Table 1 Multi-level barriers and... | Emerald Publishing

Table 1

Multi-level barriers and enablers for PHC uptake in SMI: summary table

Level	Identified barriers	Enabling strategies (from the initiative)	Recommendations for practice/policy
Patient-level	Anxiety about serious health news Fear of stigma or judgement Disrupted daily routines Cognitive impairment and motivational challenges Distrust of clinical settings	Community-based outreach in familiar, trusted settings Peer support and relational engagement Flexible appointment times	Prioritise delivery in accessible, non-clinical environments Embed peer support into care pathways Flexible, patient-centred appointment systems
Practitioner-level	Labelling/bias-diagnostic overshadowing Low confidence in raising physical health topics Concerns about triggering disengagement	Co-produced training with lived-experience narratives Video resources to humanise inequalities Practical communication strategies	Mandatory, ongoing co-produced training for all primary care staff Include administrative and nursing teams in training Foster reflexive, culturally competent practice
System-level	Fragmented/incompatible data systems Information governance constraints High workforce turnover Limited capacity for proactive outreach	Collaborative data validation and register cleaning Cross-sector partnership with voluntary sector Shared problem-solving in GP roundtables	Invest in interoperable data systems Enable integrated commissioning with voluntary sector partners Support sustainable funding for outreach and education

Level	Identified barriers	Enabling strategies (from the initiative)	Recommendations for practice/policy
Patient-level	Anxiety about serious health news Fear of stigma or judgement Disrupted daily routines Cognitive impairment and motivational challenges Distrust of clinical settings	Community-based outreach in familiar, trusted settings Peer support and relational engagement Flexible appointment times	Prioritise delivery in accessible, non-clinical environments Embed peer support into care pathways Flexible, patient-centred appointment systems
Practitioner-level	Labelling/bias-diagnostic overshadowing Low confidence in raising physical health topics Concerns about triggering disengagement	Co-produced training with lived-experience narratives Video resources to humanise inequalities Practical communication strategies	Mandatory, ongoing co-produced training for all primary care staff Include administrative and nursing teams in training Foster reflexive, culturally competent practice
System-level	Fragmented/incompatible data systems Information governance constraints High workforce turnover Limited capacity for proactive outreach	Collaborative data validation and register cleaning Cross-sector partnership with voluntary sector Shared problem-solving in GP roundtables	Invest in interoperable data systems Enable integrated commissioning with voluntary sector partners Support sustainable funding for outreach and education

Source(s): Table by author