Advancing dementia-friendly hospital care: a systematic review of healthcare professionals' reported barriers and facilitators using the theoretical domains framework.

BACKGROUND

People living with dementia are common in hospitals and often experience poorer outcomes, yet dementia-friendly hospital care (DFHC) is not consistently embedded in routine practice. A theory-informed synthesis of healthcare professionals' reported barriers and facilitators is needed to guide implementation.

OBJECTIVES

To synthesise healthcare professionals' reported barriers and facilitators to DFHC using the Theoretical Domains Framework (TDF).

METHODS

We conducted a systematic review of peer-reviewed studies published between 2015 and 2025. MEDLINE, CINAHL, PsycINFO and EMBASE were searched, with citation tracking. Eligible studies reported staff-reported barriers and/or facilitators relevant to DFHC in hospital settings. Two reviewers independently screened, extracted and appraised studies using the Mixed Methods Appraisal Tool. Determinants were classified as barriers or facilitators and mapped to TDF domains; recurrent cross-domain bundles were identified inductively. The review was registered in PROSPERO (CRD420251085854).

RESULTS

Sixty-five studies were included. Methodological quality was generally high. We coded 856 determinants: 455 barriers and 401 facilitators. Barriers were most commonly mapped to Environmental Context and Resources (14.1%), Knowledge (12.5%) and Social Influences (11.0%). Facilitators clustered mainly in Social Influences (15.2%), Environmental Context and Resources (15.0%), and Knowledge (14.2%). Recurrent barrier bundles reflected system pressures, capability gaps and social and cultural barriers; recurrent facilitator bundles reflected leadership, experiential education, interprofessional teamwork and workflow conditions that support person-centred care.

CONCLUSION

DFHC is shaped by interacting structural, social, staff-capability and workflow conditions that do not operate in isolation. Progress will likely require multi-level, multi-component implementation strategies embedded across hospital systems, not stand-alone interventions.