Work

Implementation strategies, outcomes and determinants of integrated care for cardiometabolic conditions and mental, neurological and substance use disorders: protocol for a mixed-methods systematic review

Year: 2026

Type: review

Abstract: Introduction The co-occurrence of cardiometabolic diseases and mental health conditions represents a growing global health burden, particularly in low- and middle-income countries. Although integrated, people-centered multimorbidity care is increasingly recognized as essential across settings, evidence remained limited on how these models are operationalized in routine practice and which implementation strategies are most effective to support their delivery. This protocol outlines the methods for a systematic review aiming to identify implementation strategies used to integrate care for cardiometabolic and mental health conditions, examine associated implementation outcomes, and explore contextual determinants influencing implementation across settings. Methods and analysis This protocol follows the PRISMA-P guidelines. A comprehensive search will be conducted in PubMed, CINAHL, APA PsycINFO, Scopus and Web of Science, and relevant grey literature sources. Eligible studies include randomized controlled trials, quasi-experimental studies, mixed-methods studies, qualitative studies and implementation evaluations reporting on integrated care models addressing both cardiometabolic and mental health conditions. To be included in this Systematic Review studies must detail strategies or models integrating care for at least one cardiometabolic and one mental health condition and provide data on implementation outcomes or contextual determinants. Title/abstract screening, full-text screening, data extraction and data synthesis will be conducted independently by at least two researchers following pilot testing. A formal risk of bias assessment will be performed using Mixed Methods Appraisal Tool (MMAT). A mixed-method, framework-based synthesis will be undertaken. Implementation strategies will be coded using the Expert Recommendations for Implementing Change (ERIC) taxonomy, implementation outcomes using Proctor et al.’s taxonomy, and contextual determinants using the Consolidated Framework for Implementation Research (CFIR). Quantitative data will be summarized descriptively using frequencies, proportions and summary tables, with findings stratified by country income level, setting and type of integrated care model where possible. Qualitative data will be analyzed using inductive coding and deductive mapping to implementation science frameworks.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-125828