# Integrating Artificial Intelligence (AI) in Primary Health Care (PHC) Systems: A Framework-Guided Comparative Qualitative Study

## TL;DR

This study compares how artificial intelligence is integrated into primary health care in Quebec and Iran, showing that success depends on system-wide factors like governance and infrastructure, not just technology.

## Contribution

The paper introduces a framework-guided comparative analysis of AI integration in primary health care across two distinct health systems.

## Key findings

- AI readiness in primary health care is shaped more by systemic coherence than technological availability alone.
- Quebec faces challenges related to workflow integration and professional trust, while Iran struggles with governance stability and digital infrastructure.
- Adaptive governance, sustainable investment, and workforce development are key requirements for AI integration in both settings.

## Abstract

What are the main findings?
AI integration in PHC depends primarily on systemic alignment across governance, financing, infrastructure, and workforce domains rather than technology alone.Quebec and Iran demonstrate distinct AI integration trajectories shaped by differences in system maturity and institutional capacity.

AI integration in PHC depends primarily on systemic alignment across governance, financing, infrastructure, and workforce domains rather than technology alone.

Quebec and Iran demonstrate distinct AI integration trajectories shaped by differences in system maturity and institutional capacity.

What are the implications of the main findings?
Strengthening governance coordination, sustainable financing mechanisms, and interdisciplinary workforce development are central to successful AI implementation in PHC.Comparative insights underscore the need for phased, context-sensitive digital transformation strategies rather than one-size-fits-all approaches.

Strengthening governance coordination, sustainable financing mechanisms, and interdisciplinary workforce development are central to successful AI implementation in PHC.

Comparative insights underscore the need for phased, context-sensitive digital transformation strategies rather than one-size-fits-all approaches.

Background/Objectives: The integration of artificial intelligence (AI) into primary health care (PHC) holds significant potential to enhance efficiency, equity, and clinical decision-making. However, its implementation remains uneven across contexts. This study aimed to identify the systemic, contextual, and governance-related determinants influencing AI readiness in PHC, comparing two distinct health systems, Quebec (Canada) and Iran. Methods: A qualitative, comparative design was employed. Data were collected through semi-structured interviews and focus group discussions with key informants in both settings. A framework-guided content analysis was conducted based on the four Primary Care Evaluation Tool (PCET): stewardship, financing, resource generation, and service delivery. The analysis explored shared context-specific challenges and requirements for AI implementation in PHC. Results: Analysis revealed that AI readiness is shaped more by systemic coherence rather than technological availability alone. Across both contexts, governance- and financing-related challenges were reported by the majority of participants, alongside limited data interoperability. In Quebec, challenges were more commonly articulated around operational and ethical concerns, including workflow integration, transparency, and professional trust. In contrast, participants in Iran emphasized foundational deficiencies in governance stability, financing mechanisms, and digital infrastructure as primary barriers. Across both settings, adaptive governance, sustainable investment, data standardization, and workforce capacity-building consistently emerged as key requirements for AI integration in PHC. Conclusions: AI readiness in PHC is a multidimensional process, in which implementation priorities must align with system maturity. This comparative analysis underscores that while high-resource systems must prioritize ethical integration and workflow alignment, middle-resource settings require foundational investments in governance and infrastructure. This reinforces that AI readiness is a context-dependent and phased process rather than a one-size-fits-all endeavor.