We broadly endorse Chater & Loewenstein's (C&L's) contention on the limited long-term efficacy of interventions that target individual behavior change (“i-frame” interventions), and concur with their suggestion that advocacy for, and emphasis on, “i-frame” interventions, may have potentially deleterious effects on behavior change strategies (e.g., legislation, taxation) that focus on systemic change (“s-frame” interventions) by opening opportunities for organizations to reduce investment in – or even actively oppose – them. Nevertheless, we propose that outright dismissal of “i-frame” interventions is imprudent, and argue that such interventions should be important components of coordinated, integrated, multi-strategy behavior change interventions. Our premise has two bases. First, there is evidence that well-designed and resourced “i-frame” interventions can lead to sustained behavior change (Hagger, Cameron, Hamilton, Hankonen, & Lintunen, Reference Hagger, Cameron, Hamilton, Hankonen and Lintunen2020). Second, use of “i-frame” and “s-frame” intervention strategies together as part of an integrated approach, may be optimal in bringing about sustained behavior change and allay organizational practices that undermine “s-frame” strategies. Next, we outline examples of “i-frame” interventions that have been efficacious and effective in producing long-term behavior change, and, critically, examples of integrated interventions that encompass “i-frame” and “s-frame” components.

Although C&L acknowledge that some “i-frame” interventions are successful, their overall contention is that such approaches seldom lead to sustained behavior change. However, they neglect to note the many other instances where “i-frame” interventions, correctly implemented and resourced, have demonstrated efficacy and effectiveness, including in high-quality effectiveness trials. For example, graphic-warning labels on tobacco products have been shown to substantially reduce use and promote quit attempts (Brewer et al., Reference Brewer, Hall, Noar, Parada, Stein-Seroussi, Bach and Ribisl2016; Durkin, Brennan, & Wakefield, Reference Durkin, Brennan and Wakefield2012). C&L's concerns regarding “i-frame” interventions may stem from the observed high variability in their efficacy and effectiveness, likely attributable to numerous contextual and structural factors. For example, “i-frame” interventions are seldom sufficiently scaled and have limited ongoing resource investment that ultimately mean sustained change is not realized (Hagger & Weed, Reference Hagger and Weed2019). Such interventions also tend not to have sufficient engagement from stakeholder and user groups, and support from the systems required to implement them (Koorts et al., Reference Koorts, Eakin, Estabrooks, Timperio, Salmon and Bauman2018).

Thus intervention success is often not a function of the “frame” of the intervention per se, but the lack of peripheral support for the interventions to be efficacious and effective in situ. Such support may include sustained funding necessary for the key intervention components to be delivered in the requisite dose and according to protocol, buy-in from key networks and stakeholder organizations responsible for their instigation and delivery, and other structural aspects important to maintain engagement (e.g., public buy-in, resource availability). Efforts to garner such support and the networks necessary for optimal, per-protocol “i-frame” intervention delivery have been elevated to the same level of importance as the development of the content and protocol of the intervention itself. This elevation has been mirrored by the emergence of the field of implementation science, which aims to study and develop models on how practices that have shown promise in efficacy trials, including those adopting “i-frame” strategies, into effective, sustained, and feasible practices in community settings (Luszczynska, Lobczowska, & Horodyska, Reference Luszczynska, Lobczowska, Horodyska, Hagger, Cameron, Hamilton, Hankonen and Lintunen2020).

The imperative of including structural support for “i-frame” interventions so they can be effectively implemented to produce sustained behavior change highlights the need for an integrated approach that encompasses “s-frame” strategies. The kinds of systemic supports required for “i-frame” interventions to be successful are often those that demand structural changes in the organizations and networks responsible for intervention implementation and delivery, and also in the community contexts in which interventions are delivered. This implies that a coordinated approach in which behavioral scientists work alongside implementation scientists, organizational leaders, and policymakers, and community and user groups to identify the intervention components and elements that need to be put in place to affect sustained change in the target behavior is necessary. Such an approach has been documented in formal protocols developed by implementation scientists modeling the logistics and networks required to produce efficacious and effective interventions that lead to sustained behavior change (e.g., Feldstein & Glasgow, Reference Feldstein and Glasgow2008; Glasgow, Vogt, & Boles, Reference Glasgow, Vogt and Boles1999).

C&L indicate that there are occasions where “i-frame” and “s-frame” strategies have been effectively integrated. In fact, there are many successful examples. One of the most successful examples comes from Australia's campaign to change sun-safety behaviors that led to the first decline in the rate of increase in skin cancer incidence for 40 years. The sustained coordinated approach involved large-scale, well-resourced “i-frame” messaging on use of protective clothing, sun screen, and head coverings (“slip,” “slop,” “slap”), alongside “s-frame” policy and legislation change including mandating use of sun-protective clothing for children in schools, manufacturing requirements for clothing to be ultraviolet (UV) protective, and banning solariums (e.g., Montague, Borland, & Sinclair, Reference Montague, Borland and Sinclair2001; Walker et al., Reference Walker, Maitland, Tabbakh, Preston, Wakefield and Sinclair2022). In another example, UK hospitals aiming to prevent nosocomial infections introduced “i-frame” messages, prompts, and education to hospital staff on “non-touch” techniques alongside “s-frame” components such as sourcing and availability of antibacterial products and changes in policy on aseptic-handling procedures for patients (e.g., Rowley, Clare, Macqueen, & Molyneux, Reference Rowley, Clare, Macqueen and Molyneux2010). These examples stand as blueprints for an integrated approach to behavior change. Common elements include buy-in from stakeholder organizations and user groups, systematic coordination of networks and program elements, adoption of evidence-based “i-frame” behavior change techniques, and sufficient resourcing and leadership to implement concomitant “s-frame” policy changes. We also note the imperative for advocacy work aimed at engaging stakeholder organization leadership and user groups for such coordinated approaches to be effective. Advocacy work may involve the instigation of precursory behavior change interventions that promote attitude or “culture” change within leadership and organizations. Furthermore, given the coordinated approach that integrates “i-frame” and “s-frame” components includes organization involvement and buy-in by design, it is also likely to allay the kinds of nefarious practices that undermine “s-frame” intervention components highlighted by C&L.

In summary, we echo C&L's call for broader application of “s-frame” strategies for behavior change, but argue that integration of “i-frame” and “s-frame” strategies informed by behavioral and implementation science should optimize intervention efficacy and effectiveness and inhibit undermining practices.