Major challenges and barriers for successful management of health exercises in emergencies and disasters: findings from a qualitative conventional content analysis study.

Introduction: Enhancing health system preparedness requires the design, implementation, and evaluation of disaster exercises. Conducting these exercises improves preparedness planning and promotes staff awareness and capabilities in responding to emergencies and disasters. Given the existing challenges in designing and executing disaster exercises within the health sector, this study aims to identify the main challenges and barriers to the successful management of health sector disaster exercises.

Method: This study was a conventional qualitative content analysis. Data were collected through purposive sampling through in-depth, semi-structured individual interviews with 23 managers from various health sectors. Graneheim and Lundman's conventional content analysis was employed to analyze the data, and Lincoln and Guba's recommendations were utilized to ensure the trustworthiness of the data.

Result: A total of 170 challenges (initial codes), organized into one them, five main categories and 15 subcategories, emerged after several rounds of data analysis and summarization, considering both similarities and differences. These main categories included "Organizational management", "structural and administrative system", "Ineffective policymaking", "Cultural sensitivity and social participation", and "organizing exercise steps".

Conclusion: Understanding the obstacles and challenges in implementing discussion-based and operations-based exercises in emergencies and disasters derived from the experiences of exercise implementers in the health system can help health planners and managers proactively address these obstacles and by considering these challenges and striving to reduce them before designing an exercise they can maintain and improve preparedness of their community's healthcare system through the implementation of successful and effective exercises.