Barriers and enablers to the implementation of osteoarthritis management programmes in primary or community care settings: A systematic review and qualitative framework synthesis

BACKGROUND: Osteoarthritis Management Programs (OAMPs) are evidence-based, non-surgical OA service delivery models, intended for implementation in real-world settings. Identifying barriers and enablers to effective sustained implementation of OAMPs is crucial for optimising individual (micro), service (meso) and health system (macro) benefits. OBJECTIVE: To synthesise evidence on barriers and enablers to implementation of primary/community care-based OAMPs. DESIGN: Systematic review and framework synthesis of qualitative studies published 2010-2025 (PROSPERO registration:CRD42021255698). METHODS: Barriers and enablers were identified and categorised through inductive coding, mapped to the Theoretical Domains Framework (TDF), and classified at micro, meso, or macro levels. GRADE CERQual was used to judge confidence in the findings. RESULTS: Eighteen publications (217 OAMP providers; 111 patients) were included. Twenty barrier and 20 enabler categories were mapped against 10 TDF domains. Barriers most commonly mapped to TDF domains of environmental context and resources (limited public funding and workforce)), knowledge (healthcare professionals' (HCPs) and patient knowledge), skills (limited HCP collaboration and therapeutic alliance), beliefs about consequences (patients' OA beliefs), and memory, attention and decision processes (limited HCP autonomy, patient factors affecting OAMP participation). Enablers most commonly mapped to TDF domains of environmental context and resources (enhanced integrated care, public funding), knowledge (HCPs; patients), skills, beliefs about capabilities (HCP confidence in their skills), social/professional roles and identities (expansion of professional roles), and social influences (patient social support). Most findings were judged as high or moderate confidence. CONCLUSIONS: Findings highlight opportunities to facilitate OAMP implementation in primary and community care settings, and can inform targeted implementation strategies.