The Behavior Change Wheel as a Complementary Implementation Framework for Heat-Health Action Planning

Abstract

Extreme heat is one of the most significant climate-sensitive public health challenges of the twenty-first century. In response, Heat-Health Action Plans (HHAPs) have become the principal framework for coordinating multisectoral adaptation measures. While the recently updated World Health Organization (WHO) guidance provides a comprehensive strategic framework for HHAP development, translating these strategic objectives into coordinated implementation across sectors remains a persistent challenge. This discussion paper proposes to use the existing Behavior Change Wheel (BCW; Michie et al., 2014) as a complementary implementation framework for Heat-Health Action Planning. Rather than introducing new heat-health interventions, the BCW provides an explicit behavioral implementation logic that systematically links behavioral diagnosis, intervention functions, and policy categories within a common analytical framework. This enables strategic HHAP objectives to be translated into context-specific implementation strategies across individual, organizational, and governance levels. By integrating behavioral diagnosis with intervention design and policy action, the BCW complements the WHO Heat-Health Action Planning guidance and supports the operationalization of existing HHAP core elements. The paper further illustrates how the BCW can facilitate behavioral diagnosis, intervention selection, and coordinated implementation across different implementation contexts. Conceptualizing Heat-Health Action Plans as implementation systems highlights the importance of explicitly addressing the behavioral processes through which heat-health interventions are delivered and coordinated. The proposed integration positions the BCW as a complementary implementation framework that can strengthen the coherence, feasibility, and coordination of HHAP implementation while providing a foundation for future empirical research on behavioral approaches to climate change adaptation.