The new year is a good time for clinicians to encourage behavior change in patients.
Motivational interviewing techniques, such as asking open-ended questions, can facilitate more successful counseling sessions to encourage lifestyle changes.
Healthcare professionals (HCPs) should try to avoid the “righting reflex” of giving unwanted advice to correct patients’ behavior, focusing instead on boosting their confidence about the benefits of changing their lifestyles.
Patients know that a healthy lifestyle is essential for their well-being, but change is hard. As a result, trying to convince them to exercise daily, eat a balanced diet, or quit smoking may feel like a wasted effort.
Fortunately, you can leverage patients’ resolution-fueled high motivation levels at the start of a new year by using motivational interviewing (MI) techniques to set them on the path toward lasting change.
How does motivational interviewing work?
Motivational interviewing is a science-backed strategy for behavior change that relies on establishing a partnership with patients rather than assuming an authoritarian role, according to research published by Deutsches Ärzteblatt International. This style of counseling begins with the patient’s willingness to change.
One of the primary goals of MI is to encourage “change talk,” which entails getting the patient to consider and verbalize the positive aspects of committing to a desired goal (like drinking less alcohol or monitoring their blood pressure).
Studies documented in a meta-analysis published by the Journal of Consulting and Clinical Psychology linked change talk to shifts in patient behavior.
Clinicians can reinforce positive change talk through reflections and affirmations that help encourage patients to act on their goals.
Even unmotivated patients can benefit from MI because it helps to reduce resistance and builds a foundation where change becomes possible.
Use MI to keep patients on track
Open-ended questions are a fundamental aspect of MI. However, time restrictions during medical appointments could make physicians hesitant to invite patients to elaborate on their feelings.
Learning to ask open-ended questions with clear intent and following up with a pointed reflection can help keep the conversation from veering off track, as recommended by an article published in Australian Family Physician.
Here’s an example of this method for guiding a conversation.
Physician: If you were going to change one thing about your health and lifestyle, what would it be?
Patient: I know I should stop smoking, but I’ve tried a million times and don’t think I can succeed. And part of me enjoys smoking, even though it’s bad for me.
Physician: It sounds like quitting is important to you, but you’re not sure if you can do it. You also said that part of you likes to smoke. What are the negative aspects of smoking for you?
In this scenario, the physician rolled with the patient’s resistance and redirected the conversation to focus on the reasons for change. If a patient responded by saying they would get sick less often or save money by not smoking, the physician could then affirm those benefits by paraphrasing them in a reflection.
Patients who feel heard and understood are less resistant to taking advice and setting goals, resulting in a more effective counseling session.
Avoid the ‘righting reflex’
Some healthcare professionals (HCPs) may struggle with a “righting reflex”—defined in the Australian Family Physician research as the urge to correct unhealthy behaviors by giving unsolicited advice.
Unfortunately, this authoritarian style of counseling could backfire if patients put their walls up. A back-and-forth conversation where the physician shares the benefits of change—and the patient responds with the reasons they can’t or won’t change—is counterproductive.
Instead, HCPs must resist the temptation to push for change and instead, elicit a patient’s inner desire for change. To do this, ask for permission before giving advice.
For instance, rather than directing a patient to use nicotine patches to quit smoking, ask if they are interested in learning more about nicotine replacement therapies. If they say no, respect their response and turn the conversation back to them by asking if there are any resources or education you could provide to support their goals.
Boost patient’s confidence levels
Don’t be surprised when a patient declines the offer of physician advice.
Many patients feel they’ve heard it all before and have tried various ways to achieve their goals to no avail. If that’s the case, focus on their confidence level. Once you and the patient establish the benefits of making a change, ask how confident they feel about achieving it on a scale of 1 to 10.
Follow up by challenging the patient to consider what it would take to raise their confidence level. Then, ask them to share examples of times in the past when they have achieved difficult goals, overcome challenges, or made successful changes.
Reinforcing those examples can help improve their ability to view change as a possibility—as will setting small goals, like smoking one less cigarette per day instead of quitting cold turkey.
Using methods such as these may help HCPs motivate patients to follow through on their resolutions and make real changes to the way they live in the interest of their ongoing health and well-being.
What this means for you
At the start of a new year, many patients are highly motivated. HCPs can take advantage of this time of year to help patients implement important lifestyle changes. Using the motivational interviewing technique can help build trust with your patients and encourage them to follow through on their health goals, even when they’re resistant to change.