Primary care providers’ perspectives on the implementation of couple-based collaborative management for Chinese older adults with type 2 diabetes: a mixed-methods study

Background: Couple-based collaborative management (CCMM) has shown promise in supporting chronic disease self-management among older adults and addressing the growing public health burden, but its integration into primary care remains uncertain. This study explored primary care providers' (PCPs) perceptions of CCMM using normalization process theory (NPT) to identify key factors influencing its routine implementation. Methods: Thirty five PCPs involved in a community-based randomized controlled trial completed the Normalization Measure Development (NoMAD) questionnaire. Descriptive statistics and Cronbach's alpha were used to assess quantitative data. Semi-structured interviews were conducted with five purposively selected PCPs and were analyzed thematically according to NPT constructs. Results: PCPs reported high familiarity with CCMM (mean = 8.03, SD = 1.36) and positive views regarding its potential integration into practice. Mean scores for the four NPT constructs ranged from 1.76 to 2.47, and internal consistency of the NoMAD was strong (Cronbach's alpha = 0.94). PCPs recognized CCMM as distinct from usual practice and valued its relevance (coherence), which encouraged engagement (cognitive participation). However, barriers included heavy workloads, staff shortages, limited confidence in some clinical tasks, challenges in sustaining continuity, and concerns about patient adherence and couple relationships. These factors hindered collective action and reflexive monitoring. Conclusion: PCPs understood and supported CCMM conceptually and expressed willingness to adopt it, yet structural and organizational barriers limited its practical implementation. Implementing CCMM in primary care could improve chronic disease management and promote healthy aging. Addressing workload pressures, enhancing provider training, and ensuring continuity will be essential to normalize CCMM in primary care.