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Table 1 Study characteristics

From: Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review

Author, name of intervention study, country


Aim of study

Data collection methods


Data analysis/theoretical framework

Gask et al. [42], CADET, UK


To explore the work that “needs to be done to make a collaborative care intervention for depression in primary care both workable and integrated into routine practice”

Focus groups, one-to-one interviews


12 PCPs

4 Clinical psychologists

4 Practice nurses

4 Psychiatrists

14 Mental health workers

11 patients

Normalization process model (NPM)

Coupe et al. [9], CADET, UK


“To explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting.”

“To identify barriers and facilitators to the successful implementation of CC”

Face-to-face interviews with CM and managers

Telephone interviews with GPs


6 CMs,

5 Supervisors from research team,

15 GPs

Thematic analysis and theory-driven analysis using normalization process theory (NPT)

Knowles et al. [37], COINSIDE, UK

Depression and long-term conditions

To explore (a) the extent to which “collaborative care principles and modes of working were implemented in routine care…”

and to (b) “Employ NPT as a conceptual model to identify barriers and facilitators to the adoption and integration of collaborative care…”

Face-to-face semi-structured interviews


6 Case managers

17 Practice nurses

Thematic analysis and normalization process theory (NPT)

Knowles et al. [6], COINSIDE, UK

Depression and long-term conditions

“…to examine:

a) How the collaborative care model was implemented by usual care providers in a UK setting.

b) How patients and providers understood and experienced the integration of mental and physical health care.”

Semi-structured interviews


11 PWPs

12 PNs,

7 GPs

31 Patients

The constant comparative method

Byng et al. [33], The Mental Health Link intervention (MHL), UK

Patients with long-term mental illness

To investigate how the MHL intervention “had its effects and how the process evaluation adds meaning to the results of the trial.”

Individual and group interviews


21 GPs,

8 Community

mental health workers,

7 Practice managers,

4 Mental health managers,

3 Practice nurses,

2 Psychiatrists,

1 Practice counselor

1 Facilitator

Case study using the realistic evaluation framework

Curran et al. [32], CALM, USA


To identify the facilitators and barriers to implement and sustain CALM

Qualitative interviews


14 Anxiety clinic specialists (ACS)

13 Primary care nurses

18 Primary care administrators

16 Primary care clinic administrators

Content analysis. Coding in three levels: 1: macro themes identified, 2: subcoding identifying barriers and facilitators, 3: interpretation

Eghaneyan et al. [34], (Collaborative care in a community health center), USA

Depression, anxiety (in a low-income, uninsured Latino population)

“To examine the implementation of a collaborative care model…” and “to identify perceived barriers…”

Semi-structured interviews


1 Care manager

3 PCPs

1 Nursing director

1 Project manager


Grounded theory approach. Two-leveled coding

Whitebird et al. [40], DIAMOND, USA


To identify the care model factors that were key for successful implementation of collaborative depression care

Mixed methods study:

Group interviews plus “quantitative measures of patient activation and 6-month remission rates”

42 Clinics.

The exact number of respondents is not stated.

Present at the interviews were as follows:

“…the project lead, care manager and PCP champion. Other staff encouraged to attend were other physicians, the consulting psychiatrist, and the quality improvement lead”

“Following each site visit, ICSI staff completed a structured qualitative narrative to document their assessment of factors affecting implementation […]

Summaries were then prepared by the ICSI site-visit teams and were reviewed by the entire study team”

Sanchez et al. [35], IBH (Integrated Behavioral Health), USA

Depression and anxiety (in a low-income, uninsured adult population)

How a collaborative care model for the treatment of depression works

In-depth individual interviews


1 Care manager

1 PCP champion

1 Psychiatrist

1 Director

Analysis was partly guided by pre-developed propositions but “allowed for analytical flexibility and identification of new themes”

Oishi et al. [29], IMPACT, USA

Late life depression

To explore how “’integration’ was achieved”, and to suggest “factors to consider when disseminating the model into real life settings”

Focus groups (2), semi-structured telephone interviews

11 DCSs (care managers)

Thematic analysis

Blasinsky et al. [41] IMPACT, USA

Major depressive disorder or dysthymia (older adults)

To investigate the sustainability of collaborative care in primary care

Semi-structured telephone interviews, documents describing the intervention, and site visits

Telephone interviews with 15 informants from 7 clinics: the principal investigator, co-principal investigator, depression care specialist (care manager), supervising psychiatrist, primary care physicians, program coordinator, and recruiter or screener

Not stated

Palinkas et al. [39], MDDP (multifaceted depression and diabetes program for Hispanics), USA

Depression and diabetes

To examine “perceptions of barriers and facilitators associated with implementation and sustainability”

Individual semi-structured interviews and focus groups


5 Physicians (of which 3 were also clinic directors or associate directors)

9 Nurses

3 Nurse practitioners

19 Patients

Grounded theory approach

Huang et al. [36], MHIP, USA

Depression (high-risk mothers)

To “explore aspects of the collaborative care program associated with successful treatment of depressed mothers served in a collaborative care program as well as barriers to such successes.”

Focus group interview

6 Care managers

Thematic analysis

Tai-Seale et al. [43], PCMH (Primary Care Mental Health Initiative), USA

Depression (veterans)

To “examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters”

Audio recordings of 10 patient visits and a self-administered questionnaire

6 PCPs

Qualitative analyses of transcripts using a pre-structured guide divided into six questions

Nutting et al. [30], RESPECT-D, USA


“To understand the characteristics of organizations and the intervention components that were associated with implementation and dissemination”

Telephone interviews


24 Program managers (including quality improvement staff),

7 Mental health specialists,

18 Care managers,

42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”)

Data analysis in three waves focused on emerging themes

Nutting et al. [38], RESPECT-D, USA


To examine the barriers to adopting depression care management among primary care clinicians

Semi-structured telephone interviews


24 Program managers

18 Care managers

7 Mental health specialists

42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”)

Data analysis in four waves focused on emerging themes

Wozniak et al. [31], TeamCare Intervention, Canada

Diabetes and depression

To evaluate the implementation collaborative care model in community-based primary care networks (PCNs)

In-person or telephone interviews, reflections of the research team during the intervention and systematic documentation (e.g., standardized checklist, field notes, and meeting minutes). The PCN managers completed a standardized checklist at baseline

The researchers documented their observations of and reflections on implementing TeamCare in each PCN, using a focus group format

14 PCN staff (23 interviews) and 7 specialists (13 interviews)

Content analysis using the RE-AIM framework as well as a more inductive approach