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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]