What Works to Foster Interprofessional Collaboration in Team-based Community Care Integration for Older People? A Realist Programme Theory

Background: The WHO’s Integrated Care for Older People (ICOPE) Framework stresses community-centred care integration for health and social care models responding to the increasingly complex care needs of older people. One of the key pillars of ICOPE is promoting interprofessional collaboration (IPC) within and across interdisciplinary teams. There is a scarcity of evidence that explains how to develop and sustain IPC in these contexts. Our realist evaluation of IPC within community specialist integrated care teams (CST-ICPOP) in Ireland addresses this gap.

 

Approach: Building on a realist review and synthesis of international evidence, we embedded researchers within four CST-ICPOPs to evaluate and expand the initial programme theories resulting from the literature synthesis (1,2). Extensive data collection involved structured interviews with team members (N = 39), semi-structured interviews with older people and family caregivers (N=10), survey measurement of collaborative practices in the teams, observation of team meetings, analysis of operational documents and processes and focus group meetings.

 

Retroductive analysis of the data, using both inductive and deductive reasoning, was undertaken to understand the generative causation between the observed contexts, mechanisms and outcomes. This resulted in a middle-range explanatory programme theory on what works to foster IPC in community care integration, for whom, and why.

 

Results: We provide an evidence-based explanation for the mechanisms and resources that are used by interdisciplinary teams in different contexts to foster IPC and describe the associated outcomes for community care integration for older people. These causal explanations are presented across seven domains of programme theory: (1) professional identity and growth, (2) information sharing and care coordination across boundaries, (3) effective operational and clinical governance, (4) developing a team learning culture, (5) meaningful inclusion of older people and caregivers, (6) quality improvement and programme development, (7) workforce planning and retention.

 

Implications: Our resulting programme theory clearly identifies practical resources and outcome measurements across seven domains—from governance and team learning to workforce planning—that can be readily adopted and adapted by various health systems. This essential knowledge empowers health system leaders and programme designers with the understanding required to structure integrated care service models.

 

By focusing on the identified contexts and mechanisms, they can proactively foster the interprofessional collaboration necessary for achieving sustained, high-quality care integration for older adults.

1.O'Donnell D, Ahern E, Davies C et al. A realist process evaluation of an intervention to promote competencies in interprofessional collaboration among interdisciplinary integrated care teams for older people: Study protocol. HRB Open Res 2023, 6:49 https://doi.org/10.12688/hrbopenres.13729.1

2.O’Donnell, D., Davies, C., Devaney, C. et al. How can interprofessional collaboration be fostered and sustained in team-based care integration for older people in community settings? A realist evidence synthesis. Syst Rev 14, 117 (2025).

https://doi.org/10.1186/s13643-025-02862-8