promoting health behavior change in primary care using motivational interviewing april 2011 carolyn...

Promoting Health Behavior Change in Primary CareUsing Motivational Interviewing

April 2011

Carolyn Swenson, MSPH, MSN, FNPcswenson@healthteamworks.org

303-962-8973

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Be Hopeful

Many people are “failed” self-changers (DiClemente, 2003)

Hope from helping professionals can be instrumental in facilitating change

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Spirit of Motivational Interviewing

• *Empathetic

• Collaborative

• Nonjudgmental

• Patient/Family-centered

• Individualized

• Friendly and positive

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General Goals

• Help a person find their own reasons to change

• Be curious and try to understand

• Talk less than the individual/family

• Stay with their readiness to change

• Use more open than close-ended questions

• Reflect back what you hear a person saying

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• What really matters to the person/family?

• How do they see the situation?

• What do they wish they could change?

• What has worked for them in the past?

• What has been frustrating in the past?

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General Techniques

• Ask permission

• Open-ended questions

• Assess readiness to change (for example, using 0-10 ruler)

• Explore ambivalence (look at the pros and cons)

• “Roll with resistance” (don’t argue or try to persuade!)

• Reflective listening (so they hear what they are saying)

• Provide advice and information. Then elicit feedback.

• Summarize (next steps, goals, educational information, referrals)

• End on a positive note (“thank you for having this discussion…”)

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AMBIVALENCEAMBIVALENCE

Both sides of an argument are usually already in a person…

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Explore ambivalence: pros and cons

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“What are the good things about ________?”

“What are the not so good things about________?”

Develop Discrepancy

“So, on the one hand….”

“But, on the other hand…”

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Assess Importance & Confidence

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“On a scale from 0 to 10…”

“How important is it to you to_____?“

“How confident are you that you will be able to_____?“

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Follow-up on 0-10 questions

“Why a 5 and not a 3?”

“What would it take to move from a 6 to an 8?”

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LISTEN !

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Listen for CHANGE TALK

Desire

Ability

Reason

Need

Commitment

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Reflections

Reflect back what you hear so they hear it…

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People are more persuaded by what they hear themselves say than by what someone else tells them*

*Self-Perception Theory

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• “ What things might you like to change about your family’s diet and exercise?”

• “How do you suppose your family life would be different if you did decide to limit screen time to 2 hours a day for the kids?”

• “If you did decide to change your family’s eating habits, what is the first step you would take?”

• “What might it take to make the decision to help the kids get more physical activity?”

• What do you see as your options for making some changes in your family’s diet and physical activity?”

• “What are the best reasons to make this change?”

• “So, where does that leave you now?” “What is the next step?”

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A FEW GOOD QUESTIONS…A FEW GOOD QUESTIONS…

“So, to summarize…”

• Bring the conversation to a close

• Outline next steps and the plan.

• Confirm that you got it right!

• Ask what they need and how you can help:• Information and Educational materials?

• Phone call or Follow-up visit?

• Referral(s)?

• End on a positive note! • “Thank you for having this conversation with me today”

• “It’s great that you plan to take these steps for your child’s health”

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