Sustaining values-driven innovation in primary healthcare: a protocol for identifying implementation strategies for long-term impact (longitudinal participatory study)

BACKGROUND: Responding to system pressures, fragmentation, and growing project fatigue in primary care, this study examines how values-driven innovations (VDIs) can be successfully embedded and sustained by (1) defining what constitutes a values-driven innovation, (2) identifying strategies and mechanisms that support long-term implementation, and (3) co-developing evidence-based sustainability indicators with stakeholders. By integrating four complementary theoretical frameworks and examining the full lifecycle from conceptualization to long-term sustainment, it generates actionable insights to strengthen enduring, values-based transformation in primary care. METHODS AND ANALYSIS: This study uses a longitudinal, theory-informed, multi-stakeholder design. Over three years, we follow selected VDIs from conceptualization through long-term sustainment, using multiple data sources and repeated timepoints to capture dynamic implementation processes. An integrated conceptual framework: combining realist evaluation, the Dynamic Sustainability Framework, Consolidated Framework for Implementation Research, and Normalization Process Theory, guides all phases. The three-phase design includes: (1) defining VDI and mapping the innovation landscape; (2) conducting longitudinal case studies using document analysis, serial interviews, and questionnaires; and (3) co-creating an actionable sustainability model and monitoring indicators with stakeholders. Continuous reflexive practice, triangulation, and participatory engagement ensure rigor and relevance. DISCUSSION: Despite the analytical complexity of using multiple frameworks, this integration provides a comprehensive understanding of sustainability and contextual adaptation in primary care. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of the University of Antwerp (reference number 2025-7124).