Improving adherence: The Information, Motivation, Behavior Skills (IMB) Model

How do you help people change their behaviors to improve health? What if they have a chronic illness that requires long term medication adherence, like HIV? What if they’re teens or college students engaging is risky behaviors, like consuming alcohol or unprotected sex?

Well, there’s a theoretical model that proposes an approach to these populations: The Information, Motivation, Behavior Skills (IMB) Model. “Information” targets the cognitive domain, by offering knowledge to support the behavior change. “Motivation” addresses the affective domain. It provides the opening to develop a favorable attitude toward the new behavior, and taps into existing support systems to enhance motivation. “Behavior” addresses the psychomotor domain, with return demonstrations and practice.

You’ve probably noticed features of this model are already familiar. Assessment helps you identify what the learner knows, and what motivates the learner. Individualization allows you to present the content in a way the learner understands, to optimize motivation to change behaviors. Return demonstrations are the most direct way to know if the learner can do the skill. Applying this Information, Motivation, Behavior Skills (IMB) Model could help you pay attention to these essential components of effective teaching.

I have said patient education has two levels: (1) providing information and (2) helping learners apply it to their lives. This IMB model recognizes both levels, by addressing information, motivation, and behavior skills. However, I think optimal effectiveness of adherence would be achieved if health coaching was added. Health coaching would support behavior change over time, as motivation evolves. The World Health Organization (2003) agrees, saying, “The most effective approaches have been shown to be multi-level – targeting more than one factor with more than one intervention.” (page 31)

If you want to explore this topic more, here are some resources:

Bazargan, M., Stein, J. A., Bazargan-Hejazi, S., & Hindman, D. W. (2010). Using the information-motivation behavioral model to predict sexual behavior among underserved minority youth. J Sch Health, 80(6), 287-295.

Rivet Amico, K., Barta, W., Konkle-Parker, D. J., Fisher, J. D., Cornman, D. H., Shuper, P. A., et al. (2009). The Information–Motivation–Behavioral Skills Model of ART Adherence in a Deep South HIV+ Clinic Sample. AIDS Behavior, 13(1), 66-75.

Schoster B, Callahan LF, Meier A, Mielenz T, DiMartino L. The People with
Arthritis Can Exercise (PACE) program: a qualitative evaluation of participant satisfaction. Prev Chronic Dis [serial online] 2005 Jul [date cited]. Available from: URL:
http://www.cdc.gov/pcd/issues/2005/jul/05_0009.htm.

World Health Organization. (2003). Adherence to long-term therapies: Evidence for action Available from http://apps.who.int/medicinedocs/pdf/s4883e/s4883e.pdf

Zarani, F., Besharat, M. A., Sadeghian, S., & Sarami, G. (2010). The effectiveness of the information-motivation-behavioral skills model in promoting adherence in CABG patients. J Health Psychol, 15(6), 828-837.

© 2011, Fran London, MS, RN

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