Transforming Multimorbidity Care: Organisational Barriers and Provider Behaviour in Type 2 Diabetes and Cardiovascular Disease

Lotto, R ORCID: 0000-0002-4305-0513, Newson, L ORCID: 0000-0002-5874-8762, Jones, ID ORCID: 0000-0002-3081-0069, Umeh, K, Brown, J, Madroumi, R ORCID: 0009-0001-9002-5644 and rashidi, A Transforming Multimorbidity Care: Organisational Barriers and Provider Behaviour in Type 2 Diabetes and Cardiovascular Disease. British Journal of Health Psychology. ISSN 1359-107X (Accepted)

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Abstract

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) presents intertwined behavioural and biomedical challenges; however, the organisational and professional factors that shape integrated care are poorly understood.

Objectives: To identify behavioural and organisational 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: Compartmentalised Conditions; Inhibition of Meaningful Interactions; and Gaps Between Understanding and Supporting, illustrate how limitations in capability (confidence and training), opportunity (siloed records, absence of psychological pathways), and motivation (fear aversion and entrenched norms) collectively reinforce fragmented biomedical care. These mechanisms operate across organisational 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. Conceptualising cardiometabolic care as a behavioural and communicative system identifies priority intervention targets: staff training, service redesign, interoperable records, and leadership development. These support practitioner wellbeing, interdisciplinary collaboration, and patient engagement. The findings reframe integrated T2D-CVD care as a multidirectional capability model, informing policy and practice.

Item Type:	Article
Uncontrolled Keywords:	1117 Public Health and Health Services; 1608 Sociology; 1701 Psychology; Clinical Psychology; 4206 Public health; 5203 Clinical and health psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice Psychology (from Sep 2019)
Publisher:	Wiley
Date of acceptance:	15 June 2026
Date Deposited:	01 Jul 2026 13:41
Last Modified:	01 Jul 2026 13:41
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28923

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