Healthy living concepts and definitions: A systematic review with concept analysis proposing a four-dimensional model

INTRODUCTION: Despite numerous definitions and theoretical models, healthy living remains conceptually fragmented, lacking a unified framework capturing its dynamic, multilevel, and life-course nature. We systematically identify and conceptually analyse definitions and theoretical models of healthy living (1) to characterise heterogeneity in definitions, dimensions, antecedents, and consequences, (2) to develop a typology, and (3) to propose a unifying conceptual model.

METHODS: We conducted a systematic review with an embedded concept analysis. Embase, Medline, Cochrane Central, Web of Science, CINAHL, LILACS, and Google Scholar were searched from inception to May 18, 2025, without restrictions, following PRISMA 2020 guidelines. Eligible studies included conceptual analyses or theoretical models explicitly defining healthy living; empirical studies without conceptual grounding were excluded. Systematic review methods governed study identification, selection, and data extraction. Following this mapping stage, the Walker and Avant framework was applied to synthesise attributes, antecedents, and consequences, integrated with iterative thematic analysis.

RESULTS: Of 10,067 records screened, 36 studies (1991-2025; 18 countries) were included. Definitions and theoretical justifications were highly heterogeneous. Nine conceptual dimensions and six categories of antecedents emerged, with most models emphasising physical, behavioural, and cognitive dimensions and individual-level determinants, while interactions across dimensions were rarely specified. Five major model types and ten subtypes emerged. We define healthy living as a dynamic, multidimensional life-course process integrating behavioural-physical, cognitive-psychological, social-relational, and contextual-structural dimensions.

CONCLUSION: This study addresses longstanding conceptual fragmentation and proposes a four-dimensional model of healthy living, providing a foundation for theory, measurement, intervention design, and policy.