Rethinking success in public health education and promotion: a narrative ownership framework for sustainable health behavior change

Abstract

Public health education and promotion has largely evaluated success in terms of measurable behavioral outcomes. While this outcome-centered logic has advanced intervention science, behavior change is frequently not sustained once programs end, and outcome indicators alone cannot show how change is experienced, interpreted, and held over time. The objective of this paper is to advance and operationalize the hypothesis that outcome-only definitions of success are epistemologically incomplete and ethically fragile. We proceed conceptually, identifying two structural limitations of outcome-centered evaluation, the invisibilization of temporal experience and the externalization of agency through optimization logic, and we then define a complementary evaluative dimension, specify its measurement model, and derive testable predictions. Narrative ownership is defined as the degree to which behavior change experiences, including lapses, are framed as part of an ongoing process, remain repairable through reinterpretation, and are held with a sense of authorship. We distinguish this construct from self-efficacy, autonomous motivation, self-concordance, identity-based motivation, psychological flexibility, self-compassion, and narrative identity, and we commit the framework to a falsifiable claim of non-redundancy. We propose a two-axis model crossing behavioral outcomes with narrative ownership, yielding four illustrative quadrants: integrated success, brittle success, meaningful preparation, and disempowered stagnation. We specify a second-order formative measurement model, three hypotheses in operational form, decision rules for combining the two criteria in program evaluation, and the conditions under which the framework should be abandoned. We also distinguish low narrative ownership arising from constrained options from low narrative ownership arising from interpretive processes, so that the framework does not individualize structural disadvantage. We conclude that the Narrative Ownership Framework offers a testable model for rethinking success in health behavior change, and that it may help public health educators, clinicians, and digital intervention designers distinguish short-term behavioral improvement from more durable, person-centered change.