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.

Aims: The aim of this study was to identify factors influencing midwives’ conversations about smoking, and referral to specialist smoking cessation services, using an evidence-based theoretical framework. Methods: Semi-structured, qualitative interviews were undertaken with community midwives employed within one health board region of Wales. Deductive framework analysis was employed by coding data to the domains of the Theoretical Domains Framework (TDF) and then identifying themes within domains and across participants. Results: Seven midwives took part in the study. 13, out of a possible 14 domains, were mapped from the TDF. Key enablers to conversations and referrals include knowledge of the risks of smoking in pregnancy, congruence with the professional identity of a midwife, and the use of carbon monoxide monitors in initiating conversations and referrals. Limited knowledge of the specialist service, confusion about the opt-out pathway, varied skills in communicating and engaging with women, low confidence in ability to influence women’s decisions, limited appointment times, and competing priorities were identified as barriers. Conclusion: Midwives recognise the importance of their role within the provision of smoking cessation advice and referral to specialist services. While there are continued time pressures and competing priorities for midwives, enhancing skills and confidence in collaborative, empowering approaches to addressing smoking would further support in optimising the uptake of maternity smoking cessation support. This could also enhance conversations about other public health issues such diet, physical activity, and alcohol use.

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.