Benefits of  Motivational Interviewing

Motivational Interviewing has proven to be a valuable tool in eliciting change in patient behavior. Because pediatric obesity counseling warrants change in the child and the parent/family, motivational interviewing is an important technique in a collaborative approach to becoming partners in health care. ("The Art of Health Promotion," 2004)

Motivational Interviewing Defintion

Motivational interviewing is a specific technique that can be used to help patients and their families facilitate changes. Specific strategies such as reflective listening, shared decision making, and agenda setting are key elements in motivational interviews. The main goal of motivational interviewing is to assist patients and their families through ambivalence towards change. These techniques appear to be most effective in the early stages of change. The tone of motivational interview is listening and reflective. Using a nonjudgmental demeanor and supportive climate where patients and their parents feel comfortable expressing their beliefs regarding their current behaviors. The goal is to resolve ambivalence in a way that requires the patient to do the psychological work of change. There is no confrontation of irrational thoughts or denial. Instead, the interviewer helps the patient and their family to express the reasons they are for and against change. Additionally, the interviewer discusses how their current health status and behavior choices contribute to the patient and family’s long term goals. Motivational interviewing is based on the belief that motivation to change is stronger than information given (Resnicow, Davis, and Rollnick, 2006). Schwartz et al., (2007) found documented success with a pilot study to test motivational interviewing in a primary care pediatrician’s office.  The reported results found a 2.6 decrease in BMI scores among participants with parents reporting that the intervention helped them think more about their changing their families eating habits.

Role of the Provider in Motivational Interviewing

“The collaborative relationship between patient and provider does not place the provider in the role of “expert” whose job it is to “fix” the patient by disseminating information on what the patient “should do” or dispensing unsolicited advice. Rather, the provider views the patient as an individual with expertise in his or her own behavior that is critical to the success of the behavior change effort. Consistent with this approach, the provider actively

seeks the patient’s input and direction throughout the encounter.”  (DiLillo & West, 2011)

Components of Motivational Interviewing

Motivational interviewing (MI) is a patient interviewing technique that started in substance abuse counseling. This is a non confrontational approach to patient counseling, rather than furthering the provider’s agenda for the patient. Although most MI studies have been conducted in substance abuse settings, recent literature has found beneficial evidence in health promotion.
There are four main points for successful motivational interviewing.

1. Express Empathy: Listening to the patient is important. They will express a reluctance to change and perhaps provide resistance to ideas.
2. Discrepancy Development: This technique involves reviewing the pros and cons of the current situation and the proposed behavior change. Dialogue about the current behavior and misalignment with future goals is warranted, creating a desire to change.
3. Rolling with Resistance: The provider should expect some resistance to change. However, the health care provider should attempt to redirect resistance to motivation by helping to change the patients perspective on their goal and desired outcome. New research shows that change talk predicts an actual change in behavior. (DiLillo & West, 2011). Resistance from the patient may signal to the provider to change their own motivational interviewing techniques. It signals that the push for change is coming from the provider, not the patient.
4. Support Self Efficacy: It has been shown that one of the greatest factors for success if the patients self-efficacy. Self efficacy is described as the confidence to make the proposed changes. Encouragement of the patient’s confidence and autonomy are key elements in behavior change.  (Sothern, Gordon, & Von Alman, 2006, p.63)

Motivational Interviewing Techniques

Motivational Interviewing Techniques

1. Asking open ended questions
2. Reflective listening. Reflective listening dialogue mirrors both sides of the ambivalence.

• “What would happen if you did change?”
• “What would happen if you didn’t?”

3. Affirming statements of recognition, restate what the patient is saying in their own words.

It is the lack of commitment and realistic goals that often lead to intervention failure (Barlow, 2007). Motivational interviewing targets dedication

and attitude toward behavior modification; (Tripp, Perry, Romney, & Blood-Siegfried, 2011)

Motivational Interviewing Styles of Communication

1.Following is a way for the patient to give the provider details about their life that may hinder a weight loss plan.

2,Directing allows the provider to share information with the patience about the risks of staying obese and the benefits of making healthy choices.

3.Guiding allows the provider to give information to the patient to enable them to make the best choice for their lifestyle. (Tripp, Perry, Romney, & Blood-Siegfried, 2011)

Transtheoretical Model and its Use in Motivational Interviewing

The transtheoretical model of intentional behavior

change provides a framework  that helps providers better understand the stages of behavioral change. Patients must progress though five stages of change.

1. “Precontemplation (not yet considering change)
2. Contemplation (considering change),
3. Preparation (planning and committing to change)
4. Action (making the behavior change)
5. Maintenance (maintaining and sustaining long-term change).”

To appropriately target the patient’s readiness for change, the health care provider must understand the patients’ readiness to change and match an effective intervention. This is likely to increase the success of the treatment. Moving beyond the patients readiness stage can cause an increased resistance to treatment. MI includes the notion of accepting the patient as they are in the stage of change, while encouraging healthy behaviors. (Ericksonet al., 2005)