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Using Motivational Interviewing techniques in Primary Care

Vasumathy Sivarajasingam is a GP Partner working at Hillview Surgery, Perivale, West London.

The NHS Long Term Plan1 aims to support people to live longer, healthier lives through helping them to make healthier lifestyle choices and treating preventable illness early on. Raising awareness alone is not enough. Preventing ill health requires an emphasis on the behaviours. Changing patient behaviour can take years and necessitates sustained resources.

What can we do to support our patients’ lifestyle choices?

The Primary Care Team

GPs spend extensive time counselling patients with psychiatric conditions, unhealthy behaviours and medical adherence issues. We are uniquely placed to hold opportunistic discussions with patients supporting positive lifestyle changes, and we understand the justifications for behavioural change.

As trusted professionals, we frequently are able to develop a good relationship with patients over time, and often get a sense of what motivates patients and hinders their progress.

For patients ambivalent about change, motivational interviewing is more likely to be successful.

A major challenge is the maintenance of productivity while providing counselling. There are several effective, structured counselling strategies developed for use in primary care settings.2 For patients ambivalent about change, motivational interviewing is more likely to be successful.2

Motivational Interviewing

Motivational interviewing (MI) is a focused, patient-centred counselling skill which endeavours to influence patients to make behavioural changes in the interest of their health, by helping them to explore and resolve any uncertainties.3 When motivation is only  external it does not lead to long term adherence. MI relies upon identifying and mobilising the patient’s intrinsic values and goals to stimulate behaviour change.

How can motivational interviewing benefit patients in practice?                       

Patients are often aware or heard of the rational arguments in favour of change. MI is not about telling people what behaviours they should change (for example, giving up smoking or exercising more). It is about helping a person make their own choices and enabling them to find their motivation and commitment to change, in an open and non-judgemental approach.3 People are more likely to engage in behavioural changes when they see the need for that change, rather than someone else saying it.

The role of the Motivational Interviewer is more about listening than intervening.

The role of the Motivational Interviewer is more about listening than intervening. The process often demands repeated consultations with patients, as setbacks are an anticipated part of change.

As clinicians, it is crucial that we recognise that patients are at different stages in their readiness to discuss and accept support, and we must act accordingly to their needs. Change may occur quickly or may take a considerable amount of time, depending on the patient. Knowledge alone is not enough to motivate change. By incorporating MI we can assist patients resolve their uncertainties and hesitancies that may stop them from their inherent want of change in relation to a certain behaviour or habit. In addition, we need to reiterate that it is a partnership, and highlight the importance of working together to achieve the goal set.

For MI to be a success, the clinicians need to be clear on the goals they are trying to achieve, and have interaction skills including asking open ended questions, reflective listening, affirming and reiterating statements back to the patient.3 This will help towards improving patient’s self-confidence for change.

Scenarios where motivational interviewing consulting style can help

MI outperforms traditional advice giving …. being effective even in brief encounters.

MI has been used by various healthcare providers, including psychologists, doctors, nurses and midwives, in many different areas of intervention, both psychological and physiological.4 Evidence suggests MI outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases, being effective even in brief encounters of only 15 minutes.4

People’s lifestyle and behaviours have an important impact on their health, longevity, and quality of life. MI has a vital part to play in modifiable risk factors of diseases such as tobacco use, unhealthy diet, alcohol consumption and physical inactivity. Smoking cessation before the age of 40 years reduces the risk of death associated with continued smoking by about 90 %.5 Changing such behaviours has the potential to increase not only life expectancy as such, but also healthy life expectancy.

Studies have shown that MI has benefitted a wide range of people, including those people suffering from alcohol and drug addiction, mental health issues, living with health issues such as diabetes, treatment of asthma, and plays a vital role in health promotion behaviours (e.g. smoking cessation, increasing physical activity, weight loss) and adherence to treatment and follow-up.3,4,6 A meta-analysis of outcomes across multiple medical conditions found that compared with usual care, MI strategies resulted in an average of 10% to 15% added benefit in patient outcomes such as alcohol consumption, blood pressure readings, body weight, and human immunodeficiency virus viral load.6

No studies have reported MI to be harmful or to have any kind of adverse effect.4

Going Forward

A motivational interviewing style of communication should be integrated into our patient consultations in primary health care. It helps us to work in collaboration, respect the patient’s sense of self and the patient’s autonomy of patients.3

Raising awareness provides patients the knowledge and make them aware of risks, benefits, consequences to others and opportunities to change. This helps the process of behavioural change, comprising reviewing options including available social support, commitment and reward.

Greater success and satisfaction in supporting behavioural change with all lifestyle issues leads to healthier patients, in addition to having a positive impact on drug costs.

References:

  1. https://www.longtermplan.nhs.uk/
  2. Motivational Interviewing
  3. https://en.wikipedia.org/wiki/Motivational_interviewing
  4. https://bjgp.org/content/bjgp/55/513/305.full.pdf
  5. https://pubmed.ncbi.nlm.nih.gov/23343063/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3413190/

 

Featured photo by Ross Findon on Unsplash

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