Duke Health Referring Physicians


Motivational Interviewing: Helping Patients Adopt Healthy Habits

With chronic disease on the rise, physicians have more reasons than ever to help patients adopt healthy habits that can lead to better health outcomes. But simply telling patients to change their behavior rarely has lasting effects, says Lawrence Greenblatt, MD, an internist at the Duke Outpatient Clinic and professor of Medicine in the Duke Department of Community and Family Medicine. Greenblatt says he finds the motivational interviewing technique to be more effective.

The technique involves using open-ended questions to help patients discover their own reasons and solutions for changing health behaviors, explains Krista Hirschmann, PhD, a faculty member of the Academy of Communication in Healthcare and contributor to the Academy’s new book, Communication Rx: Transforming Healthcare Through Relationship-Centered Communication. This process is more likely to translate into long-term behavior change.

Benefits for many patient populations. Motivational interviewing was first used in the drug and alcohol rehabilitation fields, but it’s applicable to any type of behavior change. A growing body of evidence suggests it is effective in improving weight control, cholesterol levels, and medication adherence, for instance.

Currently, the technique is used most often with patients who have multiple chronic conditions, but other patients can also benefit from this type of approach, Hirschmann says. Both she and Greenblatt would like to see more physicians integrate the technique into their practices. “Done right, motivational interviewing takes no more time than traditional advice giving,” Greenblatt notes.

Shortcut approach. Greenblatt uses a shortcut version of motivational interviewing that can fit easily into a typical clinical encounter. In fact, he often starts the conversation with the patient, and then another trained staff member continues working with him or her. Greenblatt first asks patients to rate on a scale of 1 to 7 how important they believe the desired change would be to their health. He then explores their rating, giving them the opportunity to find their own reasons for change. “You want to keep it positive,” he cautions.

Next, he asks patients to rate how confident they are in making the change. If their confidence is on the lower side, he asks them what could increase it. This prompts patients to brainstorm solutions, which are more likely to work because the patient has suggested them.

Hirschmann acknowledges that the approach may seem counterintuitive at first—just telling people what to do may seem like enough, especially when their health is at stake. She encourages doctors to use a little motivational interviewing on themselves, asking, “What would prompt me to change my interviewing behavior?” Just like patients, physicians tend to do what’s familiar, she says. But those who try it build confidence as they see results.