Applying Behavioural Theory in Diverse Healthcare Contexts: A Systematic Review and Narrative Synthesis

Psychological and behavioural theories are widely used to inform interventions aimed at changing healthcare practitioner behaviour. Organisational, cultural and resource contexts may influence how these theories are applied, with implications for implementation feasibility. This review examined the use of behavioural theory across healthcare settings, with particular attention to hierarchy, uncertainty and feasibility. A systematic review with narrative synthesis was conducted of 137 empirical studies published between January 2018 and January 2024. Included studies applied psychological or behavioural theory to healthcare practitioner behaviour across international settings. Hofstede’s cultural dimensions of power distance and uncertainty avoidance were used as an interpretive lens for cross-contextual analysis. Data were extracted on theory use, target behaviour, professional group and cultural contextual influences. The Theoretical Domains Framework, Behaviour Change Wheel, and COM-B model featured in 86% of studies. Hierarchy, authority and social influence were evident across cultural configurations, although their form and salience varied between settings. Procedural clarity and formalised approaches were salient in higher uncertainty-avoidance contexts. These patterns interacted with organisational and material conditions. Material constraints, particularly in low- and middle-income contexts, affected implementation feasibility. Theory nevertheless supported systematic identification of barriers and tailoring of implementation strategies. Behavioural frameworks provide a systematic means of identifying influences on healthcare practitioner behaviour, but identifying determinants does not establish their local meaning, relative importance or implications for implementation. Greater attention to cultural, organisational and material context may strengthen the application of behavioural theory across diverse healthcare settings.