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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2013

Motivational Interviewing in the Primary Care Setting 

As anyone who has tried to adopt a healthy behavior or kick a bad habit can attest, change is difficult. A central challenge for many providers is persuading patients to adopt and stick with healthful changes—from losing weight or starting an exercise program to keeping up with a medication regimen or accepting alcohol or drug treatment. But tools like motivational interviewing and programs such as Harvard Pilgrim’s Lifestyle Management Program can help clinicians influence patients to make healthy changes and support patients along the way.

Motivation Interviewing Techniques

Motivational interviewing is a patient-centered method for identifying an individual’s readiness for change and enhancing motivation by exploring and resolving ambivalence about the new behavior. These techniques promote informed decision-making and encourage patients to participate in their own health care.

The principles behind motivational interviewing include:

  • Expressing empathy: By using some of the communication techniques described below, the clinician reassures the patient that ambivalence is normal and helps the patient feel understood.
  • Supporting self-efficacy: Reinforcing that change is possible can instill confidence in patients and motivate them to change.
  • Rolling with resistance: Rather than challenging resistance, the provider focuses on helping patients identify solutions to barriers to change.
  • Developing discrepancy: These interviewing techniques often guide a patient toward presenting arguments for a healthy behavior. Doing so, and recognizing how their current behavior conflicts with their personal goal, can generate motivation.

Motivational interviewing relies on these communication strategies:

  • Open-ended questions: Asking open questions increases the patient’s involvement in the discussion.
  • Affirmations: Positive statements about the patient’s progress provide encouragement and help the patient feel supported.
  • Reflective listening: Engaging in reflective listening—which ranges from simply rephrasing a patient’s statements to providing a more in-depth summary of the patients wants and needs—fosters a sense of understanding and unity.
  • Summary statements: Providing a summary of the goals and plan to move forward can help resolve patient ambivalence and promote change.

Lifestyle Management Program

Motivational interviewing techniques are a cornerstone of Harvard Pilgrim’s Lifestyle Management Program, in which our health coaches help members establish and work toward goals. With a focus on complex cases, the Lifestyle Management Program supplements the work done in a provider’s practice.

The referral process is simple: members complete a health questionnaire and those who indicate that they are interested in coaching receive an outreach call. Providers may also encourage members to complete the health questionnaire if they believe the member would benefit from the program and the additional support.

During one-on-one telephone sessions, the health coach helps interested members identify barriers to wellness and develop a healthy lifestyle roadmap, while promoting self-reliance by offering educational materials and online resources. The coach and member collaborate to establish realistic goals, set milestones, and develop a network of support.

Health coaches employ motivational interviewing to better understand the member’s personal health goals and readiness to change. “Understanding where the individual is coming from is crucial before setting a plan. You can lecture a patient about having diabetes in control but it won’t do any good until they buy in,” explains Catherine McFadyen, director of the Care and Disease Management program.

Tapping into Individual Motivation

With motivational interviewing, the aim is to engage the patient in a productive dialogue, without judgment, about her current situation and reasons for change. It’s not to talk the individual into changing. Often, a patient is ambivalent and perceives that she has valid reasons not to change.  If this ambivalence isn’t adequately understood and managed, there’s a higher likelihood that the patient won’t comply with the plan and the treatment will fail. 

The chances of a new behavior taking root are greater when a coach helps a member identify their individual rationale for making the change. The patient’s own reasons for changing are much more powerful motivators than outside persuasion or coercion.  

As one member wrote about Lifestyle Management Program, “Together we set reasonable goals for each month, always with an eye toward what I wanted to achieve longer term.  We discussed what was working well and what needed a new approach, and she helped me strategize how I could meet my family's nutritional needs, as well as my own. That sounds simple but it was not, and this was the kind of thing that had made it so difficult for me to really change my habits in the past.”

Now the member’s blood pressure is lower and she’s steadily losing weight. Better still, she feels empowered to keep improving her health. “I take pride in my modest weekly achievements. Something very important now seems obvious:  I can succeed long term even if I fall back once in a while, and I don't need to spend time getting mad at myself for that as long as I start again and keep trying to move forward.”

To refer a patient to the Lifestyle Management Program, e-mail healthandwellness@harvardpilgrim.org. Also for complex clinical situations, United Behavioral Health (UBH) is available to provide consultative assistance.

Practitioners can call the UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call UBH at (888) 777-4742.

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