Barriers to and facilitators of integrated primary care engagement: Convergent and divergent perspectives of care team members and caregivers.

Abstract

Background: Integrated primary care (IPC) can improve access to behavioral health (BH) care, reduce stigma, and facilitate early intervention. However, few studies have examined key informants' perceptions of IPC engagement.

Objective: We qualitatively identified convergent and divergent perspectives of care team members and caregivers on pediatric IPC-related engagement barriers, facilitators, and suggestions for improvements.

Method: Care team members (N = 48, 98.3% female, 72.9% non-Hispanic/Latine White) and caregivers (N = 10, 100% female, 10.0%. Asian, 30.0% Black/African American, 60.0% non-Hispanic/Latine White) completed semistructured interviews on IPC engagement in a large pediatric primary care network. Thematic analysis was used to iteratively identify patterns of meaning, as well as convergent and divergent themes across informant groups.

Results: Convergent barriers included stigma, prolonged wait times, limited BH knowledge, difficulty navigating services, and limited BH provider availability. Whereas care team members identified more family-related barriers (e.g., beliefs, experiences), caregivers identified divergent barriers such as limited childcare. Perceived engagement facilitators converged across groups and mostly pertained to systems-related factors such as the colocation of services. Converging recommendations included additional behavioral clinicians and support staff, provision of psychoeducational resources, and expanding IPC services.

Conclusion: Although key informant groups similarly perceived many IPC benefits, including increased BH access, there are continued patient/family barriers to IPC engagement, with divergence in care team members' versus caregivers' views about the nature of these barriers. Findings suggest a need for systems-level changes to address these barriers and highlight the importance of including the unique perspectives of care team members and caregivers in future research examining IPC effectiveness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).