Introduction: One of the major reforms in the health system is the stratification of the healthcare system. Establishing appropriate connections between health service levels is carried out to reduce costs, create equity, and provide access to necessary services for all people. This research was conducted to identify the communication challenges between the first and second levels of care.
Methods: This study was conducted using a scoping review method. At the beginning of 2024, all articles published from 2010 to 2023 related to communication challenges between the first and second levels of care in Iran were searched and collected in English databases PubMed, Scopus and Web of Science, Persian databases Magiran and SID, and Google Scholar search engine using appropriate keywords. A total of 653 articles were obtained, of which 24 were included in the study. The resulting data were analyzed using the framework analysis method.
Findings: Reviewing the studies, 21 important challenges were identified and categorized into six areas: governance/leadership, service delivery, financing, facilities and equipment, human resources, and information system.
Conclusion: Weakness in proper cooperation between family physicians and specialists, insufficient training and inadequate staff skills, Weakness in cultural development and building trust in the community, and weakness in coordination among executive agencies were mentioned more than other challenges. This indicates the health system governance's insufficient attention to effectively engaging various key stakeholders in policymaking, planning an implementation process.