A Guide to Brief Motivational Multi-Health Behavior Programs

A Guide to Brief Motivational Multi-Health Behavior Programs

This article will discuss the need for brief motivational and integrated multi-health behavior programs for youth and young adults. We’ll also review the components of the Behavior-Image Model which is a framework for creating brief and integrated prevention programs. 

Why use brief motivational prevention interventions?  Below are some reasons. 

  1. Information and education alone are not effective for motivating behavior change.
  2. Brief interventions can be provided where longer-term programs can’t be, increasing program reach and the number of program settings.
  3. Brief motivational interventions like SBIRT are evidence-based practices.
  4. Brief motivational interventions can be more cost-effective than longer or more intensive programs. 

Why are integrated multi-health behavior programs so important?  Here are some reasons: 

  1. Most youth experience multiple health risk behaviors.
  2. Risks for substance use, chronic disease and both mental and physical illness are interconnected.
  3. Integrated interventions may increase the breadth of behavior effects for youth.
  4. Integrated programs can be more cost-effective than single risk programs.
  5. Integrated programs allow addressing multiple health problems simultaneously.
  6. Integrated program may have greater public health outcomes than single-risk behavior programs.
  7. Integrated multi-health behavior program are likely to be more appealing and therefore attended more by youth and parents. 

By combing brief motivational interventions with those that integrate multiple health risk behaviors into single prevention programs provides the best of both strategies.  

The Behavior-Image Model (BIM) is a conceptual framework that allows prevention and health specialists to create brief motivational programs that link healthy behavior promotion with substance use prevention (https://preventionpluswellness.com/pages/ppw-logic-model).  

For example, a program designed to promote regular physical activity and prevent alcohol use among youth. 

The three components of BIM include: 

  1. Communicate positive, aspirational peer and future images as benefits (values) and substance use as harmful to connect and increase motivation to change diverse health behaviors,
  2. Use multiple behavior goal setting/contracting to initiate action and increase self-control, self-efficacy and self-concept, and
  3. Provide environmental strategies including parent materials and training, media campaigns and youth resources to support youth positive behavior choices, parent-youth communication, and continued goal monitoring and goal setting. 

Communicating Positive Images 

The use of images in interventions, particularly positive appealing images, to influence decision-making is supported in three areas: 

  1. Image has conceptual support in multiple health behavior theories, such as Possible Selves Theory and Social Learning Theory.
  2. Image has research support in studies on self-concept, prototype images, possible selves and positive identity which show image being linked to youth health risks.
  3. The use of appealing images has practical support in image advertising and marketing of products and services as diverse as alcohol, clothing and automobiles. 

In addition, interventions that are asset-focused on healthy behavior promotion are more likely to be acceptable and enjoyed by youth, parents and providers than programs targeting only risk avoidance. 

An underlying assumption of the Behavior-Image Model is that to achieve optimal health and personal performance, as well as to prevent and mitigate declines in health status, multiple health-risk and health-promoting behaviors must be considered across the lifespan.  

This requires connecting or “coupling” two divergent behaviors in a conceptual, empirical or logical relationship.  

Opposing behavior couplings are framed as a health-risk behavior (e.g., marijuana use) counteracting or weakening the gains of a health-promoting behavior (e.g., physical activity), leading to reductions in health and personal development. 

This involves a two-step messaging process. 

Step One is to identify positive images and other benefits of a health-enhancing behavior.  For example, “Young people who engage in regular physical activity tend to feel energetic, sleep better, and look more active, fit and confident.”  (images underlined). 

Step Two is to identify how a health-risk behavior is a barrier to achieving the healthy habit and its benefits. For example, “Marijuana use can reduce your energy level needed to participate in regular exercise and achieve your fitness goals of being in-shape, looking good, and feeling fit and active.” 

Goal Setting and Image Relationship 

Emphasizing the selection of self-concordant goals that reflect one's desired image (i.e. a social or future self-image) has been shown to facilitate behavioral change. 

A major reason for failing at attaining personal goals is that they are adopted for external reasons instead of reflecting one's personal interests and values. 

Interventions which tap into commonly desired images of adolescents may result in more goal commitment and, subsequently, greater behavior change. 

To address the integration of prevention with healthy behavior promotion, we recommend the following components of effective goal setting: 

  1. Pledge or selecting type(s) of substance use to avoid.
  2. Selecting a healthy behavior to increase.
  3. Stating a measurable healthy behavior goal.
  4. Obtaining a co-signature (to increase motivational force).
  5. Identifying a place to post goals for monitoring.
  6. Completing a 7-day behavior calendar log. 

Brief motivational multi-behavior integrated interventions communicating positive images and goal setting based on the Behavior-Image Model are available from Prevention Plus Wellness (PPW), like the one-session evidence-based SPORT (Alcohol/Drug) PPW program for high school, middle school and elementary school youth: https://preventionpluswellness.com/products/evidence-based-alcohol-drug-sport-prevention-plus-wellness 

Environmental Strategies 

Beyond providing interventions that include the first two BIM components of presenting motivational communication and goal setting opportunities for youth, it’s important to also implement environmental strategies to support youth positive behavior choices, parent-youth communication, and continued goal monitoring and goal setting. 

This can include providing training and materials for parents and caregivers to increase parent-youth positive behavior and image communication and goal setting at home, like PPW Parent Training Programs:  https://preventionpluswellness.com/products/parent-prevention-plus-wellness-programs 

It can also include providing media campaigns to the communities and school districts that use multi-behavior health communication for youth and parents and opportunities for youth to set and monitor health behavior goals, like the SPORT PPW Media Campaign: https://preventionpluswellness.com/products/sport-alcohol-prevention-plus-wellness-media-campaign 

Lastly, it can include encouraging youth to continue to set and monitor health behavior goals and tracking their progress over time, like with the PPW Goal Plan Tracking Program: https://preventionpluswellness.com/products/ppw-goal-plan-tracking-program 

In conclusion, there is a critical need for brief motivational and integrated multi-health behavior programs for youth and young adults. The Behavior-Image Model is a framework for creating these types of prevention programs for youth and parents, as well as environmental strategies supporting them. 

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