Barriers and facilitators to implementing integrated brief interventions to prevent modifiable risk factors of non-communicable diseases: a systematic review using the Consolidated Framework for Implementation Research (CFIR)

Background 80% of non-communicable diseases (NCDs) can be prevented by reducing modifiable risk factors. These diseases disproportionately affect certain vulnerable groups, who are often exposed to multiple risk factors. While “integrated” primary preventive strategies exist, such as screening and brief interventions (SBIs), addressing several modifiable risk factors at once, little is known about determinants influencing their implementation. This review aimed to identify barriers and facilitators to implementing integrated SBIs, with a focus on health inequalities. Methods A systematic review was conducted in accordance with PRISMA guidelines, searching the PubMed and CINAHL databases. Articles published between January 1, 2014, and July 3, 2026, were identified using a search strategy covering six modifiable risk factors (tobacco use, alcohol consumption, insufficient physical activity, unhealthy diet, sun exposure, and weight management) and five inequality axes (gender, environment, low socioeconomic status, displaced people, and low use of self-initiated resources due to limited access). Studies were included if they reported on NCD preventive SBIs targeting at least two risk factors and one inequality axis. Determinants of SBI implementation were classified as barriers or facilitators across five domains of the Consolidated Framework for Implementation Research (CFIR). Results Of 2,594 records identified, 32 met the inclusion criteria. The most frequently addressed combination of risk factors was tobacco and alcohol use. The most frequently identified implementation determinants fell within three CFIR domains. In the Outer Setting , limited healthcare access for disadvantaged groups was a barrier, whereas supportive environments (urban design, access to healthy food and sports facilities, community–health collaborations) acted as facilitators. In the Inner Setting , the lack of gender or cultural adaptation hindered implementation, while strong cross-sector collaboration enabled it. Within the Characteristics of Individuals domain, gender stereotypes, particularly those affecting women, were identified as barriers, whereas social support networks and digital self-monitoring tools functioned as facilitators. Conclusions Few SBIs integrate multiple risk factors while also addressing inequalities. Strengthening SBI implementation will require equity-focused strategies that embed gender-sensitive and culturally adapted approaches, foster healthcare–community partnerships and leverage self-directed tools, particularly digital resources, to enhance reach, sustainability, and effectiveness.