BACKGROUND:
Care pathways (CPs) for type 2 diabetes are widely adopted to improve quality, equity, and continuity of chronic care. However, their effectiveness depends on alignment between pathway design, workforce competencies, and organizational context. Gaps between intended and actual implementation highlight the need for tools that capture behavioural, educational, and structural determinants influencing professional practice, particularly in integrated primary care models.

METHODS:
A cross-sectional survey grounded in the Theoretical Domains Framework (TDF) was administered to 445 general practitioners (GPs) within the “Euganea” Local Health and Social Care Authority (Padua, Veneto, Italy), with 142 responses collected. The validated instrument assessed determinants of CP implementation across different organizational settings, comparing GPs working in integrated medical groups (IMGs) with those in other practice arrangements. Psychometric analyses evaluated internal consistency and discriminant validity. Quantitative findings were triangulated with qualitative analysis of open-ended responses and simulated organizational audits using a structured checklist.

RESULTS:
The survey demonstrated good reliability (Cronbach’s α 0.78–0.79) and strong discriminant validity (p=0.0031). GPs working in IMGs reported significantly higher CP implementation scores than peers in non-integrated settings (15.9 vs. 13.6), indicating better organizational readiness and professional alignment. While knowledge of integrated care principles and intention to adhere to CPs were high, major barriers emerged in environmental context and resources, including limited digital infrastructure, unclear role delineation, and insufficient skill mix. Qualitative data highlighted unmet needs for targeted training, competency mapping, and stronger employer engagement to support multidisciplinary collaboration and reduce administrative burden.

CONCLUSIONS:
This study provides a robust, theory-informed tool to assess workforce-related barriers to CP implementation in primary care. Integrating behavioural assessment with auditing and performance monitoring supports workforce planning, competency-based education, and organizational learning. Applied to emerging community-based care models, this approach can guide professionalisation strategies, strengthen employer engagement, and promote sustainable, equitable chronic care delivery across health systems.