Experiences and Implementation of Patient-initiated follow-up implementation for chronic conditions: A qualitative evidence synthesis protocol.

Background The burden of chronic conditions has been growing worldwide. These conditions put an enormous pressure on health systems, communities and patients due to the daily management and close follow-up they require. Additionally, the COVID-19 pandemic severely disrupted routine care for people with chronic conditions, creating and expanding a need to explore new digital or hybrid care models with very little time and preparation. Patient-initiated follow up (PIFU) is an increasingly popular model for providing healthcare, especially for patients whose condition require follow-up over a prolonged period. PIFU holds the promise of more efficient health services and patient empowerment, including in the context of health emergencies. While this complex intervention has grown in popularity for chronic disease management, there is considerable variation in its implementation across health conditions, care settings, and patient groups. These differences and their implications for the design and delivery of PIFU approaches are poorly understood. Existing literature found mixed results in the experience of patients under PIFU approaches while the views and experiences of health professionals and other stakeholders have been comparatively less explored. As PIFU approaches are being adopted more widely, it is essential to better understand how stakeholders view, experience and deliver these approaches in order to better understand the factors affecting PIFU’s implementation, including as an approach for sustaining routine care during health emergencies. This qualitative evidence synthesis links to a systematic review assessing the effects of patient-initiated follow-up for diabetes care (PROSPERO registration number 1331488) (Bogale et al., 2026). Objectives (1) To inform the design, delivery and use of future PIFU approaches for chronic conditions by exploring the views, experiences and practices of patients enrolled in PIFU, their relatives, and healthcare workers, managers and other professionals involved in providing PIFU services for people with chronic conditions. (2) To explore differences between PIFU under normal circumstances and PIFU in times of health emergencies. Search methods We will search the electronic databases MEDLINE, CINAHL Complete, EMBASE, Web of Science, AJOL and ProQuest Dissertations and Theses for studies published since 1995. We will conduct a grey literature search in Google. We will conduct a cited reference search for all included studies in Paperfetcher. Selection criteria We will include primary qualitative studies on stakeholders’ views, experiences and practices regarding PIFU approaches for chronic conditions (apart from cancer). Stakeholders include adult patients living with one or more chronic conditions managed through a PIFU approach, their relatives, healthcare workers and managers involved in PIFU services, and other support staff involved in these services. We will include studies from any country and in any settings where PIFU is received or delivered. We will not exclude studies on the basis of language. Data collection and analysis We will use a framework analysis approach for data extraction and synthesis using NVivo15. We will assess methodological limitations using CASP, unless the beta version of CAMELOT in iSoQ becomes available before our extraction begins. We will use the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach in iSoQ to assess our confidence in each finding. We will examine each review finding to identify factors that may influence intervention implementation and developed implications for practice and for emergency preparedness.