Background and Objective: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, with disproportionate impact in low- and middle-income countries (LMICs). In Iraq, COPD outcomes are shaped not only by clinical factors but also by social determinants of health (SDOH), including income, housing, air pollution, and access to care. This study aimed to explore respiratory physicians’ perspectives on how SDOH influence clinical outcomes in COPD patients within a resource-constrained and conflict-affected setting.
Methods: A qualitative phenomenological design was employed. Ten respiratory physicians working in Baghdad Medical City were interviewed using a semi-structured guide. Interviews were transcribed and analyzed thematically following Braun and Clarke’s six-phase framework. Rigor was ensured through credibility, transferability, dependability, and confirmability, in line with Lincoln and Guba’s criteria.
Results: Five major themes and eleven subthemes emerged: (1) diagnostic and follow-up barriers, including delayed engagement and lack of structured follow-up; (2) socioeconomic influences such as air pollution, financial constraints, and poor housing; (3) healthcare system limitations, including inadequate access and medication shortages; (4) documentation gaps, with absence of SDOH recording and electronic systems; and (5) recommendations for improvement, including patient-level interventions and system-level reforms. Physicians emphasized the need for national registries, subsidized medications, and improved public health education.
Conclusion: COPD management in Iraq is deeply influenced by social and environmental factors. Integrating SDOH into clinical workflows and national health databases is essential to improve outcomes. These findings offer context-specific insights that may inform policy and practice in other LMICs facing similar challenges.