Applying the behavior change wheel to ulcerative colitis self-management: a conceptual closed-loop behavioral support...

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by recurrent relapse and remission, requiring effective patient-led self-management. However, current self-management interventions often lack a systematic behavioral framework to support long-term behavior change.

This perspective article proposes a behaviorally informed self-management framework for UC based on the Behavior Change Wheel (BCW). The framework was developed by integrating clinical guidelines, published literature, behavioral theory, and clinical observations. The Capability, Opportunity, Motivation-Behavior (COM-B) model was applied to identify behavioral barriers and guide intervention design.

The proposed framework integrates five key self-management behaviors, including medication adherence, dietary management, symptom monitoring, stress management, and regular follow-up. These behaviors are linked to COM-B-based barrier assessment, BCW intervention functions, behavior change techniques, blended delivery pathways, and an iterative closed-loop feedback system involving behavioral, clinical, psychological, and process monitoring.

The BCW-guided framework provides a theoretically grounded approach for developing individualized and adaptive self-management support in UC. Although the model remains conceptual and requires empirical validation, it may offer a structured pathway for future behavioral interventions and multidisciplinary chronic disease management.