Motivational Interviewing: Strategies For Eliciting Behavior Change

Do your patients struggle to follow their treatment plans? Treatment plan adherence is a common concern for many health practitioners, and adherence is often considered a patient-centered issue. However, modifying your own communication style may improve patient health outcomes by enhancing motivation and supporting self-efficacy. A set of techniques known as motivational interviewing involves a highly effective combination of active listening and directing. This communication style can invoke changes in behavior by equipping a patient with the confidence and resources they need to be successful. Continue reading to learn more about motivational interviewing benefits and how you can apply it to your practice.

What is motivational interviewing?

Motivational interviewing (MI) is a patient-centered counseling style and set of techniques employed by practitioners to influence a patient’s behavior and foster intrinsic motivation. MI involves several principles, including reflective listening, shared decision-making, and change talk. (7)

While the practitioner asks open-ended questions and provides advice, the ultimate goal of MI is to encourage autonomous behavioral change and provide the patient with the tools and support they need to take control of their motivations, solutions, and action plans. (7)

Many practitioners commonly use MI to support patients in instances where behaviors can be modified to improve health outcomes. Examples include:

• Chronic disease management (e.g., diabetes, cardiovascular disease)
• Drug and alcohol abuse
• Smoking cessation
• Treatment adherence
• Weight management (3)(6)

Benefits of motivational interviewing

Motivational interviewing is a highly effective strategy for influencing patient behavior. (8) Research demonstrates that MI improves treatment adherence, maximizes your time, and offers cost savings benefits to your patient and practice. (1)(9)

Invokes behavioral change

For about 80% of studies analyzed in a systematic review and meta-analysis, MI was more effective than traditional advice for addressing chronic conditions and behavioral issues in patients. (8) Further research has indicated that MI is particularly helpful for patients needing to improve or modify various factors, such as body weight, human immunodeficiency virus (HIV) viral load, dental health, sedentary behavior, or substance use. (4)

MI has also been shown to be effective in pediatric populations, particularly when parents play an active role in the counseling sessions. One meta-analysis demonstrated that MI was particularly beneficial for eliciting behavioral changes in children with type 1 diabetes, asthma, and low calcium intake. (2)

Improves treatment adherence

A 2017 meta-analysis demonstrated that MI improves medication adherence in adults being treated for chronic conditions. (9) MI has also been shown to improve the prevalent issue of low motivation or suboptimal adherence related to chronic disease management. Addressing these issues through MI can help improve health outcomes. (8)

Saves time and money

MI is intended to provide a brief intervention that can often be delivered in two to four outpatient sessions. Even a single MI session with your patient can be highly effective and may have long-lasting effects that don’t necessitate frequent visits. By minimizing the number of sessions, you can maximize your time and resources while minimizing costs for your patient. (1)

Motivational interviewing techniques

The techniques used in motivational interviewing include asking open-ended questions, stating affirmations, practicing reflective listening, and summarizing reflections. These strategies are sometimes referred to by their acronym OARS. (1)

Open-ended questions

Obtain essential information from your patient by asking open-ended questions versus simple “yes” or “no” questions. Asking open-ended questions encourages your patient to do most of the talking, providing you the opportunity to receive and evaluate as much information as possible before offering advice. (1)

Ask questions such as “what health concerns do you have?” or “what strengths do you have that can help you change your behavior?”.

Affirmations of change talk

Using affirmations, positive statements that acknowledge your patient’s strengths, can promote positive behaviors by giving the patient confidence in their ability to change. Additionally, affirmations can improve rapport and portray empathy. (1)

Listen specifically for change talk, which are statements made by your patient that indicate they’re open to changing a behavior (e.g., “I would like to eat healthier”), and sustain talk, which suggests resistance to change (e.g., “I have no intention of eating healthier”). While it’s essential to discuss perceived barriers and challenges, encourage more change talk than sustain talk. When the conversation strays to sustain talk, redirect the focus back to their strengths and motivations using affirmations. (6)

Examples of affirming responses include “I admire your resilience” or “I appreciate you taking the time to meet with me today”. (1)

Did you know? Change talk is associated with greater motivation and likelihood of behavior change. (5)

Reflective listening

Reflective listening is a strategy that involves restating the meaning of what your patient says in a responsive statement rather than a question. Reflective listening conveys empathy and prompts your patient to explore their issues and feelings. This form of communication increases your understanding of your patient’s concerns, making it an ideal practice to employ, particularly in the early phases of counseling. (1)

When putting this communication technique into practice, try rephrasing your patient’s comments and concerns using synonyms or similar phrases, and confirm with them whether or not your understanding is accurate. You can use phrases such as “it sounds like” or “I hear you saying that”.

Summarization

During a discussion with a patient, periodically summarize some of the main points of the conversation. Summarizing reinforces that you’re closely listening to your patient and provides opportunities for both parties to identify misunderstandings. It’s also helpful to summarize the primary talking points at the beginning and end of each session to ensure you’re both on the same page and that your patient has a clear understanding of what’s needed from them in terms of behavior modifications and next steps. (1)

The bottom line

Motivational interviewing is an effective patient-focused counseling style that elicits behavior change using specific strategies focused on building patient confidence and autonomy and establishing strong communication between patient and practitioner. Examples of effective strategies include asking open-ended questions, using affirmations, practicing reflective listening, and summarizing reflections.

If you use motivational interviewing in your practice, what tips do you have to share? Comment below with the strategies you’ve found most effective.