Motivating Health Behavior Change in Medical Settings: Clinical Applications of Motivational Interviewing

Introduction

A 12-year-old girl visited the emergency department twice in the last 3 months for asthma attacks, yet it is a struggle to get her to take her medication.

A 63-year-old man, recently recuperated from his second heart attack, reaches for a pack of Camels.

A 45-year-old diabetic woman is having trouble finding the time to exercise.

A 10-year-old boy whose body mass index is close to the 95th percentile drinks 2 cans of soda and eats a 12-oz bag of potato chips with his lunch every day.

These patients all have one thing in common. Their physicians or healthcare providers (HCPs) told them they needed to change their habits.

Why don't patients adhere to our recommendations? They know what they are supposed to be doing, and they know the consequences of not following medical recommendations. Patients are tired of being told what to do. Practitioners are frustrated with not being able to effect change. What can we do as practitioners to facilitate adherence? This Clinical Update will focus on Motivational Interviewing (MI) as a method to improve patients' intrinsic motivation for change and engage them as active collaborators in their own health behavior changes. Specifically, we will discuss: MI philosophy and rationale, basic principles of MI, patient-practitioner communication strategies, MI strategies to enhance motivation for change, how to handle patient resistance, and how to incorporate MI into primary care settings. In addition, we will review the evidence for the effectiveness of MI.