Motivational Interviewing - Motivating Patients to Adopt a Healthier Lifestyle

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Transcript - Motivational Interviewing - Motivating Patients to Adopt a Healthier Lifestyle

(Opening montage of various images of people exercising, eating well, meeting with their doctor, with music playing in the background.)

Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle
Minimal Intervention

(Background music fades, then stops. DR. VALLIS and DR. SELBY are standing in a waiting room. We can see an empty reception area in the background. They are alone. They each address the camera directly.)

Text on screen:
Dr. Peter Selby
Centre for Addiction and Mental Health
University of Toronto

DR. SELBY: For primary care physicians, motivational interviewing is about shifting focus from the messages we send to how those messages are received by our patients. This requires us to listen more closely to the patient to understand their perspective, and to work collaboratively to establish goals and tackle the barriers that prevent behaviour change.

Text on screen:
Dr. Michael Vallis
Queen Elizabeth II Health Sciences Centre
Dalhousie University

DR. VALLIS: The challenge is that physicians usually only have a few minutes to discuss behaviour with their patients. So we use what’s called minimal intervention: a straightforward way of applying the principles and techniques of motivational interviewing when time is short.

DR. SELBY: It gives you a checklist on what to do next, helping you stay on track and avoid long, meandering conversations. It also allows you to break the intervention into separate components, which is useful when you only have time to implement part of the intervention.

DR. VALLIS: Here we’re going to talk about two minimal intervention strategies: one to start behaviour change and the other to maintain the focus on change once recommendations have been made.

(Low background music. Narration of DR. VALLIS over text on screen.)

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The 5As: Starting Change
Ask
Assess
Advise
Assist
Arrange

DR. VALLIS: The first is called the 5As: Ask, Assess, Advise, Assist and Arrange.

(Background music fades, then stops. Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

DR. VALLIS: As you’re about to see, these are ideal for introducing issues, making recommendations and beginning behaviour modification.

(DR. SELBY and a female PATIENT are interacting in an examining room.)

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Ask

DR. SELBY: Thanks for coming in today. I would like to talk to you a little bit about your drinking. Would that be okay?

PATIENT: Yes.

DR. SELBY: Great. Excellent.

(Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

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Ask

DR. VALLIS: Asking permission to talk about the patient’s behaviour helps set the foundation for a nonjudgmental conversation.

(Background music)

Text on screen:
Ask
Asking permission sets the foundation for a nonjudgmental conversation.

(Background music fades, then stops.)

Text on screen:
Ask

DR. VALLIS: Asking is also a useful way to screen for a particular behaviour: for example, to determine if the patient smokes, drinks, is physically inactive or has unhealthy eating habits. This is an important first step that should be proactively applied to all of your patients.

(Background music)

Text on screen:
Ask
Screening for specific behaviours is an important first step.

(Background music fades, then stops. The interaction between DR. SELBY and the female PATIENT in the examining room resumes.)

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Assess

DR. SELBY: Would you be comfortable if I tried to help you reduce your drinking?

PATIENT: Sure.

DR. SELBY: Great.

(Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

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Assess

DR. VALLIS: The patient’s readiness to change can be assessed by asking general questions, for example, whether their behaviour has become a problem for them, and by using tools such as a readiness ruler or Stages of Change.

(Background music)

Text on screen:
Assess
Ask general questions to determine the patient’s readiness to change.

(Background music fades, then stops. The interaction between DR. SELBY and the female PATIENT in the examining room resumes.)

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Advise

DR. SELBY: Now that I have a better understanding of the problem, would it be okay if I recommended ways in which you can reduce the risk from alcohol?

PATIENT: Okay.

DR. SELBY: Great. So for women especially, if you can limit the amount of alcohol you have to no more than two drinks on any given day, and you also have a day of the week where you drink no alcohol, you can substantially reduce your risk from drinking. How does this sound to you?

PATIENT: I think I can do that.

DR. SELBY: Excellent.

(Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

Text on screen:
Advise

DR. VALLIS: The first two ways establish a collaborative relationship that acknowledges the complexity of the patient’s situation. The next step is to ask permission to give advice. If the patient agrees, you can then create a clinical management plan.

(Background music)

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Advise
Once you have permission to give advice, work with the patient to create a clinical management plan.

 (Background music fades, then stops. The interaction between DR. SELBY and the female PATIENT in the examining room resumes.)

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Assist

DR. SELBY: So, based on the plan we discussed, what might be a challenge in the completion of this goal for you?

PATIENT: When I go out with friends.

DR. SELBY: Right. That can be hard. Would it be okay if I shared some ideas of how you can manage that as well?

PATIENT: Sure.

DR. SELBY: Okay. So one thing that happens is that when we are out with friends, we often feel like we have to keep drinking to keep them company because it’s the social thing to do. One way in which you can spread your drinks across the evening is to alternate a drink of alcohol with a glass of water. And if you can make that drink last an hour, and then have a glass of water that lasts another hour, then in a four-hour evening, you’ve been able to stretch two drinks without seeming anti-social or, you know, against the grain of what’s going on. What do you think about that?

PATIENT: I think that could work.

DR. SELBY: That’s great, yeah.

(Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

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Assist

DR. VALLIS: Once you have a plan in place, you can propose realistic goals. Be clear that you’re not responsible for solving the patient’s problems. You’re there to support them in reaching their goals.

(Background music)

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Assist
You’re not responsible for solving the problem—you’re there to lend support.

(Background music fades, then stops. The interaction between DR. SELBY and the female PATIENT in the examining room resumes.)

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Arrange

DR. SELBY: To stay on track, often it’s helpful to get other people to assist you. So who do you think, you know, in your family and your friends, who might be able to assist you achieve this goal?

PATIENT: I think my husband could.

DR. SELBY: Your husband – that’s great. And when would it be helpful for you to come back and see me and talk more about how this is going?

PATIENT: Maybe in a few months?

DR. SELBY: That’s great, yeah. That sounds like a plan.

(Dr. VALLIS is standing alone in the waiting room. He addresses the camera directly.)

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Arrange

DR. VALLIS: Finally, focus on what will happen after the patient leaves your office and the community and family resources your patient can rely on for support. Be sure to arrange any follow-up appointments with yourself and any other appropriate healthcare providers.

(Background music)

Text on screen:
Arrange
Focus on community and family resources the patient can rely on after leaving your office.

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The 5Rs: Sustaining Change
Relevance
Rewards
Risks
Roadblocks
Repeat

(Narration by DR. SELBY over the text on screen.)

DR. SELBY: The 5Rs stand for relevance, rewards, risks, roadblocks and repeat.

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly. (Background music fades, then stops.)

DR. SELBY: And they focus on counselling a patient who is not yet ready to take action. As you’ll see, it’s important to be direct and transparent in your questions to draw out personal and meaningful answers.

(DR. VALLIS and a female PATIENT are interacting in an examining room.)

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Relevance

DR. VALLIS: Can you tell me in what way this change that we’re talking about is relevant to you for your health?

PATIENT: Well, it’ll lower my blood pressure and I’m going to lose weight, which is…

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly.)

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Relevance

DR. SELBY: This is the starting point, where you explore with the patient how important the behaviour change goal is to them.

(Background music)

Text on screen:
Relevance
Explore the patient’s willingness to change and the importance of achieving their goals.

(Background music fades, then stops. The interaction between DR. VALLIS and the female PATIENT in the examining room resumes.)

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Rewards

DR. VALLIS: So, can you tell me what’s good about staying the same?

PATIENT: I feel good when I walk and it’s a great way to manage stress.

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly.)

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Rewards

DR. SELBY: Next, seek to understand the patient’s perspective on the positive aspects of not changing behaviour. This shows you’re not being judgmental and that you respect their autonomy. It also helps prevent the patient from becoming too defensive about their behaviour.

(Background music)

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Rewards
Seek to understand, from the patient’s perspective, the advantages of not changing behaviour.

(Background music fades, then stops.) The interaction between DR. VALLIS and the female PATIENT in the examining room resumes.)

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Risks

DR. VALLIS: Can you tell me, are there any downsides of not changing?

PATIENT: Oh, there’s many downsides, like we can…

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly.)

Text on screen:
Risks

DR. SELBY: By the same token, ask questions that help the patient identify the personal disadvantages of not changing their behaviour. Reflect the dilemma to the patient, then ask what the next steps might be and if you have permission to help.

(Background music)

Text on screen:
Risks
Identify the disadvantages of not changing behaviour. Reflect the dilemma to the patient and ask permission to help.

(Background music fades, then stops. The interaction between DR. VALLIS and the female PATIENT in the examining room resumes.)

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Roadblocks

DR. VALLIS: If you did decide to change, can you identify any obstacles that might get in your way from achieving your goals and how might you overcome those?

PATIENT: Well, I think, you know, when you get into a routine, then, then there’s also…

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly.)

Text on screen:
Roadblocks

DR. SELBY: Here’s where some real, constructive honesty is required. What are the barriers or temptations that make it hard to change? Ask questions that encourage the patient to take personal responsibility for solving and overcoming the challenges they face in themselves and in their environment.

(Background music)

Text on screen:
Roadblocks
Identify the barriers to change. Encourage personal responsibility for solving and overcoming these challenges

(Background music fades, then stops. The interaction between DR. VALLIS and the female PATIENT in the examining room resumes.)

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Repeat

DR. VALLIS: And now, can you remind me of what the relevance of these health changes are for you and your goals?

PATIENT: Well, weight loss is a big one. And of course, lowering your blood pressure and your calories and…

(Dr. SELBY is standing alone in the waiting room. He addresses the camera directly.)

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Repeat

DR. SELBY: Finally, remind yourself that the first four Rs need to be explored and reviewed consistently to help the patient integrate specific behaviour changes into their lifestyle.

(Background music)

Text on screen:
Repeat
Explore and review the Rs at each follow-up visit to help patients integrate behaviour change into their lifestyles.

(DR. VALLIS and DR. SELBY are back together in the waiting room. They each address the camera directly.)

DR. VALLIS: The 5As and 5Rs are basic but effective motivational and behaviour change strategies. For a sense of how they actually work, let’s look at some scenarios. I’ll walk you through examples related to unhealthy eating and physical inactivity.

DR. SELBY: And I will show you how to use the 5As and 5Rs in situations dealing with smoking and alcohol misuse. Watching the vignettes will give you a practical sense of how to use the principles, and hopefully build your confidence and effectiveness in helping patients adopt healthy behaviours. And if you’d like more information, be sure to check out some of the additional resources found on the ''Prevention in Hand'' website.

Text on screen:
preventioninhand.ca

(Fade to black.)

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THE COLLEGE OF FAMILY PHYSICIANS OF CANADA LOGO

Production of this video was made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.