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Study Protocol

Community-based integrated care for older people living in peripheral contexts: A systematic review of the evidence

[version 1; peer review: awaiting peer review]
Sarah Murphy
https://orcid.org/0000-0002-2405-0817
1, Preetha Joseph1, Kieran Walsh1
Sarah Murphy
https://orcid.org/0000-0002-2405-0817
1, Preetha Joseph1, Kieran Walsh1
PUBLISHED 15 Jun 2026
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS AWAITING PEER REVIEW

Abstract

Introduction

Despite implementation of different community-based integrated care strategies internationally, there remain substantial difficulties in supporting older adults in small-scale peripheral places, where ageing, inequalities and needs are most evident. Peripheries comprise of rural, shrinking small-town and intra-metropolitan areas. These areas embody significant constraints and opportunities, and complicate challenges around implementation dissonance, and digital integration. There is a marked lack of research on the effects of integrated care on service users, including older adults, and on the components and strategies which make up integrated care for older people. Furthermore, community-based integrated care strategies which integrate health and social care provision have not been sufficiently evaluated, nor their attributes investigated for peripheries and older people living in these areas.

Methods

This systematic review will include empirical research on community-based integrated care interventions for community-dwelling older adults. This will include peer-reviewed literature on care delivered by multidisciplinary teams, including health and social care professionals and GPs. The databases MEDLINE, EMBASE, CINAHL, Web of Science, AgeLine and Overton will be searched. Studies will be subject to quality appraisal using appropriate tools selected based on methodology.

Conclusion

This review will describe the effectiveness of community-based integrated health and social care strategies and outcomes for older people living in peripheral contexts, as well as challenges encountered in this provision.

Prospero registration number: 1378235.

Keywords

Integrated care, older people, community-based care, rural care, multidisciplinary care, care coordination

Corresponding author: Sarah Murphy
Competing interests: No competing interests were disclosed.
Grant information: This systematic review is being completed with funding from the CONTEXT-care project, funded by the Health Research Board, and completed in partnership with the Health Services Executive (HSE) West/North-West and National Clinical Advisor for Older Persons in Ireland. Funders have not been involved in developing this protocol.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Copyright:  © 2026 Murphy S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Murphy S, Joseph P and Walsh K. Community-based integrated care for older people living in peripheral contexts: A systematic review of the evidence [version 1; peer review: awaiting peer review]. HRB Open Res 2026, 9:61 (https://doi.org/10.12688/hrbopenres.14466.1) First published: 15 Jun 2026, 9:61 (https://doi.org/10.12688/hrbopenres.14466.1) Latest published: 15 Jun 2026, 9:61 (https://doi.org/10.12688/hrbopenres.14466.1)

Introduction and rationale

Despite increased implementation of community-based integrated care strategies internationally, there remain substantial difficulties in supporting older adults in small-scale peripheral places, where ageing, inequalities and needs are most evident. Comprising of rural, shrinking small-town and intra-metropolitan areas, peripheries embody significant constraints and opportunities, and complicate challenges around implementation dissonance, and digital integration (Piroddi et al., 2022; Rasekaba et al., 2022; Walsh et al., 2014). Evaluations of integrated care have tended to be service-centred, in terms of their focus on outcomes and assessment of successful practice, rather than person-centred and focused on subjective experiences of individuals engaging with care (Greenfield et al., 2014; Liljas et al., 2019; Murphy et al., 2025). There is a marked lack of research on the effects of integrated care on service users (Baxter et al., 2020), including older adults, and a lack of understanding of components and strategies which make up integrated care for older people (Murphy et al., 2025).

Furthermore, the effectiveness of community-based integrated care strategies, that “combine healthcare and social care activities provided in a specific spatio-temporal context, in spatial and relational proximity, integrated and centred on the needs of the inhabitants of a territory”, have not been evaluated, nor their attributes investigated for peripheries (Thiam et al., 2021). Specifically, research deficits and implementation tensions converge to compromise required community-based integrated care components, representing key challenges. First, there is a lack of research on effects of integrated care, including community-based, on service users (Baxter et al., 2018, 2020), and this is especially true for older people (Liljas et al., 2019). Second, in terms of a required care-mix balance, it is unknown whether current services address diverse needs across the care continuum in peripheries (Piroddi et al., 2022). Moreover, there is no understanding of how actors, including decision-makers, older people and their carers, value combinations of health, social, and other supports (housing; ICT; psychosocial) in peripheries (Yip et al., 2021). Thirdly, in terms of required governance, existing governance approaches lack local knowledge and older people’s voices in strategic decision-making, potentially reducing the relevance and successful implementation of community-based integrated care. Equitable collaborative models, that integrate diverse perspectives are rare, as are models that regulate the totality of peripheral ecosystems. Questions also remain about how to ensure resource allocation prioritises older people’s needs (WHO, 2025). Finally, in terms of required workforce development, current policies fail to adequately coordinate paid and unpaid care workforces, while supply and training issues undermine the integration of both workforces in peripheries.

Community-based integrated care implementation and innovation, thus, critically lack evidence, undermining the potential for spatially just community-based integrated care. This review aims to address this knowledge gap by synthesising international evidence on state-of-the-art strategies in community-based integrated care for older people in peripheral contexts. This systematic review forms part of the Context-Care project, which aims to co-produce an eco-system model for community-based integrated care for older people in peripheral places.

Review objectives

  • a) Examine international state-of-the-art research on local community-based integrated care strategies for older people, with a focus on the following four key areas:

    • 1) Strategies applied in, or best suited for, peripheral contexts (rural, shrinking small-town and intra-metropolitan areas) (context);

    • 2) Different types and level of integration of health and social care provision (care mix);

    • 3) Governance and organisation of community-based integrated care delivery ( governance);

    • 4) Integration and balance of formal and informal carers (workforce integration).

  • b) Assess outcomes of community-based integrated care strategies, regarding aspects such as (1) effectiveness of integration process (2) effectiveness of overall service delivery and (3) health and wellbeing outcomes for older people.

Methods

This systematic review and protocol will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Protocols (PRISMA-P) standardised reporting guidelines (Shamseer et al., 2015). In order to effectively capture evidence on the different focus areas of community-based integrated care strategy (context, care mix, governance, workforce integration) that may be evaluated using diverse methods, this systematic review will synthesise quantitative and qualitative evidence. A narrative synthesis approach will be employed, as per PRISMA and JBI guidelines (Popay et al., 2006; Stern et al., 2020). Details on the literature search and data synthesis are provided below.

Eligibility criteria for selection of publications

As the review aims to understand the different outcomes of existing community-based integrated care solutions, specific outcome measures will not be specified a priori. The review will examine outcomes related to quality and effectiveness of community-based integrated care strategies in terms of older people’s care experiences, service delivery and cost-effectiveness.

Search strategy

The following major databases in the fields of human medicine, nursing, and gerontology will be systematically searched:

  • • MEDLINE

  • • EMBASE

  • • Web of Science

  • • AgeLine

  • • CINAHL

  • • Overton

The review team will also consider additional empirical studies recommended by the CONTEXT-care national and international advisory experts. Articles known by the authors to be relevant will also be subject to manual reference list screening.

These databases were selected to ensure a balanced search across multi-disciplinary and specialist sources, given the ambiguous and diverse conceptualisations and components of integrated care for older populations. The search strategy was formulated using a combination of key search headings and terms on integrated care, community-level intervention, older populations, and adapted to match the appropriate syntax of each database. These search headings and terms were selected based on a review of literature on community-based integrated care for older people and related tests. The search strategy, presented in Table 2 below, was developed and finalised in consultation with the review team and a research support librarian. Table 1 below summarises the eligibility criteria for selection of publications.

Table 1. Summary of inclusion and exclusion criteria.

Inclusion and exclusion criteria for selection of publications
Inclusion criteria Studies published between 1 January 2016–May 2026.
Empirical studies on community-based integrated care for older people (older person defined as 65 years or older). Studies also including other age groups where outcomes are reported for older people.
Studies reporting on care experiences in primary and community healthcare settings.
Studies published in English.
Exclusion criteria Studies published outside of the date range January 2016–May 2026.
Studies not reporting on experiences of individuals aged 65 years and older.
Non-empirical studies.
Studies not explicitly referencing integrated care.
Studies not published in English.

Table 2. Search strategy.

Search strategy
Population Subject headings: “Aged”; “Older Adulthood”
Search terms: (Elderly or “Older adult*” or “Older people” or “Older person*” or Aged or Geriatric*) OR AB (Elderly or “Older adult*” or “Older people” or “Older person*” or Aged or Geriatric*)
AND
Intervention Subject headings: “Delivery of Health Care, Integrated; Integrated health care system; “Integrated Services”; “Continuity of Patient Care”; “Continuum of Care”
Search terms: “Integrated care” or “Multi-disciplinary care” or “Multidisciplinary care” or “Inter-disciplinary care” or “Interdisciplinary care” or “Co-ordinated care” or “Coordinated care” or “Care coordination” or “Care co-ordination” or “Collaborative care” or “Integrated delivery” or “Integrated health care” or “Integrated healthcare” or “Inter-agency care” or “Interagency care” or “continuity of care” AND
AND
Context Subject headings: ‘Primary Health Care’
Search terms: Community-based OR local* or community OR neighbourhood OR locality OR rural OR urban OR peripheral OR excluded
AND
Setting Primary and community care settings
Filters
Language English
Publication dates 2016–2026
Databases MEDLINE, CINAHL, EMBASE, Web of Science; AgeLine.
Timeframe April–June 2026
Field By title AND abstract
Keyword 1 (integrated care)Keyword 2 (community-based)Keyword 3 (older adults)
Integrated care OR integrated long-term care OR integrated health system(s) OR Coordinated/co-ordinated OR collaborative care OR OR multidisciplinary care OR Interdisciplinary care OR Integrated service deliveryCommunity-based OR local* or community OR neighbourhood OR locality OR rural OR urban OR peripheral OR excludedAged OR ag*ing OR old* people OR old* person OR elder* OR 65+ OR senior* OR later life OR geriatric* OR pensioner*

Study selection

Records obtained from the search will be uploaded to Endnote and screened using Rayyan. Duplicates will be removed, and articles will be screened and selected by two reviewers independently (SM and PJ). First, articles will be screened by abstract and title. Each reviewer will classify citations into three groups: ‘exclude’, ‘include’, and ‘unsure’. Any disagreements between the two reviewers will be discussed with and resolved by a third reviewer (KW). A pilot screening exercise will be conducted on a random sample of five studies. Two reviewers (SM and PJ) will independently screen the same five studies by title and abstract. The eligibility criteria will be clarified if not sufficiently clear. Subsequently, the reviewers will retrieve the full text of all ‘unsure’ and ‘include’ citations, and these will be screened by the two reviewers independently using the same eligibility criteria. Excluded papers will be further grouped under specific reasons for exclusion.

A Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow diagram will display the study selection process and summarise the inclusion and exclusion of studies at each stage of the review by providing reasons for exclusion.

Quality appraisal

A quality appraisal of all included studies will be conducted independently by the two researchers. Tools were selected according to studies’ methodologies. The Joanna Briggs Institute (JBI) tools for qualitative and quantitative research (Lockwood et al., 2015; Moola et al., 2020; Barker et al., 2023; Barker et al., 2024) and the Mixed Method Appraisal Tool (MMAT) (Hong et al., 2018) for mixed method studies will be applied. In the absence of specific tools for reviews, any included reviews will be subject to assessments consisting of questions concerning their methodologies, search strategies and analyses. The researchers will conduct the quality appraisal independently and discuss with the review team to compare and resolve any differences.

Data extraction and synthesis

Narrative synthesis will be employed in line with Cochrane guidelines, as a statistical approach or meta-analysis is not appropriate given the diversity in study designs and outcome measures (Higgins et al., 2024). Quantitative and qualitative data will be presented and described textually; quantitative results will be analysed for direction of effect rather than statistical analysis, to avoid any bias arising from the diversity in outcome measures and statistical methods used across the studies. The analysis will follow three steps. Firstly, a standardised data extraction form will be developed. Data will be extracted by three reviewers independently. Any discrepancies will be resolved through discussion with the entire review team as required. Secondly, convergent thematic analysis will be conducted on the extracted data, as per guidelines on narrative synthesis (Popay et al., 2006; Stern et al., 2020). Extracted data will be coded independently by two reviewers and common overarching themes with respect to community-based integrated care strategy and governance, outcomes, implementation, and context/place will be identified. Each reviewer will also independently identify themes under focus areas including care mix, governance, and workforce integration, as outlined below. Thirdly, data will be compared and discussed with the review team to establish the final broad themes.

The data extraction chart will be developed using Microsoft Excel, capturing the following data:

  • • Bibliographic information: authors, year of publication, country;

  • • Study design: Overall study design (Qualitative/quantitative/mixed methods), theoretical approach/conceptual framework, method of analysis;

  • • Study population: gender, age, sample size;

  • • Integrated care definition/ framework: operational definition/framework of (community-based) integrated care;

  • • Community-based integrated care strategy details: description and parameters of solutions, duration, delivery, stakeholders/care coordination strategy;

  • • Outcomes: Care experiences, assessment tools, service delivery and effectiveness, workforce;

  • • Implementation: Barriers and facilitators of implementation, service uptake;

  • • Place: Place type, characteristics of community/neighbourhood;

  • • Peripheral contexts: challenges, opportunities specific to peripheral contexts and processes;

  • • Care mix: Type/level of integration of health and social care provision;

  • • Governance: governance structure and coordination of community-based integrated care delivery;

  • • Workforce integration: Integration and mix of formal and informal carers;

  • • Scale: geographic scale of application of strategy;

  • • Digitalisation: digital components of the community-based integrated care strategies;

  • • Dissonance: evidence or discussion of dissonance of community-based integrated care strategies, e.g. divergence between local meso-level practice and higher-level goals, and the divergences within peripheries between older people, unpaid-care workforces and professionals.

Discussion

This systematic review will synthesise available empirical evidence to describe the effectiveness of community-based integrated health and social care strategies and outcomes for older people living in peripheral contexts, as well as challenges encountered in this provision. This will inform future research, addressing knowledge gaps on i) the effects of integrated care on service users, including older adults; ii) the components and strategies which make up integrated care for older people; and iii) community-based integrated care strategies which integrate health and social care provision for peripheries and older people living in these areas.

Ethical consideration and dissemination

Formal ethical approval is not required for this systematic review as all included data included are anonymous secondary data. This systematic review will adhere to the PRISMA standardised reporting guidelines. It will be published in a peer-reviewed journal and disseminated through the Irish Centre of Social Gerontology, University of Galway.

Data availability statement

This protocol has been uploaded to Prospero registry and allocated Prospero registration no.: 1378235 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420261378235), along with the requisite PRISMA checklist for use with protocol submissions. The PRISMA checklist for systematic review protocols has also been uploaded to Zenodo https://doi.org/10.5281/zenodo.20275395 (Murphy et al., 2026). No datasets were generated or analysed during the current study. All extracted data arising from this systematic review will be presented in the form of a data extraction chart, as per PRISMA reporting guidelines and will be made publicly available in the form of publication.

Creative Commons Zero v1.0 Universal.

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Murphy S, Joseph P and Walsh K. Community-based integrated care for older people living in peripheral contexts: A systematic review of the evidence [version 1; peer review: awaiting peer review]. HRB Open Res 2026, 9:61 (https://doi.org/10.12688/hrbopenres.14466.1)
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