Traditional approaches to changing health behaviours have primarily focused on education and raising awareness, assuming that increased knowledge leads to better decisions. However, evidence suggests these methods often fail to result in sustained behavioural change. The dual-process theory of decision-making highlights that much of our behaviour is driven by automatic, intuitive processes, which educational interventions typically overlook. Compounding this challenge, behavioural research is often conducted on small groups, making it difficult to scale insights into broader societal issues, where behaviour is influenced by complex, interconnected factors. This review advocates for integrating behavioural science with systems approaches (including systems thinking and approaches to complex adaptive systems) as a more effective approach to resolving complex societal issues, such as public health, sustainability, and social equity. Behavioural science provides insights into individual decision-making, while systems approaches offer ways of understanding, and working with, the dynamic interactions and feedback loops within complex systems. The review explores the commonalities and differences between these two approaches, highlighting areas where they complement one another. Design thinking is identified as a useful structure for bridging behavioural science and systems thinking, enabling a more holistic approach to problem-solving. Though some ideological challenges remain, the potential for creating more effective, scalable solutions is significant. By leveraging the strengths of both behavioural science and systems thinking, one can create more comprehensive strategies to address the “wicked problems” that shape societal health and well-being.

Within the context of reopening society in the summer of 2021, as the UK moved away from ‘lockdowns’, the Government of Wales piloted the return of organized ‘mass gatherings’ of people at a number of test events. The current study reports behavioral observations that were made at two of the test events to inform this process. The researchers were particularly interested in four key factors: how (1) context within a venue, (2) environmental design, (3) staffing and social norms, and (4) time across an event, affected the personal protective behaviors of social distancing and face-covering use. Data collection was undertaken by trained observers. Adherence to protective behaviors was generally high, but there is clear evidence that these behaviors were shaped in a systematic way by the environment, situational cues, and the passage of time during the events. Some instances of large-scale non-adherence to personal protective behaviors were documented. An analysis within a dual-process framework suggests ways to understand and respond to supporting target health behaviors in groups of people where intervention is deemed valuable, such as in complex or ambiguous contexts. This is one of the first studies to include a ‘true’ behavioral measure in understanding human responses to COVID-19. It demonstrates that behavioral observations can add precision and granularity to understanding human behavior in complex real-world contexts. Given the significant physical and mental health burden created acutely and chronically by COVID-19, this work has implications for how governments and organizations support target populations in other complex challenges facing us today, such as in sustainability, and healthy lifestyle behaviors. An individual’s intentions are not always matched by their actions, and so the findings support a balanced liberal paternalistic approach where system-level changes support appropriate individual-level decisions to engender collective responsibility and action.

Contact tracing is one of the key public health response actions to control the outbreak of a novel virus. This paper describes the preparation process, activation and operational experience for contact tracing of individuals in response to confirmed COVID-19 cases in Wales. A descriptive approach has been adopted and lessons learned from our initial public health response to COVID-19 will be used to develop a new operational model for contact tracing in Wales. As part of preparations for the response in Wales, Public Health Wales formed a Contact Tracing Cell (CTC) ready to be mobilised in the event of a confirmed case. Trial activation of the CTC during the preparation period helped to resolve some issues before ‘real’ activation. A highly flexible approach was needed due to the constant changes to the guidance that required rapid understanding, updates to pathways and clear communication to contact tracers. Our experience and recommendations may benefit future efforts to control the spread of the virus in Wales and elsewhere, particularly in supporting COVID-19 outbreaks in enclosed settings such as care homes or in geographically localised areas. Learning from the initial public health response to COVID-19 will guide the delivery and implementation of a new contact tracing model as we move to a later stage of the pandemic when containment measures become feasible in localised outbreaks. This may include scaling-up the CTC to mobilise contact tracers to local teams and the potential use of digital technologies to support the next operational model of the CTC in Wales.

There are concerns that the growing popularity of e-cigarettes promotes experimentation among children. Given the influence of the early years on attitude and habit formation, better understanding of how younger children perceive vaping before experimentation begins is needed, to prevent uptake and inform tobacco control strategies. We explored Welsh primary schoolchildren’s (aged 7–11) awareness of e-cigarettes relative to tobacco smoking, their understanding of the perceived risks and benefits and their intentions and beliefs about vaping. Data was collected using a mix of methods in June and July 2017 from 8 purposively selected primary schools across Wales. Four hundred and ninety-five children (52% female) aged 7 years (n = 165), 9 years (n = 185) and 11 years (n = 145) completed a class-administered booklet encompassing a draw and write exercise and survey. Ninety-six children participated in 24 peer discussion groups comprised of 2 boys and 2 girls from each year group. Data were analysed independently and findings triangulated. Survey analyses used frequencies, descriptive statistics and chi-squared tests. Content analysis was undertaken on the draw and write data and peer discussion groups were analysed thematically. Study findings highlight that primary schoolchildren have general awareness of e-cigarettes. Vaping was perceived to be healthier than smoking and there was some recognition that e-cigarettes were used for smoking cessation. Understanding of any health harms was limited. Few children intended to smoke or vape in the future but almost half thought it was okay for grownups. Children’s perceptions were influenced by exposure through family and friends. Findings suggest a need for e-cigarette education in primary schools, to highlight the associated risks of e-cigarette experimentation including the potential for tobacco initiation.

Traditional approaches to changing health behaviors have primarily focused on education and raising awareness, assuming that increased knowledge leads to better decisions. However, evidence suggests these methods often fail to result in sustained behavioral change. The dual-process theory of decision-making highlights that much of our behavior is driven by automatic, intuitive processes, which educational interventions typically overlook. Compounding this challenge, behavioral research is often conducted on small groups, making it difficult to scale insights to broader societal issues, where behavior is influenced by complex, interconnected factors. This review advocates for integrating behavioral science with systems approaches (including systems thinking and approaches to complex adaptive systems) as a more effective approach to resolving complex societal issues, such as public health, sustainability, and social equity. Behavioral science provides insights into individual decision-making, while systems approaches offer ways of un-derstanding, and working with, the dynamic interactions and feedback loops within complex systems. The review explores the commonalities and differences between these two approaches, highlighting areas where they complement one another. Design thinking is identified as a useful structure for bridging behavioral science and systems thinking, enabling a more holistic approach to problem-solving. Though some ideological challenges remain, the potential for creating more effective, scalable solutions is signif-icant. By leveraging the strengths of both behavioral science and systems thinking, one can create more comprehensive strategies to address the “wicked problems” that shape societal health and well-being.