Motivational Interviewing for Health Behaviour

Motivational Interviewing (MI) aims to help patients identify and change behaviours that place them at risk of developing health problems.

This article will enable you to gain knowledge of the stages of change and the principles of MI. By the end you will be able to put into practice the principles of MI.

When to Use Motivational Interviewing

MI is a useful tool when discussing health behaviours. Health behaviours are any behaviour relating to health, for example exercise, smoking, food and alcohol consumption.

The reason we are interested in health behaviours is because they can influence health for better or worse.

Health Behaviour Examples

Examples of harmful behaviours:

• Smoking is related to lung, throat and stomach cancer, coronary heart disease (CHD), emphysema.
• Alcohol consumption is related to liver cirrhosis, pancreatic and liver cancer, hypertension and memory deficits.

Examples of beneficial behaviours:

• Exercise is linked to reduction in weight, increased longevity, protection against osteoporosis and improved self-confidence.
• Reduction in weight, through diet and exercise, is linked to enhanced wellbeing and improved blood pressure, along with a reduction in CHD and diabetes risks.

Health professionals can help people by telling them about healthy food choices and motivating them to change.

What is Motivational Interviewing?

MI was developed to help people consider changing their behaviour and increase their motivation to change (Miller & Rollnick, 1992). It doesn’t show people how to change but motivates them to want to change.

The theory that underpins MI is the Transtheoretical Model, which is also known as the stages of change (Prochaska et al. 1985; Prochaska & Goldstein 1991; Prochaska & Velicer 1997). In this model people show different levels of motivation at different stages of behaviour change. The stages are shown in the figure below:

Figure 1: The Transtheoretical Model or Stages of Change

Stages of Behavioural Change

The stages of behaviour change include:

• Pre-contemplation: not intending to make any changes
• Contemplation: considering a change
• Preparation: making small changes
• Action: actively engaging in a new behaviour
• Maintenance: sustaining the change over time
• Relapse: fall back into old behaviours

Once the current stage the client is in has been identified, the support offered can be tailored to their readiness to change.

We can use MI to support clients in the process of moving from not ready, through to motivation to change, then to actually changing their behaviour. The MI approach is respectful, client-centred, evocative, collaborative and empowering.

How do we do Motivational Interviewing?

Rollnick, Mason and Butler (1999) set out the key tasks in consultations about behaviour change.

• Establish rapport by being friendly, relaxed and actively listening.
• Set agenda collaboratively, where the client can prioritise a behaviour to address.
• Assess the importance, confidence and readiness to change.
• Explore the importance of change further, by probing the pros and cons of the behaviour.

Building confidence is a key aspect of motivating people and them ultimately being successful in changing their behaviour.

Key Skills for Motivational Interviewing:

• Open ended questions e.g. about readiness, importance, confidence, pros and cons of change/no change.
• Affirmations to build confidence e.g. recognising strengths, successes, and efforts to change.
• Reflections e.g. repeating, re-phrasing or paraphrasing what has been said.
• Summaries e.g. listen carefully and summarise what has been said.

An easy way to remember this is the acronym ‘OARS’.

Motivational Interviewing – ‘Rolling with Resistance’

When using MI you need to listen out for resistance talk e.g. “I don’t want to change” and roll with this resistance. You can use the key skills above, to encourage change talk e.g. “I ought to change”.

To roll with resistance you can use scaling to help the client assess their own readiness to change e.g. “how important is it for you to make the change on a scale of 1 not important to 10 very important?” Building confidence is also an important aspect which can be probed e.g. “what strengths do you have that you might use to help you succeed?”

To shift gears and move the client forward, you can support the individual to create a change plan to change their behaviour. For example, “the changes I want to make are…” or “the steps I plan to take to make this change are…”.

The Nutrition for Health and Sustainability course will build your understanding of what makes up a healthy and sustainable diet. By using motivational interviewing, you will be able to support others in changing their behaviour for improved health and quality of life.

What we would like you to do

1. Take a few minutes to think about a situation where you have tried to get someone to change their behaviour in either a professional or personal setting. How did you approach this and what challenges did you face?
2. Consider the statements below and what you would do if they came up in a consultation. Try forming a reflective statement that you could use to respond to the statements.

“Sometimes I have good intentions and try to eat healthier for a few days, but my willpower breaks down really quickly.”

“I worry that if I keep going on like this, I’ll have a heart attack.”

“I know it’s bad for me, but one bad habit isn’t that bad, I’d be a lot more boring if I didn’t have something, you know?”

Author: Dr. Amelia Hollywood