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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.