Abstract
Malaria remains a major public health challenge. Intervention effectiveness is heavily mediated by human behaviour. This review synthesizes evidence on how behavioural factors influence the uptake, use, and impact of malaria interventions in endemic regions. We conducted a systematic review of studies (2000-2025) from PubMed, Google Scholar, Dimensions, and HINARI. Using the PEO framework, we included studies on behavioural factors and intervention effectiveness from endemic regions. Quality was assessed with CASP checklists; narrative synthesis was guided by behavioural theory. A total of 59 studies were included. Evidence was concentrated in sub-Saharan Africa (83%), with mostly cross-sectional designs (63%). Most studies (85%) exhibited a low risk of bias. Key themes studied were: (i) ITN use: ownership-use gap due to discomfort and misconceptions; (ii) Healthcare-seeking: delays and alternative care shaped by cost, access, trust; and (iii) Trust: distrust diverts care to informal providers. Protective determinants such as knowledge, perceived severity, and affordability were identified, whereas risk-enhancing determinants included discomfort, health system constraints, and perceived ineffectiveness. The findings indicate that malaria intervention effectiveness is fundamentally contingent on human behaviour. Technical strategies must address experiential barriers, build trust, and be locally tailored. Integrating behavioural insights is essential for sustainable control.