Currently submitted to: JMIR Research Protocols
Date Submitted: Apr 17, 2026
Open Peer Review Period: May 5, 2026 - Jun 30, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Integration of Mental Health Services into Primary Health Care in Low- and Middle-Income Countries: Protocol for a Qualitative Systematic Review
ABSTRACT
Background:
Background:
The integration of mental health services into primary health care is a pivotal strategy for reducing the treatment gap in low- and middle-income countrie. Despite strong global policy endorsement, implementation remains inconsistent and is shaped by a complex interplay of health system, sociocultural, and contextual factors. Qualitative evidence capturing stakeholder perspectives on these factors has not been synthesised in a theory-informed manner, limiting the depth and policy relevance of existing reviews.
Objective:
Objective:
This review aims to synthesise qualitative evidence on individual, interpersonal, organisational, and policy-level factors that influence the integration of MHS into PHC in LMICs.
Methods:
Methods:
This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews. A comprehensive search will be conducted in PubMed, Embase, Web of Science, Scopus, CINAHL, and the Cochrane Library for studies published from January 2000 to December 2025. Eligible studies will include qualitative and mixed-methods research involving key stakeholders in primary mental health care in LMICs. Two independent reviewers will screen records, extract data using JBI SUMARI, and appraise study quality using the JBI Critical Appraisal Checklist for Qualitative Research. Data synthesis will employ the JBI meta-aggregation approach, with findings organised using a socio-ecological framework. Confidence in synthesised findings will be assessed using the ConQual approach.
Results:
Results:
The review is currently in progress. The protocol was registered in PROSPERO (CRD42024533735) before commencement of formal screening or data extraction. Preliminary scoping searches have been conducted to inform the search strategy. Database searching, title and abstract screening, full-text assessment, and data extraction are planned for completion by the end of 2026. Synthesised findings are expected to be published in 2026.
Conclusions:
Conclusions:
This review will generate contextually grounded, policy-relevant evidence to support the design and scale-up of integrated MHS in resource-constrained settings. Findings will identify modifiable factors affecting integration across multiple health system levels and inform the development of evidence-based implementation strategies in LMICs. Clinical Trial: PROSPERO CRD42024533735
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