7 tools to help patients adopt healthier behaviors

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Applied Evidence

7 tools to help patients adopt healthier behaviors

J Fam Pract. 2015 February;64(2):97-100,102-103

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References

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Motivational interviewing

In contrast to a deficit model (“You are lacking something; I have it, and I will install it in you”), motivational interviewing focuses on strengths (“You have what you need, and together we will find it”).For patients who are in the Precontemplation or Contemplation stages of change, MI might be a helpful approach. MI is a person-centered counseling style that addresses ambivalence about change while strengthening internal motivation for, and commitment to, change. It originally was used in addiction treatment, but has since been studied for and applied to a wide variety of medical and psychological conditions.³⁴

MI has an underlying perspective (often called the “spirit” of MI) that includes partnership, acceptance, compassion, and evocation.³⁴ Partnership implies a respectful collaboration between equals—while the FP may be an expert on a particular diagnosis, the patient is the expert on herself. Acceptance is unconditional positive regard and involves a nonjudgmental and person-centered recognition of an individual’s absolute worth and potential that supports autonomy and affirms strengths. Compassion is the sense of actively promoting a patient’s well being and prioritizing his or her needs over your own. Evocation refers to calling forth the patient’s own wisdom based on a realization that the patient has motivation and resources that can be elicited.

In contrast to a deficit model (“You are lacking something; I have it, and I will install it in you”), MI focuses on strengths (“You have what you need, and together we will find it”).

The skills of MI are practiced in a series of 4 sequential and overlapping processes known as Engaging, Focusing, Evoking, and Planning.³⁴ Engaging is establishing a helpful connection and working relationship with a patient. Focusing is developing and maintaining a specific direction toward a goal (or goals). Evoking is eliciting the patient’s own motivations for change. Planning is developing commitment to change and formulating a specific action plan. Five core communication skills are used flexibly and strategically during these 4 processes: asking open questions, affirming, reflective listening, summarizing, and informing and advising with permission.³⁴

Putting MI into action

Motivational interviewing focuses on a patient’s strengths and elicits the patient’s own motivations for change.CASE › An FP who wants to use MI with Mr. G would begin the Engaging and Focusing processes by asking permission: “May I ask you a question about weight loss?” If Mr. G says Yes, the FP would start the process of Evoking using scaling questions, such as: “On a scale of one to 10, where one means it’s not at all important, and 10 means that it’s very important, how important to you is losing weight?" (Mr. G: “I’d say 9, it is very important to me.”) “On a scale of one to 10, where one means that you are not at all confident, and 10 means that you are extremely confident, how confident are you that you can lose weight?” (Mr. G: “I’m a 6.”)

“Why are you at 6 rather than 1?” (Mr. G: “I have lost a few pounds in the past, so I know a little bit about losing weight.”) “What would have to happen for you to get to 7, that is, for you to become just a little bit more confident?” (Mr. G: “I would need to get my family’s support.”)

The FP would implement the Planning process by suggesting that Mr. G talk to his wife about taking a walk with him after dinner and buying skim milk instead of 2%.

CORRESPONDENCE
Michael Raddock, MD, Department of Family Medicine, MetroHealth Medical Center; 2500 MetroHealth Drive, Cleveland, Ohio 44109; mraddock@metrohealth.org