Motivational interviewing techniques in interactions with patients and caregivers can improve adherence and outcomes, according to Robyn McHugh, PT, DPT, OCS, CSCS. McHugh and Victoria McQuiddy, OTR/L, MHS—both from Cincinnati Children's Hospital—were presenters at the June 13 session "Use of Motivational Interviewing Techniques to Improve Self-Management in Physical Therapist Practice."
McQuiddy set the stage by explaining that by the year 2020, it is estimated that more than 150 million people in the United States will be living with a chronic condition. As a result, health care providers need to promote patient self-management and that home programming is an essential element in encouraging self-management. In turn, motivational interviewing techniques often can help patients in their ability to self-manage and thereby achieve better outcomes.
Self-management core skills include problem solving, decision making, resource utilization, a patient–provider partnership, and action planning, McQuiddy said.
All these can be enhanced by motivational interviewing, which McHugh defined as "a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence."
More simply, she continued, motivational interviewing is a conversation about change. It has a particular purpose, is collaborative, honors patient autonomy, and evokes the patient's motivation for change.
Motivational interviewing uses open-ended questions, rather than ones that can be answered with a "yes" or "no." This allows for further discussion and enables providers to understand patient situations more clearly. Motivational interviewing also uses various types of "reflections"—repeating statements by patients and families so that they can hear what was said. This demonstrates the health care provider's understanding of what the patient and family said, building trust and allowing the patient or family to clarify points.
She explained that the traditional health care provider–patient interaction places a heavy emphasis on the patient acknowledging the problem. Further, the patient's acceptance of the "diagnosis" is considered essential for change. On the other hand, motivational interviewing reduces the emphasis on labels and places the emphasis on personal choice and responsibility for deciding future behavior. The health care provider conducts an objective evaluation to assess the impact of the behavior but focuses on eliciting the patient's own concerns regarding the behavior.
"Medicine in health care has always followed a very paternalistic model. We try to engage families, but self-management takes it a step farther. We need to collaborate with patients and families. Often, traditionally, action plans are therapist-driven. Instead, let the patient and the family come up with the goals," McQuiddy said. However, she added, "We're not taking away our ability to use our skills as therapists. Nor is this the classic motivational interview [which involves a separate session or interview with a patient or client]. This is about weaving techniques of motivational interviewing into sessions."