determined and the preliminary codes were extracted. Then the codes were categorized based on their similarities and differences. In the final stage, the content hidden in the data was extracted. The researchers used MAXQDA 10 software in combination with manual methods for classification and analysis.

The rigor of the study

This study employed Guba’s trustworthiness criteria: credibility, dependability, confirmability, and transferability [17]. Credibility was enhanced through prolonged engagement with the phenomenon, allocating sufficient time for data collection and ongoing review. The researcher established rapport with participants, conducting audio-recorded interviews lasting between 35 and 110 min.

Dependability was ensured through an independent assessment of study procedures by external qualitative researchers, who compared their findings. Confirmability was strengthened through step-by-step reviews and auditing of data collection and analysis procedures, as well as audio recording and verbatim transcription of interviews.

Although qualitative findings have limited transferability, the researcher provided detailed descriptions of participant selection, data collection, and analysis procedures to facilitate application in similar contexts. This included adequate data description and socio-demographic characteristics of participants, enabling readers to evaluate the applicability of findings to other contexts [18].

The comprehensive description of data collection and analysis techniques demonstrates the trustworthiness, stability, and consistency of the data obtained [19].

Results

The study included 16 nurses employed in various departments of hospitals in northern Iran. Participants were predominantly female, married, and held held bachelor’s degrees in nursing. Their ages ranged from 27 to 52 years (mean age:38 years), with work experience ranging from 4 to 24 years. Detailed demographic characteristics of the participants are presented in Table 1.

Table 1.

Demographic characteristics of study participants (N = 16)

Participant	Age	Sex	Marital status	Position	Ward	Work Experiences
1	35	Female	Married	Head nurse	ICU	12
2	27	Female	Married	Staff nurse	CCU	4
3	36	Male	Married	Staff nurse	Surgery	9
4	42	Male	Single	Staff nurse	Emergency	17
5	51	Female	Married	Head nurse	Internal	26
6	37	Female	Married	Staff nurse	Genecology	9
7	39	Male	Married	Staff nurse	Cardiac	10
8	29	Male	Married	Staff nurse	Neurology	6
9	44	Male	Married	Staff nurse	Internal	18
10	34	Female	Single	Staff nurse	ICU	12
11	38	Female	Single	Staff nurse	Pediatric	12
12	27	Female	Single	Staff nurse	Cardiac	7
13	52	Female	Married	Head nurse	Neurology	25
14	48	Male	Single	Staff nurse	CCU	15
15	36	Female	Single	Staff nurse	Neurology	7
16	32	Female	Single	Staff nurse	Internal	8

Data analysis led to the identification of one overarching theme, two categories, eight subcategories, and a total of 850 codes. The central theme was titled “Luxurious or Necessary,” with the categories labeled “Luxurious Care” and “Enriched Nursing Care” (Table 2).

Table 2.

Main theme, categories, and subcategories of Person-Centered care from nurses’ perspectives

Main theme	Category	Sub category
Luxurious or Necessary	Luxurious care	Being support
		Being heard
		Being compassionate
		Individualized care
	Enriched nursing care	Care with competent
		Care with commitment
		Care with conscience
		Care with respect

The participants’ perceptions of the concept of person-centered care (PCC) were diverse. Some participants viewed PCC as a ceremonial or luxurious form of care, considering it impractical and time-consuming in the context of developing countries. Others, however, perceived it as an enriched, professional approach to nursing.

Luxurious care

The participating nurses described PCC as a form of luxurious care and expressed that providing such care was challenging due to their heavy workloads and responsibilities. The subcategories of luxurious care included being supportive, actively listening, and providing compassionate care.

Being supportive

Nurses recognized patient support as both a moral obligation and a professional responsibility, encompassing a range of actions and interventions. However, they reported that high workloads, large patient volumes, and diverse responsibilities frequently hindered their ability to consistently offer comprehensive support [1, 2].

Participant 5 highlighted this challenge: “In the environments where we work, we can only provide basic patient care. It is not always possible to assess the patient’s condition and offer continuous support.”

Being heard

Active listening is defined as a behavioral-communicative pattern in which attentive listening and hearing facilitate constructive and positive interactions between nurses and patients. It signifies a deliberate effort to engage in meaningful dialogue. Participant 8 expressed the challenges associated with active listening: “… that we are always with the patient and listen to what they are saying, which is not possible. This is not a private hospital or a home; I have eight patients here, and I can’t do these things.”

Being compassionate

Compassion and compassionate care are defined as an awareness of patients’ pain and suffering, coupled with efforts to reduce or eliminate their distress. The defining characteristic of compassion is its combination of empathy with a practical desire to act and alleviate pain and suffering.

A 25-year-old nurse expressed, “It’s true that we should understand the pain and sorrow of our patients, be compassionate, and be concerned, but we are also human. We get tired and get frustrated, so I need to be given 50 million Rials (Iranian currency) so that I can do this job…”.

Individualized care

Individualized care is defined as a nursing approach that incorporates patients’ personal characteristics, clinical status, life circumstances, and individual preferences to facilitate their active participation in decision-making processes. This patient-centered methodology seeks to tailor care to the unique needs of each individual. However, some healthcare practitioners described this approach as impractical within their current work environments, often referring to it as “luxury care” due to the challenges associated with its implementation.

A 31-year-old nurse articulated this perspective, stating: “While it is true that we are taught to care for and treat our patients holistically, considering their mental, psychological, physical, and spiritual conditions, this ideal is often impractical in real-world healthcare settings. We encounter this concept in textbooks and literature but implementing it fully in practice is challenging. In my view, this approach represents a form of luxury or idealized nursing care that is difficult to achieve in our current environment.”

Other participants described person-centered care (PCC) as the provision of correct, scientific, professional, and humane care. They perceived it as a comprehensive and enriched form of nursing that should be prioritized across all healthcare settings. The concept of enriched nursing care emerged as a key category from the interviews and included four subcategories: care with competence, care with commitment, care with conscience, and care with respect.

Care with competence

Nursing competence encompasses the comprehensive knowledge, skills, and abilities required for nurses to deliver safe and effective care across various domains. These domains include clinical practice, safety protocols, communication, and leadership. Participants in the study consistently emphasized the provision of competent care as an essential professional requirement.

One participant identified as Participant 9,emphasized the importance of continuous learning and preparation: “I make an effort to attend the training sessions provided to us. When time is limited, I focus on studying the specific conditions of the patients under my care. This approach allows me to deliver more appropriate and higher quality care to each individual.”

Care with commitment

Care with commitment emerged as a significant subcategory, representing a fundamental principle of high-quality healthcare deeply ingrained within the nursing profession. Nurses who embody this commitment recognize that their role transcends formal job responsibilities, encompassing a holistic approach to patient care.

One participant (P13) articulated their understanding of person-centered care in terms of this commitment: “I strive to uphold, to the greatest extent possible, the values, behaviors, and relationships that my patient entrusts to me. Furthermore, I endeavor to fulfill the implicit and explicit agreements I have established with my patient throughout treatment.”

Care with conscience

Conscience serves as a cornerstone of ethical nursing practice, guiding clinical interventions and ensuring alignment with the core values and beliefs of the profession. It upholds the integrity of nurses, influencing their decision-making processes and fostering a commitment to providing high-quality, ethical care.

A nurse working in a critical care unit, identified as Participant 1, shared their perspective on the role of conscience in their professional practice: “I believe the essence of nursing is more prominently manifested in critical care units. The distinction between professional and unprofessional care significantly impacts the patient treatment process. In this unit, my actions are primarily guided by my conscience and nursing ethics, because most of our patients are unconscious and unaccompanied.”

Care with respect

The final subcategory of enriched nursing care, nursing with respect, constitutes a crucial element of exemplary nursing practice. Respect in nursing is characterized as an intentional act that demonstrates consideration for the interests and well-being of patients. In this context, nurses recognize each individual as a unique person with distinct interests, passions, thoughts, beliefs, values, and ethics.

A nurse identified as Participant 14 articulated their understanding of person-centered care in terms of respect: “My duty as a nurse is to consider each patient under my care in different shifts as a distinct human being who has interests, expectations, thoughts, and needs that are separate and different from others, and I must respect that.”

Discussion

The findings of this study highlight two important themes in nurses’ understanding of PCC: luxurious care and enriched care, each with distinct subcategories. These themes reflect the multifaceted nature of PCC, encompassing not only medical care but also emotional, social, and spiritual aspects of patient well-being [20, 21].

Luxurious care, as described by participating nurses, includes being supportive, being hearing, providing compassionate care, and individualized attention. However, nurses acknowledged the challenges in delivering such care given their large workloads and numerous responsibilities. This tension between ideal care and practical constraints highlights a significant challenge in implementing PCC in real-world healthcare settings [22].

Patient advocacy emerged as a crucial component of PCC, viewed by nurses as both a moral duty and an integral part of their professional roles. Consistent with the current study, previous research has highlighted that advocacy is a fundamental role of nursing professionals. This role is crucial for safeguarding patients in situations where clinicians may engage in unsafe practices, errors are detected, caregivers lack competence, or support is inadequate. Furthermore, advocacy enhances public health, ensures the safety of vulnerable patients, improves access to healthcare, and elevates the overall quality of care [23, 24]. Seyhan et al. (2025) indicated that there is a moderate and positive relationship between patient support behaviors and nurses’ comprehension of professional values [25]., while Barlem et al. (2015) noted that nurses’ patient advocacy is grounded in personal values and professional skills [26].

The scope of patient advocacy has expanded over time, moving beyond protection against unethical acts [27, 28] to encompass comprehensive support for patients and their families [29]. This evolution reflects the growing recognition of patients as active participants in their care, aligning with the World Health Organization’s definition of PCC as “empowering people to take charge of their own health rather than being passive recipients of services” [16].

Effective nurse-patient relationships and communication skills are crucial for PCC implementation. Research indicates that PCC necessitates strong communication skills to facilitate meaningful interactions between patients and nurses [30, 31]. However, Bagherian et al.‘s (2020) study revealed that many patients feel dissatisfied with the quality and quantity of communication from healthcare providers [32], highlighting a gap between PCC ideals and current practice.

Compassionate care emerged as a fundamental aspect of PCC, with empathy serving as a core component [33]. Recent global healthcare priorities have emphasized ethical, humane, and patient-centered values [33]. However, Sharif et al. (2023) cautioned against excessive or inappropriate displays of compassion, which patients may perceive as unpleasant or undignified [34]. This underscores the need for a balanced approach to compassionate care that respects patients’ dignity and individual preferences.

Individualized care and attention to patients’ specific needs were identified as essential elements of PCC. This aligns with Sheeran et al. (2023), who stressed the importance of recognizing each patient as a unique individual [35], and Abugre et al.‘s (2024) emphasis on PCC as a needs-based model grounded in patients’ cultural values and spiritual beliefs [36].

Despite the significance of luxurious care, various studies have recognized the challenges associated with providing such care. These challenges include a shortage of trained healthcare professionals, organizational culture, governance and policy challenges and healthcare inequalities [37–40]. Many low- and middle-income countries face severe shortages of doctors, nurses, and other health care workers, leading to high patient-to-provider ratios, excessive strain on health care workers, and poor quality care [37, 41]. Social determinants of health, such as poverty, education, and social inequality, significantly influence the quality-of-care individuals receive. Patients from disadvantaged backgrounds are more likely to experience subpar care due to factors including limited access to healthcare services, lower health literacy, and discrimination within the healthcare system [37, 42]. Furthermore, healthcare facilities that serve low-income or marginalized populations often face challenges related to inadequate funding and staffing, which can result in substandard care [37]. Governance and policy issues are crucial determinants of healthcare quality [40, 43]. One of the primary challenges confronting healthcare systems in low- and middle-income countries is the presence of outdated or nonexistent health policies that do not adequately address the evolving healthcare needs of these populations [37, 44]. In many cases, health care policies may be poorly designed or implemented, resulting in gaps in service delivery, inequalities in access to care and its quality, lack of attention to patients’ needs, and inadequate support for them [37, 45].

The concept of enriched care emerged as a comprehensive approach to nursing that integrates competence, commitment, conscientiousness, and respect. Nursing competence, encompassing knowledge, skills, and abilities across various domains [46], was identified as fundamental to PCC. Factors influencing competence include work experience, education level, emotional intelligence, and organizational environment [47].

Professional commitment, another key aspect of enriched care, varies among nurses due to factors such as job satisfaction, religious beliefs, and personal ethics [48]. Recent studies have reported varying levels of professional commitment among nurses [49, 50], highlighting the need for strategies to foster and maintain commitment in the nursing profession.

Conscientious care, guided by ethical principles and moral sensitivity, represents a cornerstone of nursing practice [51]. It involves integrating personal moral and ethical standards into clinical decision-making [52, 53] and motivates nurses to excel in their caregiving roles [52].

Respectful care emphasizes treating patients with dignity while honoring their autonomy, preferences, and individuality [54]. This includes preserving privacy, maintaining confidentiality, providing gender-sensitive care, and enabling shared decision-making.

In conclusion, this study’s findings contribute to a deeper understanding of PCC in nursing practice, highlighting the complex interplay between ideal care and practical constraints. The identified themes of luxurious care and enriched care provide a framework for implementing PCC that respects patients’ dignity, autonomy, and individual needs while acknowledging [34] the challenges faced by nurses in delivering such care.

Our study builds upon existing models of PCC by integrating the cultural and contextual factors specific to the Iranian healthcare system. While previous models have primarily focused on Western healthcare settings, our findings reveal how cultural values, such as collectivism and respect for family involvement, shape nurses’ understanding and implementation of PCC in Iran. This cultural lens enriches the existing literature by demonstrating that PCC is not a one-size-fits-all approach but must be adapted to fit the unique sociocultural context of each region. Our findings challenge the notion that PCC can be fully realized in high-pressure healthcare environments without addressing systemic issues. The tension between the ideal of luxurious care and the practical constraints faced by nurses in Iran highlights the need for a more nuanced understanding of PCC that considers the realities of healthcare delivery in resource-limited settings. This challenges previous models that may overlook the impact of workload and organizational support on the ability to provide person-centered care. Additionally, our study provides insights into the specific challenges and opportunities faced by nurses in Iran, such as the influence of religious beliefs and cultural norms on patient interactions. By highlighting these regional factors, we contribute to a more comprehensive understanding of PCC that is sensitive to the diverse experiences of nurses and patients across different cultural contexts.

Future research should explore strategies to overcome barriers to PCC implementation, including addressing workload issues and enhancing communication skills among healthcare providers. Additionally, investigating the impact of recent global events, such as the COVID-19 pandemic, on PCC delivery and the role of technological advancements in shaping future PCC practices would be valuable.

These findings have important implications for nursing practice, education, and policy. They underscore the need for continued professional development focused on enhancing cultural competence, communication skills, and ethical decision-making. Moreover, healthcare organizations should strive to create supportive environments that enable nurses to deliver person-centered care effectively, balancing the ideals of PCC with the realities of modern healthcare settings.

Conclusion and implications

This study enhances our understanding of person-centered care (PCC) in nursing, revealing a dichotomous perspective among nurses. Some view PCC as essential, while others perceive it as a luxury. The identified themes of luxurious care and enriched care provide a framework for implementing PCC that respects patients’ dignity and autonomy while acknowledging the challenges faced by nurses in delivering such care.

To address these challenges, healthcare organizations should create supportive environments and develop educational initiatives to strengthen nurses’ skills in providing quality, person-centered care. This includes fostering a view of PCC as a professional duty rather than a luxury. Future research should explore strategies to overcome barriers to PCC implementation, including workload issues and the impact of global events and technology. By implementing these recommendations, healthcare systems can enhance patient outcomes and community health through improved PCC practices.

Strengths and limitations

This study’s primary strength lies in its qualitative methodology, which facilitated the generation of rich, nuanced data on the concept of PCC. The inclusion of both head nurses and shift nurses as participants contributed to data diversity, enhancing the study’s comprehensiveness and validity.

However, several limitations warrant consideration. Firstly, the exclusive use of semi-structured interviews for data collection may have precluded participation from individuals uncomfortable with one-on-one dialogue. Future research could benefit from incorporating focus groups to diversify data collection methods. Secondly, conducting interviews at the end of nurses’ shifts, while accommodating participants’ preferences, may have introduced potential bias due to fatigue and residual effects of ward conditions. Subsequent studies should consider optimal timing for data collection to mitigate these factors. Lastly, this study examined PCC solely from the nurses’ perspective. Future qualitative investigations exploring patients’ perceptions of PCC would provide valuable complementary insights, contributing to a more holistic understanding of this critical concept in healthcare delivery.

Abbreviations

PCC

Person-Centered Care

CCU

Coronary Care Unit

ICU

Intensive Care Unit

Author contributions

N.M. made substantial contributions to the study design, analysis, and interpretation of data, revised the article critically, and was responsible fordataacquisition.F.B. reviewed relevant literature, contributed to drafting manuscript sections, and assisted with interpretation of findings. S.B. made substantial contributions to the concept, design, data analysis, and interpretation of data, revised the article critically, and approved the version to be published. S.M. participated in contribution and data collection and prepared the first draft of manuscript. All authors reviewing and approving the final manuscript.

Funding

This study was financially supported by the Research Vice-Chancellor of Mazandaran University of Medical Sciences (Grant No. 22747). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. F.B. did not receive financial support for her contribution to this work.

Data availability

The datasets without confidential information used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted following the World Medical Association’s Declaration of Helsinki. The study was approved by the ethics committee of Mazandaran University of Medical Sciences and registered at IR.MAZUMS.REC.1404.027. The study materials (interview questions and informed consent form) were approved by the university’s ethics committee. Before the interviews, participants were informed via telephone about the study’s objectives, voluntary participation, data collection methods, and the reasons for recording the interviews. Willing participants were asked to complete the informed consent form, after which they participate in this study. They were informed of their right to withdraw from the study at any point. The roles of researchers and participants, as well as confidentiality and anonymity of information, were explained. Additionally, transcripts were anonymized, and data were stored securely.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.