Unpacking the design, implementation and uptake of community-integrated health care services

A critical realist synthesis

Bibliographic Data

ID21878622
AuthorsFerdinand C Mukumbang (0000-0003-1441-2172, University of Washington, corresponding author), Denise De Souza (0000-0003-0926-8313, Torrens University Australia), Hueiming Liu (0000-0001-9077-8673, Sydney Local Health District), Gabriela Uribe (Sydney Local Health District), Corey Moore (0000-0002-0089-5356, Ingham Institute), Peter Fotheringham (0000-0003-1853-8194, University of Newcastle Australia), J Eastwood (0000-0003-1549-4368, Sydney Local Health District), John G Eastwood (Ingham Institute, Liverpool, New South Wales, Australia)
Year2022
Volume7
Issue8
Pagese009129
Publication date2022-08-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-009129
PMID35940630
OpenAlexW4290673504
LanguageEN
Citations received4
References cited51

INTRODUCTION: Community-integrated care initiatives are increasingly being used for social and health service delivery and show promising outcomes. Nevertheless, it is unclear what structures and underlining causal agents (generative mechanisms) are responsible for explaining how and why they work or not. METHODS AND ANALYSIS: Critical realist synthesis, a theory-driven approach to reviewing and synthesising literature based on the critical realist philosophy of science, underpinned the study. Two lenses guided our evidence synthesis, the community health system and the patient-focused perspective of integrated care. The realist synthesis was conducted through the following steps: (1) concept mining and framework formulation, (2) searching for and scrutinising the evidence, (3) extracting and synthesising the evidence (4) developing the narratives from causal explanatory theories, and (5) disseminate, implement and evaluate. RESULTS: Three programme theories, each aligning with three groups of stakeholders, were unearthed. At the systems level, three bundles of mechanisms were identified, that is, (1) commitment and motivation, (2) willingness to address integrated health concerns and (3) shared vision and goals. At the provider level, five bundles of mechanisms critical to the successful implementation of integrated care initiatives were abstracted, that is, (1) shared vision and buy-in, (2) shared learning and empowerment, (3) perceived usefulness, (4) trust and perceived support and (5) perceived role recognition and appreciation. At the user level, five bundles of mechanisms were identified, that is, (1) motivation, (2) perceived interpersonal trust, (3) user-empowerment, (4) perceived accessibility to required services and (5) self-efficacy and self-determination. CONCLUSION: We systematically captured mechanism-based explanatory models to inform practice communities on how and why community-integrated models work and under what health systems conditions. PROSPERO REGISTRATION NUMBER: CRD42020210442

Empowerment · Health care · Interpersonal communication · Knowledge management · Political science · Public relations · Community Health and Development · Computer Science · Health Policy Implementation Science · Interprofessional Education and Collaboration · Psychology · Social Psychology