Exploring barriers to and facilitators of the implementation of community-based rehabilitation service delivery for severe mental illness using the consolidated framework for implementation research (CFIR): a qualitative study

Background: Community-based rehabilitation (CBR) services are crucial for improving the prognosis of people with severe mental illness (SMI) in China and other developing countries. However, these services face limitations and a lack of stakeholders’ insights. This study examines the barriers and facilitators to implementing CBR services for people with SMI in China to inform future improvements.

Methods: This study employed a descriptive qualitative design guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were conducted with 32 stakeholders (16 mental health practitioners, 11 people with SMI, and 5 family caregivers) to explore their perceptions of factors influencing the implementation of CBR services for people with SMI. The interview data were analyzed and reported using the updated CFIR, with MAXQDA 2022 software facilitating the analysis process.

Results: Within the CFIR, the following key constructs were identified as critical to CBR services implementation for people with SMI: (1) innovation—considering the evidence base, complexity, and cost of the intervention; (2) outer setting—encompassing critical incidents, local attitudes and conditions, partnerships and connections, policies and laws, financing, and external Pressure; (3) inner setting—reflecting structural characteristics, relational connections, communications, and culture; (4) individuals—encompassing both innovation deliverers and recipients; (5) process—focusing on assessing needs and engaging stakeholders.

Conclusions: Implementing sustainable and effective CBR services for people with SMI in China and similar settings requires early stakeholder involvement and attention to several key factors. These include a robust evidence base, readily accessible and standardized CBR services, enhanced training and team development for service providers, precise service needs assessment, active community engagement, and sustained policy and financial support.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-025-13052-6.