Health Program Guidelines

When presenting information about health with the goal of changing health behaviors, there are a few things you should keep in mind.

1. As with any group facilitation, you should make sure you establish an environment in which everyone feels welcome and comfortable. 
2. Consider your approach to sharing health knowledge – what are the messages you’re actually sending and will your audience be ready to hear them? The following guidelines will assist you in successfully facilitating health-related workshops.

Creating Positive Group Spaces

When presenting and/or discussing potentially sensitive information, it is always a good idea to set up some group agreements in order to create a positive and productive environment. While no space can ever be entirely “safe” for everyone, establishing some ground rules can help. Here are a few agreements to include, but you and your group can also come up with some additional ones of your own:

• Respect - It is important to remember that people in the room likely have had different life experiences, some of which may be related to the topic of discussion. When you are speaking, remember to speak only for yourself and avoid speaking on behalf of entire identities or types of people, even if you are a member of that group. When listening to others, if someone says something you disagree with or that you find offensive, give the person the benefit of the doubt and assume they had good intentions. Find a way to talk about it constructively and respectfully.
• Confidentiality – While it cannot be guaranteed, what is said in the room stays in the room. (Note to RAs: the room itself makes a difference, so try to pick one that affords the group some privacy.) You should only share what you feel comfortable sharing. If someone says something interesting while working in small groups or on an activity, ask them before you share their thoughts with the whole group. When you share your own ideas, also remember to leave out any identifying information, even about people who are not present.  
• Taking care of yourself – It’s okay if you need to take a break! You can feel free to step out of the room and return when you’re ready. 

Adapted from the HAVEN, One Act, and Safe Zone program manuals.

Social Norming

When presenting information, one should keep in mind the idea of presenting positive or negative social norms. For example, saying that 1 million Americans do a certain unhealthy behavior makes it sound like a lot of people do it, when the goal might actually be to convince people that the unhealthy behavior is not the norm. Instead, one should emphasize how many millions of people AREN’T doing that behavior.

In the field of social psychology, Robert Cialdini discusses this issue in the context of injunctive and descriptive norms. Injunctive norms are norms of which a person thinks others approve or disapprove(1). Descriptive norms are those that a person thinks other people actually do or enact(1). To promote positive health behavior change, it is important to make sure your messages are consistent and in the direction of change that you wish to see(1). Here is a good example: The UNC Core survey data from 2010 indicates that 31.6% of students would rather NOT have alcohol available at parties they attend and 70.1% of students refused an offer of alcohol or other drugs in the last 30 days! This shows that many students do not wish to be around alcohol and that many don’t drink, even when it’s available. Before you present health behavior information, think about the message your facts are actually sending.

Harm/Risk Reduction

Wellness Services takes a risk reduction approach by encouraging students to make honest risk/benefit analyses about drinking and other health behaviors. Harm reduction is a continuous process for students in which accomplishing any step towards healthy behavior change, rather than eliminating all risk, is seen as a positive outcome(2). We understand that some students might make unhealthy choices sometimes and, without supporting or discouraging these choices, our goal is to reduce the risks they take in doing so by providing resources to help them stay healthy. As student leaders, you are a resource for other student and can empower them with the information they need to make the best choices for them as individuals.

Stages of Change: The Transtheoretical Model and Motivational Interviewing

At Wellness Services, we also use a strategy called “motivational interviewing” to work with individual students on changing health behaviors such as alcohol and other drug use. In motivational interviewing, the Wellness staff empowers students (or in your case, the RAs will empower residents) to talk about their own behaviors and readiness to change them(2).

According to the Transtheoretical Model (TTM), an individual moves through five stages in the process of behavior change(2, 3). People can move back and forth between stages as their motivation, or readiness to change, fluctuates(2, 3). Still, any overall progress through the stages as a result of a workshop or counseling intervention is great(2)! Whether you are speaking with a student one-on-one or conducting a workshop with a group of residents, it will be helpful to consider what mindset they are in and modify your presentation of information accordingly when possible.

The five stages of change include:

• Precontemplation – In this first stage of change, a person has not even considered that their behavior is unhealthy and therefore are not planning on changing their actions(2, 3). When working with students at this level of readiness to change, you should increase their knowledge about the risks associated with their behavior(2).
• Contemplation – In this second stage, a person acknowledges the risks that go along with a given behavior and intends to change their behavior eventually though might need some help getting motivated(2, 3). In order to help students commit to changing, remind them of the positive consequences of changing and teach them the risk reduction skills they might need to do so(2).
• Preparation – In this third stage, a person is ready for and intending to change, but might not have a specific plan of action(2). You can help students progress through this stage by talking with them to set a goal and/or informing them about the different changes they can make(2).
• Action – In this fourth stage, a person enacts the risk reduction strategies they have learned and makes changes in their health behavior(2, 3)! As a student leader, you can support the students around you as they employ these strategies for change and offer information and resources as necessary(2).
• Maintenance – In this final stage, a person can be said to have actually changed their behavior(2). Note, though, that they might still move backwards through the process, even at this stage(2, 3). Whether or not that happens, providing resources and informational support to your friends and fellow students can help them stay in or return to this stage of change(2).

It is likely that individuals within your audience will be at different levels of readiness for change, but that’s okay! Remember that wellness is here for you. If you need information on a health topic other than what is already available to you, wellness can guide you and your students to other resources or provide further workshop sessions.

Sources:

1. Cialdini, R. B. (2003). Crafting normative messages to protect the environment. Psychological Science, 12(4), 105-109.

2. Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief Alcohol Screening and Intervention for College Students: A harm reduction approach. New York: The Guilford Press.

3. Prochaska, J. O., Redding, C. A., & Evers, K. E. (2008). The Transtheoretical Model and Stages of Change. In K. Glanz, B. K. Rimer & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice, 4th Edition (97 – 121).  San Francisco, CA: Jossey-Bass.