JOURNAL OF PUBLIC HEALTH AND DISEASES
Integrity Research Journals
ISSN: 2705-2214
Model: Open Access/Peer Reviewed
DOI: 10.31248/JPHD
Start Year: 2018
Email: jphd@integrityresjournals.org
Facilitators and behavioural barriers to the uptake and sustained use of malaria prevention interventions in Sub-Saharan Africa: A Mixed-Methods Systematic Review
https://doi.org/10.31248/JPHD2025.192 | Article Number: 818D84131 | Vol.8 (4) - October 2026
Received Date: 28 August 2026 | Accepted Date: 24 September 2026 | Published Date: 30 October 2026
Authors: Ifeyinwa Ogechi Chukwukwe* , Oluchi Ndidi Ekwufulem , Tochukwu Favour Chikezie , Clement Abah Alexander , Kelechi Chikezie , Victoria Ndidi Uwanuruochi and Amarachukwu Faith Okafor
Keywords: health behaviour, Barriers and facilitators, COM-B, intervention adoption, health intervention adherence, implementation science, malaria prevention.
Malaria prevention requires that those eligible to receive it get it, accept it, use it properly, complete it and keep it up. Evidence on these behaviours is scattered across interventions, settings and study designs. This mixed-methods systematic review identified and synthesised individual, perceptual, interpersonal, household, community, economic, health-system and structural determinants of actual malaria-prevention behaviour in Sub-Saharan Africa and examined evaluated implementation strategies. PubMed/MEDLINE, African Journals Online, Global Index Medicus, Cochrane CENTRAL, OpenAlex, APA PsycINFO, ClinicalTrials.gov and Google Scholar were searched without date or language restrictions on 15 and 16 July 2026, and reference lists were scanned. Eligible reports measured an actual or consequential prevention behaviour, at least one determinant and an empirical determinant–behaviour connection. Risk of bias was assessed with design-specific tools, and quantitative and qualitative findings were synthesised separately and integrated through a joint display with COM-B and ecological-level mapping. After removal of duplicates, 19,517 records remained for title and abstract screening; 1,124 full-text reports were assessed. All data included resulted from 69 unique studies conducted in 25 countries, with 47 studies focusing on insecticide-treated nets or long-lasting insecticidal nets. The following factors were associated with uptake and continuity: intervention-specific knowledge, self-efficacy, perceived effectiveness and safety, trust, comfort of the product, household support, costs, geographical access, commodity availability, provider behaviour and delivery reliability. Facilitators included door-to-door delivery, free provision, service integration, practical demonstrations, trusted counselling and follow-up. Self-reported data was the predominant type of evidence collected, and behaviour lasting longer than a single day or night was less commonly assessed than current or previous-night use. In conclusion, malaria-prevention behaviour reflects co-occurring determinants of capability, opportunity, and motivation across individual, household, community, and service-delivery levels. Programmes should measure actual and continued behaviour, not just the distribution or ownership of commodities.
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