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A new theory for health behavior change: implications for alcohol and drug education.

Recently a new theory in health promotion--the multi model theory (MTM) of health behavior change has been proposed by Sharma (2015; 2017). The theory is designed to address health behavior change as opposed to mere behavior acquisition, to influence both one time behavior acquisition and long-term behavior continuation, to be applicable in individual, group and community settings, and to be culturally robust. In alcohol and drug education we are interested in altering negative behaviors such by facilitating smoking cessation, replacing binge drinking with responsible drinking, or helping abstinence from psychoactive drugs, while building several positive behaviors and interventions such as preventing smoking among adolescents, developing refusal skills against drugs, preventing use of illicit drugs, or by preventing underage drinking of alcohol. MTM has the ability to predict, explain, and alter all these behaviors, using constructs that have been tested and proven to be successful in other theories. Furthermore, MTM is a parsimonious model that cuts all the "junk" variables and focuses on the salient constructs.

MTM dissects health behavior change into two components: initiation of the behavior change and sustenance or continuation of the health behavior change. In the context of negative alcohol and drug education behaviors initiation would entail starting with the decision to quit the negative behavior and sustenance would entail attaining abstinence from the negative behavior. In the context of positive alcohol and drug education behaviors initiation would entail not initiating a negative behavior and sustenance would entail continuing to not initiate a negative behavior. This differentiation between initiation and sustenance is needed because, according to this theory, the constructs that influence initiation of change are different than the constructs that sustain the behavior change.

The first construct according to MTM is the construct of participatory dialogue that influences initiation of a health behavior. This has been adopted from the Freire's model of adult education (Freire, 1970). It entails having a two-way communication between the person facilitating behavior change (certified health education specialist, counselor, health coach, health educator, lay health volunteer, nurse, nurse practitioner, pharmacist, physician, and so on) and the person wanting to alter his or her behavior in which the facilitator tries to underscore the advantages of changing the health behavior over the disadvantages. This construct is akin to the constructs of pros and cons in transtheorertical model (Prochaska, 1979) or the perceived benefits and perceived barriers in health belief model (Rosenstock, 1974). However, this conceptualization is based on Freire's (1970) adult education model that emphasizes two-way communication process which is not present in the other two models. The key here is that in order for behavior change to happen the advantages must outweigh the disadvantages and this must be done through a participatory approach in which the person, group or community get convinced of the advantages and take ownership of arriving at this conclusion.

The second construct for initiation of health behavior change according to this model is behavioral confidence derived from Bandura's (1986) self-efficacy and Ajzen's (1991) perceived behavioral control. However, this conceptualization is somewhat different in the sense that it is futuristic as opposed to the existing conceptualization of "here and now." For alcohol and drug education behaviors it would be the belief in one's ability to quit the problem behavior or the belief in one's ability to prevent oneself from not engaging in a potentially harmful behavior. The person may not have this belief right at this moment but is able to project it for near future and this can help in initiation of the health behavior.

The third construct for initiation of health behavior is physical environment derived from Bandura (1986) and several other theories. In this construct, all cues and objects related to the addiction in the environment, or their removal, affect the initiation or ending of the health behavior.

In order to facilitate sustenance of a health behavior there are also three constructs. The first is emotional transformation derived from the emotional intelligence theory (Goleman, 1995; Salovey & Mayer, 1990). This entails ability to direct one's emotions/feelings to the goal of health behavior change, motivating oneself toward accomplishing the health behavior change, and overcoming self-doubt in accomplishing the goal.

The second construct for sustenance of health behavior change is practice for change derived from Freire's (1970) adult education model's praxis which refers to active reflection and reflective action. It involves keeping a self-diary to monitor one's progress, ability to stick to the goal if one encounters barriers, and ability to change one's plans if faced with difficulties.

The final construct for sustenance of health behavior change is social environment derived from construct of environment (Bandura, 1986), helping relationships (Prochaska, 1979), social support (House, 1981) and so on. This involves getting help from family member, friends, or health care professionals and so on.

So we see that this new theory has the potential to help with health behavior changes in alcohol and drug education. I urge the readers to plan either a predictive study to test this model or an intervention study to alter positive or negative alcohol and drug education behaviors using this approach.

Manoj Sharma, MBBS, MCHES, Ph.D., FAAHB

Professor, Behavioral & Environmental Health School of Public Health

Jackson State University

350 West Woodrow Wilson Avenue

Jackson, MS 39213

(601) 979-8850 (Phone)

(601 979-8848 (Fax)

manoi.sharma(d) (E-mail)


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Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ: Prentice Hall.

Freire, P. (1970). Pedagogy of the oppressed. New York: Continuum.

Goleman, D. (1995). Emotional intelligence. New York: Bantam.

House, J. S. (1981). Work, stress, and social support. Reading, MA: Addison-Wesley.

Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Homewood, IL: Dorsey Press.

Rosenstock, I. M. (1974). Historical origins of the health belief model. In M. H. Becker (Ed.), The health belief model and personal health behavior (pp. 1-8). Thorofare, NJ: Charles B. Slack.

Salovey, P., & Mayer, J. (1990). Emotional intelligence. Imagination, Cognition, and Personality, 9, 185-211.

Sharma, M. (2015). Multi-theory model (MTM) for health behavior change. WebmedCentral Behaviour, 6(9), WMC004982. Retrieved from http://www.webmedcentral. com/article_view/4982

Sharma, M. (2017). Theoretical foundations of health education and health promotion. (3rd ed.) Sudbury, MA: Jones and Bartlett.
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Author:Sharma, Manoj
Publication:Journal of Alcohol & Drug Education
Article Type:Editorial
Date:Apr 1, 2016
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