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Table 2 Overview of findings related to the four dimensions of Normalization Process Theory (NPT)

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

NPT-dimensions Enablers Barriers
Coherence Training [9]
Physician champion [35]
Clarification of roles and responsibilities among professionals [40, 42, 29]
Lack of educational programs [31]
Cognitive participation Professionals made aware of positive patient outcomes [41, 32, 38]
Local opinion leaders [32, 35, 40]
Covering PCPs operating costs related to collaborative care [40]
Psychiatric supervision can ease scepticism among staff about medication [39]
Lack of engagement among the PCPs [33, 9, 32, 34, 37, 31]
Time pressures [33, 9, 43, 38, 30]
Problems with reimbursement [38]
PCPs being uncomfortable with diagnosing and treating mental health illness [32, 34, 39]
PCP concerns about sharing patients’ private health information [35]
Collective action Co-location of CM and PCP [9, 32, 37, 29, 39, 38, 40, 6]
Regular face-to-face interaction between professionals [9, 32, 38, 29]
Interaction between professionals being centered on patient cases [33] Face-to-face patient referral between professionals [40]
Professionals able to engage with patients [36, 42, 39, 29]
CMs’ social and professional skills, e.g. being visible, able to build relationships [33, 32, 34, 29, 40]
Good educational programs for CMs [33, 34, 29, 40]
Model not being burdensome or create a problems with workload [32, 41, 43]
Instruments for including patients and keeping track of progress [34, 29, 35, 30]
Absence of co-location of CM and PCP [33, 9, 32, 34]
Lack of space for additional staff [39, 32]
Difficulties engaging patients due to patients’ problems being too severe or complex [9, 36] and/or due to patients’ preferences [6]
Primary care staff having difficulties managing mental health problems [34]
Making the model work experienced as consuming [39, 9, 30, 38]
IT-systems hindered effective communication (e.g. double registration, limited access, lack of integration) [9, 37, 29, 39, 34].
Reflexive monitoring Professionals experience that patients benefit from collaborate care [32, 35, 38]
Primary care providers value systematic patient feedback [33, 32, 29, 38] and instruments for monitoring patient progress [34, 36, 35, 30]
Systematic monitoring enable active follow up which strengthen implementation [29]
Lack of systems for monitoring patient progress [33]
Absence of immediate access to objective data on patient progress [39]