A Behavior Change Model for Internet Interventions

  • Lee M. Ritterband
  • Frances P. Thorndike
  • Daniel J. Cox
  • Boris P. Kovatchev
  • Linda A. Gonder-Frederick
Original Article



The Internet has become a major component to health care and has important implications for the future of the health care system. One of the most notable aspects of the Web is its ability to provide efficient, interactive, and tailored content to the user. Given the wide reach and extensive capabilities of the Internet, researchers in behavioral medicine have been using it to develop and deliver interactive and comprehensive treatment programs with the ultimate goal of impacting patient behavior and reducing unwanted symptoms. To date, however, many of these interventions have not been grounded in theory or developed from behavior change models, and no overarching model to explain behavior change in Internet interventions has yet been published.


The purpose of this article is to propose a model to help guide future Internet intervention development and predict and explain behavior changes and symptom improvement produced by Internet interventions.


The model purports that effective Internet interventions produce (and maintain) behavior change and symptom improvement via nine nonlinear steps: the user, influenced by environmental factors, affects website use and adherence, which is influenced by support and website characteristics. Website use leads to behavior change and symptom improvement through various mechanisms of change. The improvements are sustained via treatment maintenance.


By grounding Internet intervention research within a scientific framework, developers can plan feasible, informed, and testable Internet interventions, and this form of treatment will become more firmly established.


Internet interventions eHealth Online treatment Behavior change Behavior change model Scientific framework 


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Copyright information

© The Society of Behavioral Medicine 2009

Authors and Affiliations

  • Lee M. Ritterband
    • 1
  • Frances P. Thorndike
    • 1
  • Daniel J. Cox
    • 2
  • Boris P. Kovatchev
    • 3
  • Linda A. Gonder-Frederick
    • 2
  1. 1.Department of Psychiatry and Neurobehavioral Sciences, Behavioral Health and TechnologyUniversity of Virginia Health SystemCharlottesvilleUSA
  2. 2.Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Medicine ResearchUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Department of Psychiatry and Neurobehavioral Sciences, Diabetes TechnologyUniversity of Virginia Health SystemCharlottesvilleUSA

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