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Doctors aren’t the only ones who understand the critical importance of healthy living. But often they are the ones who hold the keys to change.
Whether patients need to lose weight, adopt a healthy eating plan or quit smoking, you can play a critical role—particularly when patients are undergoing periods of relapse.
Dr. Bruce Berger, professor at Auburn University, Ala., suggests an approach called “motivational interviewing,” a method of communication used to encourage individuals to change.
When it comes to behavioral change, ambivalence is a common reaction, Dr. Berger said at a recent TRICARE conference. In fact, 70 percent of people who are faced with change do not feel ready to comply.
Dr. Berger suggests taking three to five minutes during patient visits to apply motivational interviewing techniques that can help individuals move past feelings of resistance and through several “stages of change” (see chart). The object is to move patients from one stage to the next rather than directly to action. Once each stage is achieved, action can occur and maintenance of the new behavior can be sustained.
Such motivational interviewing techniques include the following:
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Assess the patient’s readiness to adhere to a prescribed regimen. This can be achieved by discussing “the good things and the less good things.” Discover what the patient likes and dislikes about the proposed changes. Discuss if the patient believes he or she can do what is asked, what will help, and what might be potential barriers.
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Help the patient move forward in the stage continuum by using stagespecific, tailored questioning. Gauge the patient’s lifestyle and how he or she views it. Asking the patient to describe a typical day’s routine will help you to identify dietary needs/problems and exercise habits.
Posing questions such as “What is making it difficult to [insert behavioral change]?” or “What would have to happen in order to implement the change?” enable patients to create their own resolutions.
It is essential that patients recognize the benefits that will come from engaging in the changed behavior. Ask open-ended questions to determine how they believe they will benefit. If they don’t know, or if they don’t list all of the results, it is appropriate to share information to help them see the rewards that will likely come.
Dr. Berger suggests the following during motivational interviews:
When gathering information and assessing patients’ needs: listen carefully, express empathy, help patients make their own decisions, roll resistance, avoid argumentation, develop discrepancy and support self-efficacy.
When eliciting change talk: ask evocative questions, explore readiness, explore the decisional balance, elaborate, query extremes, look back/look forward and explore goals and values.
He also offers an acronym, GAWPOW, as a guide to help health care providers communicate and motivate change:
Goals—Discuss what the new regimen will do for the patient.
Action—Learn what actions are required to achieve results.
When—Establish a start date.
People—Discuss whether individuals or things can offer motivation.
Obstacles—Encourage the patient to be honest and realistic in removing barriers.
What—Establish what the patient will use to measure his or her success.
For more information about motivational interviewing and the stages of change, you can view the presentation Dr. Berger gave to Military Health System providers at the 2005 TRICARE Conference online at the link below.
Additional information can also be found in the June 2004 ACP Observer article, “Strategies to help patients change their behavior,” at the link listed below.
Stages of Change
Dr. Berger’s presentation: www.tricare.osd.mil/conferences/2005/ppt/086BBerger.ppt
ACP Observer article: www.acponline.org/journals/news/jun04/behavior.htm
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