How does Motivational Interviewing fit into a primary care setting where there is a limited amount of time for “patient” consultations? While the Spirit of MI and the fundamental method of MI (OARS) are still applicable to primary care settings, it can be helpful to think about MI in healthcare settings not as a counseling approach, but as a communication style that incorporates respectful communication skills that are sometimes more directive in the context of a brief, structured interview that is common in healthcare settings.
Brief MI in Primary Care Settings
MI in primary care settings works by activating a person’s own motivation to change health behaviors and to adhere to treatment plans. In various clinical trials people exposed to MI are more likely to:
- enter, stay in, and complete treatment
- participate in follow-up visits
- adhere to glucose monitoring and to improve glycemic control
- increase exercise and fruit and vegetable intake
- reduce stress and sodium intake; to keep food diaries
- reduce unprotected sex and needle sharing; to improve medication adherence
- decrease alcohol and illicit drug use
- quit smoking
- have fewer subsequent injuries and hospitalizations (Rollnick, Miller, & Butler, 2008, p. 5)
Three Communication Styles
1. Following: Listening predominates. The goal is to understand the other’s perspective. Following is not necessarily concerned with behavior change.
2. Directing: Taking charge predominates. The goal is to manage behavior and tell others what to do.
3. Guiding: Helping the other find his/her own way predominates. The goal is to help the other find his/her own solutions to problems and make choices about behavior change. (Miller & Rollnick, 2008)
All of these styles of communication are used in everyday life and are best suited to different circumstances. They are often intermixed and skillful communication involves shifting among these styles according to the context and the nature of the relationship.
Three Core Communication Skills
1. Asking: elicits information and meaning in order to develop an understanding of the other’s perspective and experience.
2. Listening: is an active process that communicates understanding of the other’s perspective and experience.
3. Informing: is the primary means for communicating information, wisdom and knowledge to the other (Miller & Rollnick, 2008)
Directing Style relies heavily on informing.
Following Style relies heavily on listening.
Guiding Style relies on a balance of asking, listening and informing. (Miller & Rollnick, 2008)
MI is a refined form of the guiding style which is useful in helping people make decisions about health behavior change that are consistent with the consumer/client/patient’s values, goals and priorities. It relies on a balance of asking open-ended questions, reflective listening and non-judgmental, respectful informing (Miller & Rollnick, 2008).