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Putting prevention into practice (Green Book)


Motivational interviewing and brief behavioural interventions are useful skills that help the GP assist patients to change their health related behaviour. 'Motivational interviewing' has been defined as 'a directive, patient centred counselling style for eliciting behaviour change, by helping patients to explore and resolve ambivalence' and has been shown to be effective in a number of areas in the primary care setting, including smoking cessation, hazardous drinking, physical activity, nutrition and diet, and chronic disease.

Patients vary greatly in their motivation to change behaviour and to adhere to treatment plans for chronic disease. Addressing behaviour change is one of the biggest challenges the GP faces in prevention. Complementary approaches to addressing motivation are:

  • focus on the practical and circumstantial factors that might inhibit motivation (eg. patients' understanding of the health issues, belief in their ability to change, cultural and gender differences)
  • use of motivational interviewing techniques to explore and understand the patient's motivation. This is a useful approach when patients show a degree of ambivalence.

Motivational interviewing involves systematically directing the patient toward motivation to change, offering advice and feedback when appropriate, selectively using empathetic reflection to reinforce certain processes and seeking to elicit and amplify the patient's discrepancies about their health related behaviour to enhance motivation to change.

Patients will be motivated to make changes if they believe there are benefits and that the costs of remaining the same are high. However, if patients believe there are few benefits arising from the specific behaviour, and significant costs associated with making a change, they are likely to remain unmotivated (Figure 6).

Figure 6. Cost benefit balance