Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP

Be Hopeful Many people are “failed” self-changers ( DiClemente, 2003 ) Hope from helping professionals can be instrumental in facilitating change 2

Spirit of Motivational Interviewing *Empathetic Collaborative Nonjudgmental Patient/Family-centered Individualized Friendly and positive 3

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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 5

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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? 7

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…”) 8

AMBIVALENCE AMBIVALENCE Both sides of an argument are usually already in a person… 9

Explore ambivalence: pros and cons 10 “ 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…” 11

Assess Importance & Confidence 12

“On a scale from 0 to 10…” “How important is it to you to_____?“ “How confident are you that you will be able to_____?“ 13

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?” 14

LISTEN ! 15

Listen for CHANGE TALK D esire A bility R eason N eed Commitment 16

Reflections Reflect back what you hear so they hear it… 17

People are more persuaded by what they hear themselves say than by what someone else tells them* * Self-Perception Theory 18

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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?” 20 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” 21