Assessing readiness and maturity for integrated care implementation in Saudi Arabia: a convergent mixed methods study

Abstract Background Integrated care (IC) aims to reduce fragmentation across services, providers, and care pathways and to improve person-centered, coordinated delivery, yet translating IC into practice remains challenging. Few mixed methods studies have examined implementation maturity together with the organizational and leadership conditions shaping it. This study assessed IC maturity across four health clusters in three regions of Saudi Arabia, explored leaders' perceptions of barriers and facilitators, and examined how maturity scores aligned with those perspectives. Methods A convergent parallel mixed methods design was used, with data collected concurrently from September 2024 to March 2025. IC maturity was measured with the Scaling Integrated Care in Context (SCIROCCO) self-assessment tool, completed by 119 of the 200 leaders approached (total-population sampling of eligible cluster and primary health care [PHC] leaders; 60% response), and analyzed with descriptive statistics and multivariable linear regression. Semi-structured interviews with 11 cluster and PHC leaders were examined using thematic analysis, and the two strands were integrated through a joint display to generate meta-inferences. Results Overall IC maturity was moderate, with all 12 domains in the moderate band (mean total 34.9/60). Ratings were highest for breadth of ambition, evaluation methods, and standardization and simplification, and lowest for funding, innovation management, and removal of inhibitors. In multivariable analysis, both the presence of a formal IC unit (B = 5.2, 95% CI [0.7, 9.6]) and higher self-rated IC knowledge (B = 1.9 per point, 95% CI [0.8, 3.0]) were independently associated with higher maturity, whereas differences across clusters were not statistically significant. The knowledge association was specific to IC and robust across specifications. Qualitatively, policy reforms, digital initiatives, and prevention-oriented approaches were key facilitators, while persistent barriers included staffing shortages, limited financial flexibility, limited PHC involvement in pathway design, weak communication, and poor interoperability. Conclusions IC maturity was associated with both formal organizational structures, notably dedicated IC units, and leaders' self-rated knowledge of IC, alongside the alignment of governance, financing, workforce, and information systems with routine practice. These findings suggest that greater cluster-level financial autonomy, empowering PHC leaders in pathway design, building workforce capacity, and advancing interoperable health records may be important enabling conditions for translating IC into person-centered, coordinated care.