What is motivational interviewing?
Motivational interviewing is a patient-focused method of discussion around a health-based topic, designed to elicit ideas, feelings and motivations around a behaviour and to inspire change. It is most often used when consulting patients on “risky behaviours”, for example, smoking. The theory is to guide the patient’s attention to a positive that they themselves have selected in order to provide motivation to make a change that you want them to make.
Motivational interviewing in action
An example could be considered as follows:
Instead of stating:
“You must quit smoking, otherwise you’re going to have a short life expectancy”
(prescriptive)
One could state:
“If you quit smoking you’ll be more likely to see your children grow up and get married” (motivating)
Finding out what’s important to the patient
Motivational interviewing relies on identifying what is most important to the patient and then framing the change you wish them to make in those terms. In the example above, the patient’s children were of utmost importance to them. By framing the medical issue into a more real and identifiable status, it makes it far more relevant to the patient. Most patients are aware of the dangers of smoking but without giving an achievable target or aim, they will be unlikely to make any changes to their behaviour. Motivational interviewing takes time, and looks at the WHAT (do I have to change), WHY (do I have to change) and HOW (can/should I change) of behaviour. It avoids being prescriptive in nature with a tilt towards guiding the patient to make their own decisions, which can help move people from contemplating change to actually making a change.
Focus on patient-centred care
This technique has been known since its conception by William Miller, a clinical psychologist, and has some evidence to suggest that it is of some benefit. It is taught to healthcare professionals to teach empathy, openness, understanding and communication skills. It fits in well with today’s patient-centred healthcare, where patients must be informed and allowed to make decisions in their health along with the practitioner.
Is motivational interviewing necessary?
Motivational interviewing requires more time (which is ever-lacking) and patience than prescribing a patient a therapy and moving on. A recent Cochrane review (2019) suggested that motivational interviewing might be slightly more likely to help people smoking compared to other therapies, but the evidence was insufficient to make a substantive claim. More likely, is that a combination of motivational interviewing and supportive therapies will lead to a better outcome.
Summary
Motivational interviewing is a valid technique to support patients to enable and support patients to stop smoking. It may be of benefit to patients who are resistant to change, if carried out correctly, and should be remembered as a strategy to manage patients when the opportunity arises.
References:
- Resnicow K, McMaster F. Motivational Interviewing: moving from why to how with autonomy support. Int J Behav Nutr Phys Act. 2012;9:19.
- Lindson N, Thompson TP, Ferrey A, Lambert JD, Aveyard P. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2019, Issue 7.
- Miller WR, Rollnick S. (2012). Motivational Interviewing, Helping People Change, 3rd ed. New York: Guilford Press.
Aadam Anwar is a Surgical Directorate Pharmacist at Luton and Dunstable Hospital, with a keen interest in mental health. He is an advocate for raising awareness and promoting the treatment of mental health in the Muslim community.