JMIR Publications

ABSTRACT

Digital behavior change interventions (DBCIs), including smartphone applications, wearable devices, and AI-driven adaptive systems, have become a dominant approach for promoting changes in health-related behavior. Although meta-analyses have consistently demonstrated short-term effectiveness, a recurring finding is that these effects are attenuated once user engagement declines or the intervention ends. We describe this phenomenon as the sustainability paradox: the same design features that maximize behavioral success during use, such as automated guidance, real-time feedback, and gamified rewards, may undermine the conditions necessary for the behavior to persist once the intervention is terminated. This study introduces narrative ownership as a conceptual framework for understanding and addressing this paradox. Narrative ownership refers to the extent to which individuals experience behavior change as an ongoing, interpretable, and self-authored process and comprises three components: process framing, narrative repair, and authorship. We argue that many contemporary DBCI architectures unintentionally displace these experiential processes by automating lapse correction, redirecting behaviors without interpretation, and externalizing the attribution of success. Therefore, to translate this framework into practice, we outlined three design principles for sustainable digital interventions: reflective pauses that support process framing, lapse reinterpretation features that enable narrative repair, and meaning-linking interfaces that strengthen authorship. Together, these principles reposition the user not merely as the recipient of behavioral guidance but also as the author of their own story of change in digital health interventions.