Exploring strengths, challenges, and experiences of using a national call center during the Covid-19 pandemic: a qualitative study

Eslami Jahromi et al. BMC Health Services Research https://doi.org/10.1186/s12913-025-13642-4 (2025) 25:1461 BMC Health Services Research Open Access RESEARCH Exploring strengths, challenges, and experiences of using a national call center during the Covid-19 pandemic: a qualitative study Maryam Eslami Jahromi1, Haleh Ayatollahi2* and Ali Ebrazeh3 Abstract Background Investigating experiences of staff and callers of call centers/hotlines during the Covid-19 pandemic is essential to identify perceived strengths, challenges, and opportunities for improving service delivery. This study aimed to explore experiences and perspectives of staff and callers of the 4030 call center during the Covid-19 pandemic. Methods This was a qualitative study in which data were collected via conducting semi-structured interviews with the call center’s staff (n = 5), consultants (n = 24), and callers (n = 35). The data were analyzed using the framework analysis approach. Result The results included four main themes emerged from interviewing the staff and consultants of the call center: the rationale behind establishing the 4030 call center, its operational processes, strengths, and challenges. Interviews with the callers included three key main themes: reasons for contacting the call center, its strengths, and challenges. Conclusion During the Covid-19 pandemic, the 4030 call Center played an important role in reducing the burden of in-person visits to healthcare centers as well as providing psychological support to the public. Despite advantages such as preventing disease spread and alleviating public concerns, challenges including the large number of calls, long waiting times, and limitations of telephone counseling were reported. Therefore, healthcare policymakers need to pay more attention to the strengths and challenges of the call centers during health crises to improve service delivery and use past experiences for future planning. Keywords Call centers, Covid-19, Hotlines *Correspondence: Haleh Ayatollahi 1 Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran 2 Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, No. 4, Rashid Yasemi St, Vali-Asr St, Tehran 1996713883, Iran 3 Department of Public Health, School of Public Health, Qom University of Medical Sciences, Qom, Iran © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/. Eslami Jahromi et al. BMC Health Services Research (2025) 25:1461 Page 2 of 12 Introduction Covid-19 posed a major threat to global health and was officially declared as a pandemic by the World Health Organization (WHO) on March 17, 2020. Since then, various strategies have been implemented worldwide to mitigate the impact of the pandemic [1]. These strategies included quarantine measures, curfews, stay-at-home orders, social distancing, travel restrictions, border closures, as well as temporary shutdown of schools, retail stores, restaurants, workplaces, and public events from 2020 to 2022 [2]. The Covid-19 pandemic also transformed the delivery of healthcare services globally. Telemedicine emerged as a critical technology to ensure continued healthcare access in response to the pandemic and the need for physical and social distancing [3]. Health authorities recommended replacing in-person outpatient consultations with telephone calls to reduce the risk of viral transmission during the pandemic [4]. Accordingly, many countries established telephone hotlines, helplines, and call centers [5], which experienced a substantial increase in calls by late March 2020 [2]. These systems primarily aimed to provide psychological support, disseminate reliable information about Covid-19, offer healthcare advice, and conduct triage assessments [5]. Several studies examined the role and impact of hotlines/call centers )telephone counseling( during health crises. A study in 2020 reported that 84% of calls to crisis hotlines ended with a positive outcome, meaning that the caller’s issue was either resolved during the call or the caller was referred to a local healthcare provider, indicating that such hotlines/call centers can effectively reduce pressure on healthcare systems and provide support to individuals in crisis [6]. The Covid-19 pandemic further affected hotline usage and increased both the volume and complexity of calls, with callers primarily seeking psychological support and information related to Covid19, reflecting a significant need for healthcare services [7]. Another study showed that hotline callers during the pandemic reported mental health concerns, including anxiety, depression, and sleep disturbances, and services provided through hotlines helped to reduce these concerns and provided effective support [8]. In addition, frequent callers often experienced serious mental and physical health problems, and were frequently in crisis, suggesting that service models should be tailored to address the specific needs of frequent callers for efficient resource utilization [9]. Evidence also points to the measurable benefits of hotline interventions. Systematic reviews and large-scale evaluations report high satisfaction of callers and shortterm reductions in distress following calls [6]. Another study showed that between 70% and 89% of callers reported positive experiences, with significant reductions in psychological distress [10]. National evaluations, such as the Samaritans Helpline study in the UK, further demonstrated decreases in distress scores and improvements in wellbeing, while emphasizing the specific needs of frequent callers and the importance of targeted service models [11]. A study by Fongwen et al. demonstrated that call centers and telehealth services during the covid-19 pandemic supported timely communication, triage, and dissemination of reliable health information, especially in resourcelimited conte (...truncated)