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Sustainable Change Sequence: A framework for developing behavior change interventions for patients with long-term conditions

Glyn Elwyn, Katy Marrin, Dominick L Frosch, James White



Interactive interventions are increasingly advocated to support behavior change for patients who have long-term conditions. Such interventions are most likely to achieve behavior change when they are based on appropriate theoretical frameworks. Developers of interventions are faced with a diverse set of behavioral theories that do not specifically address intervention development. The aim of our work was to develop a framework to guide the developers of interactive healthcare interventions that was derived from relevant theory, and which guided developers towards appropriate behavior change techniques.


We reviewed theories that inform behavior change interventions, where relevant to the management of long-term conditions. Theoretical constructs and behavior change techniques were grouped according to similarity in aims.


We developed a logic model that operationalizes behavior change theories and techniques into five steps likely to lead to sustained behavior change. The steps are: 1) create awareness of need; 2) facilitate learning; 3) enhance motivation; 4) prompt behaviour change; and 5) ensure sustainability of behaviour change.

Conclusion and Practice implications

A framework that sequences behavioural change techniques along a sustainability model provides a practical template for the developers of interactive healthcare applications and interventions.


Behavioral medicine, chronic illness, logic model, long term conditions, person-centered healthcare self-management interventions

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