Factors that influence the commissioning and implementation of integrated care for adults at risk of cardiovascular disease and mild-to-moderate mental health concerns in the UK: a systematic review protocol

BACKGROUND: Cardiovascular disease (CVD) risk factors and mild-to-moderate mental health concerns (anxiety, depression) often co-occur and can worsen individual health outcomes, increase healthcare burden, and related costs relative to non-co/multi-morbidity. Existing evidence from both staff and service users suggests that integrating care for this population can be beneficial but challenging. Therefore, it is important that the key influences on integrated care are mapped to behavioural science frameworks so that intervention strategies in the system are actionable. This review aims to synthesise findings on which individual, organisational, social, and system-level factors influence integrated care for people experiencing co-occurring CVD risk factors and mild-to-moderate mental health concerns from the perspective of a range of health and social care professionals.

METHODS: This systematic review will search MEDLINE, Embase, Emcare, PsycInfo, CINAHL, and grey literature in PsyArXiv and HMIC. Included studies will be qualitative primary research published in the English language reporting on the factors that influence the commissioning and implementation of integrated care for adults at risk of CVD and experiencing mild-to-moderate mental health concerns. This will be from the perspective of healthcare professionals, managers, commissioners, and policymakers. A thematic synthesis will identify relevant actions, actors, context, targets, and timeframes using the AACTT framework, and influences on actors' behaviour will be mapped to the Consolidated Framework for Implementation Research (CFIR) and the Theoretical Domains Framework (TDF).

DISCUSSION: Data from this review will provide insight for a larger NHIR-funded programme of work that aims to optimise Integrated Care Services (OptICS) that will develop a whole-systems map to identify appropriate targets and intervention strategies to optimise integrated care. This review will offer a novel contribution to knowledge by synthesising qualitative evidence from a range of stakeholders on the influences on commissioning and implementation of integrated care for adults with physical and mental health comorbidities, mapped to complementary implementation frameworks.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42024554221.