The Functional-Actor Transition Dilemma: A Structural Explanation for Post-Intervention Attenuation in Prevention Programs

Despite sustained investment in lifestyle prevention programs, many interventions demonstrate limited post-intervention sustainability, with behavior or practice adherence commonly declining upon withdrawal of external program support. This pattern reflects a persistent structural limitation in prevention science, whereby participants remain functionally dependent on continued programmatic actuation for behavioral continuity rather than transitioning into autonomous agents for preventive actions. This phenomenon is mediated by interventional prevention models prioritizing delivery-phase implementation and near-term outcomes, while under-theorizing the psychosocial and operational processes required for enduring behavior maintenance following program termination. Numerous existing frameworks and theories directly consider and aim to increase participant shareholding of preventive behaviors, yet in practice, there remains a gap between who is left with ownership of these behaviors or practices at the end of an intervention. To address this gap and stimulate intentional progress within prevention science around this gap, this manuscript formally identifies and articulates a foundational problem in prevention sustainability, herein termed the Functional-Actor Transition Dilemma (F-ATD), which characterizes the often unactuated transition process by which participants shift from reliance on external functional actors as drivers of behavior continuance to internally driven, self-regulated forces of behavior persistence.