Ambivalence and hesitancy (A/H) are conflicting affective states that precede the delay or abandonment of health behaviour change. Recognition of A/H at the video level is difficult, since the signal arises from disagreement across and within facial, vocal, linguistic, and bodily modalities, and manifests differently across individuals. The proposed PRISM-AH (Predictive Reasoning over Interacting Streams for Multimodal Ambivalence/Hesitancy Recognition), is a framework that treats A/H as a multimodal conflict that unfolds over time. Frozen vision, audio, and text encoders are aligned into short time windows and passed to a lightweight streaming model that scores cross-modal dissonance, predicts each next window to expose a hesitation surprise signal, discovers behaviour prototypes, and is conditioned on participant metadata. Dense window-level annotations supervise the model as an auxiliary objective, and the decision threshold is calibrated for macro F1. A knowledge-guided large language model then reasons over structured evidence using the expert cue taxonomy of the dataset, and its verdict is fused late only when validation performance improves. On the labelled public test partition of 525 videos, PRISM-AH attains a macro F1 of 0.6133, compared to the reported zero-shot baseline of 0.2827. The reasoning gain is validated to transfer from validation to the larger test partition.

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