Barriers and Facilitators to Integrating Traditional Chinese Medicine into Primary Healthcare in Singapore: A Systematic Review Protocol

Background: The integration of Traditional Chinese Medicine (TCM) into primary healthcare systems represents a significant opportunity to enhance healthcare delivery in multicultural societies. Singapore's unique position as a modern healthcare hub with deep cultural roots in traditional medicine provides an important context for examining this integration process. Objective: To systematically identify, evaluate, and synthesize evidence regarding barriers and facilitators affecting TCM integration into Singapore's primary healthcare system through a comprehensive mixed-methods systematic review. Methods: This systematic review protocol follows PRISMA-P guidelines and employs a mixed-methods approach. Database searches will include PubMed, Scopus, Web of Science, CINAHL, AMED, Singapore Medical Journal archives, and Chinese medicine databases (CNKI, Wanfang Data) from inception to December 2025. No language restrictions will be applied. Study selection and data extraction will be conducted by two independent reviewers using Covidence systematic review software. Quality assessment will utilize the Mixed Methods Appraisal Tool (MMAT) for diverse study designs, with additional tools (CASP checklists, GRADE-CERQual) applied as appropriate. Data Synthesis: A convergent integrated approach will combine narrative synthesis with framework analysis. The Consolidated Framework for Implementation Research (CFIR) will guide the organization and interpretation of barriers and facilitators across five domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. Quantitative findings will be synthesized narratively, while qualitative data will undergo thematic synthesis. Integration will occur through triangulation protocols and matrix mapping. Expected Outcomes: Comprehensive mapping of multi-level barriers and facilitators, identification of evidence gaps, development of a conceptual framework for TCM integration, and evidence-based recommendations for policy and practice in Singapore's healthcare system.