Motivational Interviewing Flashcards
What is ambivalence?
- Person experiences competing motivations
- Do not assume you know what another person’s costs and benefits are
> people want to change but dont change
What are the stages of change?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse
What is MI based on?
Based on the concept that people are more often ambivalent (stuck) or resistant versus totally opposed to change.
What triggers change?
Firstly, change is a process NOT an event
- When patient connects with something of intrinsic value, something important to them
- When intrinsic motivation arises from patients exploring how their present reality differs from what they really want and value (discrepancy)
- When patients explore their ambivalence to change (I want to, and I don’t want to)
- When they feel confident that they can change
How do people change?
Recognise that current behaviour is a concern or a problem
Believe that they will be better off if they change
Believe that they are able to change
- Motivational interviewing is about pulling all these effects together
Give examples of DARN-CAT of change talk:
A) Desire
B) Ability
C) Reasons
D) Need
E) Commitment
F) Actuation
G) Taking steps
A)
- Statements about preference for change.
- “I want to …” “I would like to …” “I wish. … “
B)
- Statements about Capability.
- “I could …” “I can …” “I might be able to . . . “
C)
- Specific Arguments for Change “I would probably feel better if …”
- “I need to have more-energy to play with my kids … “
D)
- Statements about feeling obliged to change.
- “I ought to “ “I have to “ “I really should …”
E)
- Statements about the willingness of change.
- “I am going to “ “I promise …” “I intend to“
F)
- Statements about their willingness to change.
- “I am ready to “
- “I will start tomorrow…”
G)
- Statements about action taken.
- “I actually went out and. …”
- “This week I started …”
What is sutain talk? Why do patients use it?
Sustain talk is the opposite of change talk
- their desire to stay as they are
- their worries about being able to change
- reasons not to change
- need to stay as they are
What are some properties of MI?
- A form of patient-centred counselling
- Evidenced-based and effective intervention for eliciting behaviour change and adherence to treatment
- Aims to identify where the patient is in relationship to considering a change and assists patient accomplish the various tasks required to transition from pre-contemplation to maintenance stage
- Aims to activate patients’ own motivation for change and adherence
- Helps clients explore and resolve ambivalence about specific health behaviour changes
- Reflect concerns and emotions of patient in a positive, empathetic, and non-confrontational way
- Provide insight or new information to address concerns in a non-judgemental way
What is the spirit of MI?
MI is NOT about motivating or persuading people to change
MI is as much a “way of being with people” as a set of skills
- Partnership
- Acceptance
- Compassion
- Evocation
> What concerns do you have about your asthma control
> What might you do to improve control
To encourage patients to express their own reasons for concern with their lifestyle behaviours and arguments for change
What is some evidence for MI? Patients are more likely to..
- Enter, stay in and complete treatment
- Participate in follow up visits
- Reduce stress and sodium intake
- Keep food diaries
- Quit smoking
- Improve medication adherence
- Fewer subsequent injuries and hospitalisation
Why is MI an ideal match for many pharmacy settings?
- Increased efficacy with patients with a wide variety of health issues
- Increased revenue streams (MI programs – smoking cessation, weight loss)
- Better pharmacist-patient relationships
What can pharmacists do for patients with chronic illnesses are different as often have misconceptions about the illness and its severity, consequences if left untreated especially if illness is asymptomatic
- pharmacist using MI - can fill gaps in patient’s understanding or knowledge, then invite patient to respond to this information
- pharmacist using MI must be aware that without a strong foundation of rapport with the patient, information can be interpreted by the patient as judgemental or shaming
What are the FOUR principles of MI?
- Express empathy through reflective listening
- Develop discrepancy between clients’ goals or values and their current behaviour –>imagine what life will be like, what will happen if you dont change/change, what is keeping them away from their goals
- Roll with client resistance rather than opposing it directly. Avoid argument and direct confrontation –> slow down and listen more
- Support self-efficacy and optimism
What is RULE in MI?
Resist the righting reflex
Understand your patient’ s motivation
Listen to your patient
Empower your patient
What is OARS in MI?
OARS – strengthens change talk
Open-ended questions
Affirming
Reflecting
Summarising
