Chronic diseases such as hypertension, diabetes, and dyslipidemia are major contributors to mortality and healthcare burden worldwide. Despite high awareness of health risks, many patients fail to adopt proactive health behaviors due to behavioral inertia and a gap between knowledge and action.

This study aims to investigate the evolution and driving mechanisms of proactive health behavior in patients with chronic diseases based on goal commitment theory. By integrating prospect theory and evolutionary game theory, this study will explore how behavioral strategies evolve under different levels of goal commitment.

In addition, a behavioral intervention based on the Stimulus-Organism-Response (SOR) model will be developed to enhance patient activation and promote adherence to proactive health behaviors. A parallel controlled intervention study will be conducted to evaluate the effectiveness of the goal commitment-based intervention.

The findings of this study are expected to provide theoretical and practical evidence to improve chronic disease management and promote proactive health behaviors.

Chronic diseases, including hypertension, diabetes, and dyslipidemia, account for a substantial proportion of morbidity, mortality, and healthcare expenditure. Although a large proportion of patients are aware of their health risks, more than half fail to adopt proactive health behaviors. This gap between awareness and action is often attributed to behavioral inertia and insufficient motivation.

This study aims to explore the evolution and driving mechanisms of proactive health behavior among patients with chronic diseases based on goal commitment theory. The theoretical framework integrates prospect theory and evolutionary game theory to model behavioral decision-making under uncertainty and dynamic interactions.

First, a theoretical model will be constructed to simulate the evolution of proactive health behaviors under different levels of goal commitment, using evolutionary game analysis. Second, a conceptual framework based on the Stimulus-Organism-Response (SOR) model will be developed to examine how goal commitment influences patient activation and social norms, thereby affecting proactive health behavior.

Empirical data will be collected through multi-site surveys among patients with chronic diseases. Subsequently, a parallel controlled intervention study will be conducted to evaluate the effectiveness of a goal commitment-based intervention in improving proactive health behaviors.

Inclusion criteria include adult residents diagnosed with at least one chronic condition (hypertension, diabetes, or dyslipidemia), with adequate cognitive ability and willingness to participate. Exclusion criteria include inability to participate in group activities, current hospitalization, or severe psychiatric or cognitive disorders.

The study is expected to provide insights into the mechanisms underlying proactive health behavior and offer evidence-based strategies for improving chronic disease management.

Inclusion Criteria:

• Residents living in the study area for at least 1.5 years
• Diagnosed with at least one chronic disease, including hypertension, diabetes mellitus, or dyslipidemia
• Conscious and able to communicate effectively
• Educational level of primary school or above
• Able to use a smartphone and common mobile applications (e.g., WeChat)
• Willing to participate and provide written informed consent

Exclusion Criteria:

• Non-residents of the study area
• Unable to participate in group-based intervention activities
• Currently hospitalized
• Diagnosed with severe cognitive impairment, dementia, or psychiatric disorders
• Participants with severe comorbidities that may interfere with study participation

Individual participant data (IPD) will be shared upon reasonable request. De-identified data supporting the findings of this study will be made available to qualified researchers after publication of the primary results. Data access will be subject to approval by the corresponding author and institutional review, in accordance with ethical and data protection regulations.