Algorithm-Driven Fourth Generation Multi-Theory Model for Alcohol and Drug Education.
Health behavior research, as it relates to alcohol and drug education programs, evolved from the first-generation knowledge-based programs starting in the 1960's that primarily relied on knowledge, attitudes and practices (KAP) surveys. Such programs are still being used in many developing countries and by local public health departments in the United States (Sharma, 2017). The second-generation programs were skill-building programs such as the refusal-skills programs used in the US and European countries to combat drug problems among teens or the problem-solving skills programs used among school children to deal with stress-coping or improving academic performance or providing alternatives to risky behaviors and a myriad of other health and social issues (Sharma, Petosa, & Heaney, 1999). The third-generation alcohol and drug-education interventions relied on explicit behavioral theories and have been labeled by some as evidence-based programs. Tebb and colleagues (2016) provide a systematic review of the use of theory in computer-based interventions to reduce alcohol use among adolescents and young adults. Likewise, Melendez-Torres and colleagues (2016) have summarized interventions using theory to reduce drug problems among youth. The currently emerging fourth-generation programs are multi-theory programs that focus on crucial constructs from proven theoretical models, break down the behavior-change process into initiation and maintenance and are brief and precise. One such model is the multi-theory model (MTM) of health behavior change (Sharma, 2015) that has been applied to a variety of health behaviors in a variety of target populations which the readers can search for and read. In this paper, we describe an algorithm for its application in Figure 1.
This is the first attempt in health-behavior research to operationalize an algorithm utilizing a theoretical model. It starts with the first decision of whether to imitate the behavior change or to reinforce it. In alcohol and drug education this can pertain to termination of alcohol use, termination of drug use, reinforcement of protective skills among youth for prevention and so on. The second step is the loop of participatory dialogue that establishes the advantages of behavior change over any potential disadvantages and at the same time building behavioral confidence. Following these steps, changes in physical environment need to be fostered that support the behavior change. For sustaining the behavior change, once again the trinity loop of practice for change, emotional transformation and changes in social environment need to be cultivated. Details on these constructs of MTM can be assimilated through several publications on this topic. We hope this attempt to reify an algorithm which is in its nascent stage will spark more interest and debate among drug and alcohol educators which will lead to its adoption in actual interventions and that will build protective behaviors and terminate harmful ones around drugs and alcohol use.
Manoj Sharma, MBBS, Ph.D., MCHES[R]
Editor, Journal of Alcohol & Drug Education Professor, Behavioral & Environmental Health Jackson State University 350 W. Woodrow Wilson Drive Jackson, MS 39213
Malvika Sharma, MD
Rardin Family Practice Wexner Medical Center The Ohio State University 2231 North High Street Columbus, OH 43201
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|Author:||Sharma, Manoj; Sharma, Malvika|
|Publication:||Journal of Alcohol & Drug Education|
|Date:||Apr 1, 2019|
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