![Page 1: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/1.jpg)
Promoting Health Behavior Change in Primary CareUsing Motivational Interviewing
April 2011
Carolyn Swenson, MSPH, MSN, [email protected]
303-962-8973
1
![Page 2: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/2.jpg)
Be Hopeful
Many people are “failed” self-changers (DiClemente, 2003)
Hope from helping professionals can be instrumental in facilitating change
2
![Page 3: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/3.jpg)
Spirit of Motivational Interviewing
• *Empathetic
• Collaborative
• Nonjudgmental
• Patient/Family-centered
• Individualized
• Friendly and positive
3
![Page 4: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/4.jpg)
4
![Page 5: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/5.jpg)
General Goals
• Help a person find their own reasons to change
• Be curious and try to understand
• Talk less than the individual/family
• Stay with their readiness to change
• Use more open than close-ended questions
• Reflect back what you hear a person saying
5
![Page 6: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/6.jpg)
6
![Page 7: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/7.jpg)
• What really matters to the person/family?
• How do they see the situation?
• What do they wish they could change?
• What has worked for them in the past?
• What has been frustrating in the past?
7
![Page 8: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/8.jpg)
General Techniques
• Ask permission
• Open-ended questions
• Assess readiness to change (for example, using 0-10 ruler)
• Explore ambivalence (look at the pros and cons)
• “Roll with resistance” (don’t argue or try to persuade!)
• Reflective listening (so they hear what they are saying)
• Provide advice and information. Then elicit feedback.
• Summarize (next steps, goals, educational information, referrals)
• End on a positive note (“thank you for having this discussion…”)
8
![Page 9: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/9.jpg)
AMBIVALENCEAMBIVALENCE
Both sides of an argument are usually already in a person…
9
![Page 10: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/10.jpg)
Explore ambivalence: pros and cons
10
“What are the good things about ________?”
“What are the not so good things about________?”
![Page 11: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/11.jpg)
Develop Discrepancy
“So, on the one hand….”
“But, on the other hand…”
11
![Page 12: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/12.jpg)
Assess Importance & Confidence
12
![Page 13: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/13.jpg)
“On a scale from 0 to 10…”
“How important is it to you to_____?“
“How confident are you that you will be able to_____?“
13
![Page 14: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/14.jpg)
Follow-up on 0-10 questions
“Why a 5 and not a 3?”
“What would it take to move from a 6 to an 8?”
14
![Page 15: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/15.jpg)
LISTEN !
15
![Page 16: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/16.jpg)
Listen for CHANGE TALK
Desire
Ability
Reason
Need
Commitment
16
![Page 17: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/17.jpg)
Reflections
Reflect back what you hear so they hear it…
17
![Page 18: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/18.jpg)
People are more persuaded by what they hear themselves say than by what someone else tells them*
*Self-Perception Theory
18
![Page 19: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/19.jpg)
19
![Page 20: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/20.jpg)
• “ What things might you like to change about your family’s diet and exercise?”
• “How do you suppose your family life would be different if you did decide to limit screen time to 2 hours a day for the kids?”
• “If you did decide to change your family’s eating habits, what is the first step you would take?”
• “What might it take to make the decision to help the kids get more physical activity?”
• What do you see as your options for making some changes in your family’s diet and physical activity?”
• “What are the best reasons to make this change?”
• “So, where does that leave you now?” “What is the next step?”
20
A FEW GOOD QUESTIONS…A FEW GOOD QUESTIONS…
![Page 21: Promoting Health Behavior Change in Primary Care Using Motivational Interviewing April 2011 Carolyn Swenson, MSPH, MSN, FNP cswenson@healthteamworks.org](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfdd1a28abf838cb1a8e/html5/thumbnails/21.jpg)
“So, to summarize…”
• Bring the conversation to a close
• Outline next steps and the plan.
• Confirm that you got it right!
• Ask what they need and how you can help:• Information and Educational materials?
• Phone call or Follow-up visit?
• Referral(s)?
• End on a positive note! • “Thank you for having this conversation with me today”
• “It’s great that you plan to take these steps for your child’s health”
21