Transforming multimorbidity care: Organizational barriers and provider behaviour in type 2 diabetes and cardiovascular disease.

BACKGROUND

Healthcare professionals' behaviours are central to effective multimorbidity management yet remain underexplored in behavioural medicine. Co-existing type 2 diabetes (T2D) and cardiovascular disease (CVD) present intertwined behavioural and biomedical challenges; however, the organizational and professional factors that shape integrated care are poorly understood.

OBJECTIVES

The objective of this study was to identify behavioural and organizational determinants of integrated T2D-CVD care and to apply behaviour change theory to provider practice.

DESIGN

Sixteen healthcare professionals in North-West England participated in semi-structured interviews.

METHODS

Data were analysed inductively using reflexive thematic analysis within a critical realist framework. The COM-B model (capability, opportunity, motivation, behaviour) informed interpretation of these inductive findings.

RESULTS

Three interconnected themes: Compartmentalized conditions; inhibition of meaningful interactions; and gap between understanding and supporting illustrate how limitations in capability (confidence and training), opportunity (siloed records, absence of psychological pathways) and motivation (risk aversion and entrenched norms) collectively reinforce fragmented biomedical care. These mechanisms operate across organizational and cultural boundaries and explain persistent gaps in risk communication, cross-disciplinary collaboration and limited psychological support.

CONCLUSIONS

This study provides a theory-informed qualitative application of the COM-B model to healthcare professional behaviour in multimorbidity care, demonstrating how system design and professional culture shape interacting determinants. Conceptualizing cardiometabolic care as a behavioural and communicative system identifies priority intervention targets: staff training, service redesign, interoperable records and leadership development. These support practitioner well-being, interdisciplinary collaboration and patient engagement. The findings reframe integrated T2D-CVD care as a multidirectional capability model, informing policy and practice.