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Clinical guidelines

SNAP Guide

Motivational interviewing

Motivational interviewing is a non-confrontational client-centred counselling strategy aimed at resolving ambivalence and increasing a person’s motivation to change.20 It is an acknowledged care skill required by a wide range of healthcare workers.21–26 There is strong evidence of the benefit and impact a motivational interviewing approach has on health outcomes in a number of areas, including lifestyle change, chronic disease and adherence.27–37

Motivational interviewing involves:38

  • helping the patient to identify areas for change
  • highlighting any discrepancies between present behaviour and broader goals
  • encouraging the patient to examine the benefits they would experience from improving their lifestyle (eg. nutrition, physical activity) and self-management skills
  • asking the patient to compare potential outcomes if they do make changes versus if they do not
  • asking the patient to identify any challenges, barriers or negative aspect involved in making improvements (eg. costs, access to good food)
  • helping the patient determine specific and achievable solutions to the challenges, barriers and negative aspects involved in change
  • establishing the patient’s motivation and confidence to make changes
  • asking the patient to summarise, in their own words, their goals and how they are going to achieve them.

There are various contributors and barriers to consider when determining the best approach to assess and assist behavioural change, including cultural issues, physical environment/residence, beliefs and expectations, literacy, interest and motivation, addictive behaviour, coping style, and emotions and mood.

For patients who are not confident about their ability to succeed, various methods can be used to help them commit to making a change (refer to the list above). Asking patients to weigh up the pros and cons of making a change versus staying the way they are is a common technique. This is called ‘decision balance’ and can help patients decide whether to immediately make a change.

For those patients who are ready to make a change, time can be spent explaining and planning how they can make that change. Patients who have already made a change may require follow-up to monitor progress and deal with any relapses or difficulties.

The process provides insight into the issues that patients have around their health-related lifestyle and the importance, motivation and ability to make any changes in their behaviour. 

References

  1. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009;64(6):527–37.
  2. Lupu AM, Stewart AL, O’Neil C. Comparison of active-learning strategies for motivational interviewing skills, knowledge, and confidence in first-year pharmacy students. Am J Pharm Educ 2012;76(2):28.
  3. Daeppen JB, Fortini C, Bertholet N, et al. Training medical students to conduct motivational interviewing: a randomized controlled trial. Patient Educ Couns 2012;87(3):313–8.
  4. Anstiss T. Motivational interviewing in primary care. J Clin Psychol Med Settings 2009;16(1):87–93.
  5. Hinz JG. Teaching dental students motivational interviewing techniques: analysis of a third-year class assignment. J Dent Educ 2010;74(12):1351–6.
  6. White LL, Gazewood JD, Mounsey AL. Teaching students behavior change skills: description and assessment of a new Motivational interviewing curriculum. Med Teach 2007;29(4):e67–71.
  7. Burke PJ, Da Silva JD, Vaughan BL, Knight JR. Training high school counselors on the use of motivational interviewing to screen for substance abuse. Subst Abus 2005;26(3–4):31–4.
  8. Butler CC, Simpson SA, Hood K, et al. Training practitioners to deliver opportunistic multiple behaviour change counselling in primary care: a cluster randomised trial. BMJ 2013;346:f1191.
  9. Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr Phys Act 2012;9:22.
  10. Taggart J, Williams A, Dennis S, et al. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract 2012;13:49.
  11. Macdonald P, Hibbs R, Corfield F, Treasure J. The use of motivational interviewing in eating disorders: a systematic review. Psychiatry Res 2012;200(1):1–11.
  12. Hardcastle S, Blake N, Hagger MS. The effectiveness of a motivational interviewing primary-care based intervention on physical activity and predictors of change in a disadvantaged community. J Behav Med 2012;35(3):318–33.
  13. Chilton R, Pires-Yfantouda R, Wylie M. A systematic review of motivational interviewing within musculoskeletal health. Psychol Health Med 2012;17(4):392–407.
  14. Soderlund LL, Madson MB, Rubak S, Nilsen P. A systematic review of motivational interviewing training for general health care practitioners. Patient Educ Couns 2011;84(1):16–26.
  15. Smedslund G, Berg RC, Hammerstrom KT, et al. Motivational interviewing for substance abuse. Cochrane Database Syst Rev 2011;5:CD008063.
  16. Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. J Consult Clin Psychol 2011;79(4):433–40.
  17. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2011;12(9):709–23.
  18. Lai DT, Cahill K, Qin Y, Tang JL. Motivational interviewing for smoking cessation. Cochrane Database Syst Rev 2010(1):CD006936.
  19. Sharing Health Care: Guidelines for General Practitioners working with Chronic Conditions Melbourne: The Royal Australian College of General Practitioners; 2001.

 

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