Interventions aiming to change multiple healthcare professional behaviors: A systematic review

Healthcare professionals' (HCPs) routinely engage in multiple different clinical actions. We aimed to identify and synthesize the characteristics of multiple behavior change interventions in HCPs.

Five electronic databases were searched up to June 2025 for randomized trials of interventions aiming to change more than one clinical behavior, including behavior change advice. Two reviewers independently screened and extracted 20 % of the data. Quality was assessed using Cochrane's Risk of Bias 2 tool and content of interventions was coded using Behavior Change Ontologies. Evidence was narratively synthesized.

Seventeen studies were included, most targeting physicians. Clinical behaviors varied in type and specificity and were inductively categorized into seven upper-level domains: 'provision of behavior change advice', 'screening/assessment/measurement', 'prescription of medication', 'referrals', 'treatment', 'diagnosis' and 'medical history taking'. Interventions were mostly brief (median = 5 days) and delivered through a combination of face-to-face and at-a-distance modes of delivery (41 %) and in group settings (47 %). Only 3 trials reported using theory to inform intervention development (18 %). Each intervention used at least one behavior change technique (BCT; 22 BCTs identified). The most frequent BCTs were 'set behavior goal' (90 %), 'add objects to the environment' and 'present information from credible influence'(63 % each).

Current interventions are highly heterogeneous in the clinical behaviors targeted for change and approaches to their measurement. Greater recognition of the multiple behavior nature of such interventions, and on reporting their content accordingly, may contribute to understanding whether and how best to intervene on more than one clinical behavior.

PROSPERO (CRD42022327108) and Open Science Framework (https://osf.io/g7mwf/files/yfqrt).