Transforming the behaviour change conversation the motivational interviewing way (Lifestyle Medicine Conference Presentation)

We were thrilled to have presented our work with Melbourne University at the Lifestyle Medicine Conference in May 2020.

Our presentation at the conference highlighted our 2 day training program in motivational interviewing (MI) and its application in supporting clients to manage their osteoarthritis, as part of a trial project focusing on delivering health care interventions online.

For further details, please see the information provided below, plus our conference presentation recording.

Introduction/Background

Motivational interviewing (MI) is an evidence-based counselling approach. It is patient-centred, focused and goal orientated. The clinician focuses on intentionally facilitating change by helping patients explore ambivalence, thereby strengthening their motivation for change¹.

In 2018, Health & Wellbeing Training Consultants were invited by Melbourne University’s Centre for Health, Exercise and Sports Medicine to present a training program on MI to dietitians and physiotherapists participating in a trial project working online with patients to treat osteoarthritis through exercise and weight loss.

Methods

The clinicians initially filled out a pre-needs assessment form to ensure that what was presented in the training was relevant and valuable for them, but to also help us tailor the training to ensure that relevant skills based areas were covered, so it suited their needs.

The clinicians participated in our 2 day training program in MI that not only focused on developing good communication skills, but also the key skills and principles of motivational interviewing.

In addition, the training focused on how to manage patients who are resistant to making changes to their diet for example, or patients who are “not engaging in long-term physical activity because they’re afraid of pain or worsening of their condition”.

Over the course of the two days, the clinicians put MI into practice and role played various case studies that were specifically developed for them, and this project.

A month later a half day refresher and check in session was provided where the clinicians reflected on what was going well for them and where they were struggling. The refresher focused on asking evocative questions to help elicit the change talk, how to engage in more complex reflections, as well as how to implement the change talk, with additional role plays included in the training.

Post MI training, the clinicians’ audio consultations were then reviewed to assess the application of MI, including how often they affirmed, sought collaboration, emphasised autonomy, and/or used complex reflections.

To review the recordings, an evidence based tool – the motivational interviewing treatment integrity² (MITI) tool was used, where a reviewer assessed a 20 minute random segment within consecutive consultations. MITI provides a behavioural coding system generating a total MI compliance score, thus enabling structured feedback to be provided to the clinician.

As part of this, individual feedback was provided on the two sessions which highlighted what the clinician did well and how to improve, and this was written up for each clinician.

Following this, some general feedback was provided in a one hour online webinar (of the clinician’s initial and follow up consultations). This webinar provided the clinicians with the opportunity to be able to ask questions and seek further clarification, and with their permission and without identifying anyone, their actual interactions were shared. Various examples from the clinicians’ transcripts were highlighted to emphasise some of the key points as to what they were doing well and how they could improve.

This helped to make the feedback session much more authentic and very useful, for both the clinicians and for us, the trainers.

Discussion

Overall, the clinicians did very well. They all made a genuine attempt to incorporate MI into their practice and they did so by applying and utilising a range of MI tools, skills and principles, such as evoking and sustaining change talk, respecting patient autonomy and using reflections, affirmations and summaries.

In addition, the clinicians improved between the first and subsequent session, and as a result were able to get better outcomes for their clients.

They took their interaction style to the next level with a counselling approach, an interaction style that facilitated change, and as such, they were no longer in their traditional roles of educating and instructing and telling clients what they should be doing, and instead took the role of a behaviour change facilitator.

There was evidence of a real understanding of the MI spirit, and they demonstrated a very good understanding of this, as well as the MI principles and skills.

With this, came a level of excitement for the clinicians, as they were providing treatment at a higher level than what they had previously done before.

There was also however, some room for improvement and further development, and in particular, the importance of not slipping into the ‘expert’ and ‘advice giving’ role, as well as refraining from talking too much.

Conclusions

This presentation explores the collaboration with Melbourne University and the application of MI in health care.

Motivational interviewing is a useful communication approach helping clinicians engage in the behaviour change and healthy lifestyle conversation with patients in routine practice across all health settings.

What Health & Wellbeing Training Consultants offered, was a comprehensive program where clinicians were able to develop their knowledge, skills and confidence to put motivational interviewing into practice.

This project highlights that MI skills can be developed, practiced and applied, and highlights the positive impact trained clinicians in MI can have with their daily interactions with patients…

Acknowledgements

Our sincere thanks to the University of Melbourne and the clinicians who participated in the program, and who gave us permission to share this experience and their story…

Conference presentation

Want to learn more? Want to know how to use this highly effective approach with your clients?

Want to improve your knowledge, confidence and skills in motivational interviewing?

If you would like to learn more and would like to learn how to engage and communicate with your clients that will motivate them for change, rather than against it, then sign up for one of our upcoming training days in motivational interviewing.

Alternatively if you would like a session on motivational interviewing presented in your workplace, please contact us today.

Our training programs are ideal for professionals who would like to offer extended support (or brief intervention depending on time), and would like to increase their skills, knowledge and confidence in motivational interviewing to enable them to do this.

Applying the principles of motivational interviewing in every client consultation is possible and achievable. Let us show you how.

We hope you enjoyed this article and until next time wishing you all great health and wellbeing!

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REFERENCES:

1. Rollnick S. & Miller W.R. (1995).  What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334.

2. Moyers T.B., Martin T., Manuel J.K. & Miller W.R. (N.D.). The Motivational Interviewing Treatment Integrity (MITI) Code: Version 2.0. University of New Mexico Center on Alcoholism, Substance Abuse and Addictions (CASAA).