fourth-generation multi-theory model (mtm) of health behavior change as a novel strategy for sustainable health promotion: a systematic review

Background: health promotion has evolved significantly since its conceptualization, emphasizing the need for sustainable interventions to address population health challenges. this systematic review explored the effectiveness of the multi-theory model (mtm) of health behavior change in promoting sustainable health behavior. methods: following prisma guidelines, a comprehensive search was conducted across medline, cinahl, apa psycinfo, and academic search premier databases. from 883 records sourced after removal of duplicates, abstracts were screened and followed by complete article reading and screening. eight experimental studies (four randomized controlled trials and four quasi-experimental studies) published between 2016 and 2024 were included. data extraction focused on study design, population, interventions, and outcomes, with risk of bias assessed using cochrane tools (rob 2 and robins-i). results: the findings revealed significant improvements in health behaviors, including reduced water pipe smoking, increased physical activity, healthier diets, and enhanced quality of life. mtm constructs—particularly participatory dialogue, behavioral confidence, emotional transformation, and practice for change—showed strong, statistically significant effects (p < 0.001). process evaluations confirmed high intervention fidelity, strong engagement, and feasibility for community implementation. despite small sample sizes, biases, and heterogeneous designs, the interventions effectively promoted sustainable, equitable behavior change across diverse populations. overall, the results demonstrate the mtm’s potential for long-term health promotion through integrated behavioral and environmental strategies that align with public health sustainability goals.conclusion the review underscores mtm's potential as a robust framework for sustainable health promotion. by integrating environmental sustainability principles and fostering community engagement, mtm-based interventions can address social determinants of health and promote long-term behavior change. future research should focus on scaling mtm interventions, addressing methodological limitations, and exploring its integration with other sustainability frameworks to enhance public health outcomes.