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Unhealthy lifestyle behaviours underlie both conditions. The Multimodal Lifestyle Intervention (MLI) LEEF integrates physical activity, nutrition, and behavioural strategies, tailored to motivational challenges common in depression, offering a dual focus on mental and physical health. However, unpublished process data revealed very limited referral to MLI\u2011LEEF from both primary and secondary care, and consequently low initiation rates, signalling clear implementation challenges. This study addresses this gap by translating prioritised implementation determinants into conceptually and empirically grounded implementation strategies and examining what works, how, and under which conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This quasi\u2011experimental, explanatory sequential mixed\u2011methods study will implement MLI\u2011LEEF across ten general practices and three secondary mental health care outpatient clinics in the Northern Netherlands. Implementation strategies will be developed and tailored using Causal Pathway Diagramming and applied over a six\u2011month period. Quantitative data will be collected before, during, and after implementation to assess proximal implementation outcomes (the immediate, observable effects of an implementation strategy), distal implementation outcomes (adoption and sustainability), service\u2011level penetration, and patient outcomes. Following the implementation period, semi\u2011structured interviews will be conducted with referrers from each participating organisation. Site\u2011specific topic guides, informed by each organisation\u2019s implementation plan, causal pathway diagrams, and quantitative implementation outcomes, will probe how strategies generate change (mechanisms), how they influence targeted determinants, and which contextual conditions (preconditions, moderators) shape implementation strategy functioning.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This study will respond to fieldwide calls in implementation science for rigorous, transparent, and context-sensitive approaches to developing and evaluating implementation strategies. By examining how strategies shape referral and initiation in routine general practice and specialist mental health services, and by clarifying the mechanisms and contextual conditions under which they are effective, the study will generate actionable insight into why implementation succeeds or falters in real-world care. These insights will provide essential groundwork for strengthening the reach and adoption of MLI-LEEF and will offer transferable guidance for embedding multimodal lifestyle interventions into everyday care, while advancing generalizable knowledge of how implementation strategies produce change.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>10.17605\/OSF.IO\/XJHCB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43058-026-01031-9","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T10:13:38Z","timestamp":1782814418000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing a multimodal lifestyle intervention for depression and overweight in primary and secondary care: protocol for an implementation study exploring what works, how, and under what conditions"],"prefix":"10.1186","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9443-8211","authenticated-orcid":false,"given":"Sven J.G.","family":"Geelen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nienke","family":"Paauwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie M. van","family":"Zonneveld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huibert","family":"Burger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolette","family":"Moes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maartje","family":"Hofman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dani\u00eblle C.","family":"Cath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nynke D.","family":"Scherpbier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk E.M.","family":"Willems","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"issue":"4","key":"1031_CR1","first-page":"33","volume":"3","author":"T Singh","year":"2006","unstructured":"Singh T, Williams K. 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BMJ: Br Med J. 2015;350:h1258.","journal-title":"BMJ: Br Med J"}],"container-title":["Implementation Science Communications"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s43058-026-01031-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43058-026-01031-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s43058-026-01031-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:50:08Z","timestamp":1789685408000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s43058-026-01031-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,30]]},"references-count":50,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["1031"],"URL":"https:\/\/doi.org\/10.1186\/s43058-026-01031-9","relation":{},"ISSN":["2662-2211"],"issn-type":[{"value":"2662-2211","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,30]]},"assertion":[{"value":"1 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All study procedures will be conducted in accordance with relevant guidelines and regulations including the Declaration of Helsinki. The Medical Ethics Review Committee (METC) of the University Medical Center Groningen (UMCG) has assessed this study and determined it is not subject to the Medical Scientific Research Act (WMO) [2024\/665] date 12-12-2024 and [2025\/277] date 09-05-2025. Patients referred to MLI\u2011LEEF will be informed about the study and asked to provide written informed consent for the use of their routine clinical data for research purposes. Only data from patients who have provided consent will be included in the analyses. All participating healthcare professionals, both in general practice and in SMHC outpatient clinics, will be asked to provide informed consent for participation in the study\u2019s quantitative components (e.g., surveys, adoption grade) as well as its qualitative components (e.g., interviews, focus groups, reflective logs). Participation is voluntary, and professionals may withdraw at any time without consequences for their role within the organisation or the implementation process.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"190"}}