Statistically significant results were only elucidated upon statistical adjustments and examination of behaviours individually. Potential effective components of CBI include setting up environmental reminders, addressing misconceptions and skills-training while that of MI was the communication style. MI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours.
Motivational interviewing: a systematic review and meta-analysis
Abstract Background Chronic heart failure remains a major public health concern due to its high prevalence and disease burden. Aim To compare the applicability of cognitive behavioural interventions and motivational interviewing on improving self-care behaviours in patients with chronic heart failure. Results Motivational interviewing showed higher potential in improving HF self-care behaviours, but sustainability remains unclear.
Conclusion MI and CBI could be used synergistically by extracting their key effective components to strengthen the intention-behaviour link in improving HF self-care behaviours. Keywords Cognitive. In subsequent consultations, when these strategies don't work, it is easy to give up hope that he will change his drinking, characterise him as 'unmotivated' and drop the subject altogether.
In MI, the opposite approach is taken, where the patient's motivation is targeted by the practitioner. Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking — or not. Motivational interviewing emphasises eliciting reasons for change from the patient, rather than advising them of the reasons why they should change their drinking. What concerns does he have about the effects of his drinking? What future goals or personal values are impacted by his drinking?
The apparent 'lack of motivation' evident in the patient would be constructed as 'unresolved ambivalence' within an MI framework. The practitioner would therefore work on understanding this ambivalence, by exploring the pros and cons of continuing to drink alcohol.
Facilitating behaviour change in the general practice setting
They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. For example, drinking may impact the patient's values about being a loving partner and father or being healthy and strong. A discussion of how continuing to drink maintaining the status quo will impact his future goals to travel in retirement or have a good relationship with his children may be the focus.
The practitioner would emphasise that the decision to change is 'up to him', however they would work with the patient to increase his confidence that he can change self efficacy. The practical application of MI occurs in two phases: building motivation to change, and strengthening commitment to change.
These basic counselling techniques assist in building rapport and establishing a therapeutic relationship that is consistent with the spirit of MI. This involves goal setting and negotiating a 'change plan of action'. In the absence of a goal directed approach, the application of the strategies or spirit of MI can result in the maintenance of ambivalence, where patients and practitioners remain stuck. This trap can be avoided by employing strategies to elicit 'change talk'.
Alternatively, if a practitioner is time poor, a quick method of drawing out 'change talk' is to use an 'importance ruler'. Example: 'If you can think of a scale from zero to 10 of how important it is for you to lose weight. On this scale, zero is not important at all and 10 is extremely important. Where would you be on this scale? This technique identifies the discrepancy for a patient between their current situation and where they would like to be. Highlighting this discrepancy is at the core of motivating people to change.
This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient. Next, it is important to build the patient's confidence in their ability to change. This involves focusing on the patient's strengths and past experiences of success. Again, a 'confidence ruler' could be employed if a practitioner is time poor.
Example: 'If you can think of a scale from zero to 10 of how confident you are that you can cut back the amount you are drinking. On this scale, zero is not confident at all and 10 is extremely confident. Finally, decide on a 'change plan' together. This involves standard goal setting techniques, using the spirit of MI as the guiding principle and eliciting from the patient what they plan to do rather than instructing or advising.
If a practitioner feels that the patient needs health advice at this point in order to set appropriate goals, it is customary to ask permission before giving advice as this honours the patient's autonomy.
Efetividade da entrevista motivacional na melhoria da saúde bucal: revisão sistemática
Examples of key questions to build a 'change plan' include:. It is common for patients to ask for answers or 'quick fixes' during Phase II. In keeping with the spirit of MI, a simple phrase reminding the patient of their autonomy is useful, 'You are the expert on you, so I'm not sure I am the best person to judge what will work for you.
But I can give you an idea of what the evidence shows us and what other people have done in your situation'. In general practice, the particular difficulties associated with quick consultation times can present unique challenges in implementing MI. Miller and Rollnick 17 have attempted to simplify the practice of MI for health care settings by developing four guiding principles, represented by the acronym RULE:. The righting reflex describes the tendency of health professionals to advise patients about the right path for good health.
This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo. Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour.
Motivational interviewing in practice requires clinicians to suppress the initial righting reflex so that they can explore the patient's motivations for change. It is the patient's own reasons for change, rather than the practitioner's, that will ultimately result in behaviour change. By approaching a patient's interests, concerns and values with curiosity and openly exploring the patient's motivations for change, the practitioner will begin to get a better understanding of the patient's motivations and potential barriers to change.
Effective listening skills are essential to understand what will motivate the patient, as well as the pros and cons of their situation. A general rule-of-thumb in MI is that equal amounts of time in a consultation should be spent listening and talking.
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Patient outcomes improve when they are an active collaborator in their treatment. A truly collaborative therapeutic relationship is a powerful motivator. Patients benefit from this relationship the most when the practitioner also embodies hope that change is possible. If a practitioner has more time, four additional principles Table 5 can be applied within a longer therapeutic intervention.
Barriers to implementing MI in general practice include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients' overwhelming desire for 'quick fix' options to health issues and the brevity of consultation times. These barriers to implementing MI in primary care represent significant cons on a decisional balance.
On the other hand, the pros for adopting an MI approach with patients who are resistant to change are compelling. While we are not advocating MI for all patient interactions in general practice, we invite practitioners to explore their own ambivalence toward adopting MI within their practice, and consider whether they are 'willing, ready and able'.
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Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice. For further information and online motivational interviewing training opportunities visit www. To open click on the link, your computer or device will try and open the file using compatible software. To save the file right click or option-click the link and choose "Save As Follow the prompts to chose a location.
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Article Download article Download Citations. Kate Hall Tania Gibbie Dan I Lubman Background One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. Discussion Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Downloads Help with downloads.