Motivational interviewing (MI) can be an effective tool in supporting clients to make the decision to join your walking group, as well as for keeping motivation up as the group progresses. MI empowers people to decide to change health-related behaviour by helping them resolve ambivalence, build intrinsic motivation, and strengthen commitment. This technique, pioneered by psychologists William R. Miller and Stephen Rollnick, has been widely applied in a range of health-related settings.
MI is a client-centred communication technique in which both parties aim to achieve mutual understanding. By using open-ended questions and listening to potential group members, you can empower people to choose to make healthy changes in their lives, instead of being prescriptive or authoritative. Your aim is to help group members move from status talk (‘I can’t’ or ‘It doesn’t work’) to change talk, where new possibilities are considered (‘I want to’ or ‘I can’). MI recognizes that ambivalence is a necessary phase in behaviour change and aims to help people resolve this ambivalence to make healthy changes. The following techniques are useful in one-to-one conversations with potential group members, and are also helpful during group introduction, orientation, or goal-setting sessions.
Strategies of Motivational Interviewing
A good way to keep MI strategies in mind is the OARS acronym:
- Open-ended, probing questions
- Affirming or Acknowledging responses
- Reflective listening
Open-ended, probing questions
In MI, questions typically start with ‘what,’ not ‘why.’ What-questions invite discussion and convey genuine interest, whereas why-questions often make people feel defensive. What-questions also supply more information so that you can better understand potential group members and their needs and goals, as well as resources or supports that they may require.
The following questions may be useful in exploring a potential group participant’s feelings before joining the group:
- I have some information about a walking group that is starting up. Would you like me to share it with you?
- What’s important to you about your health and well-being? Your social interactions? The way your days are spent?
- What would be a benefit for you of being part of this walking group?
- What would you need to be a part of the group?
- What could I do to help?
Affirming or acknowledging responses
Your goal in responding is to convey a sincere acknowledgment of the difficulties and challenges your potential group member has experienced, while supporting and promoting their self-efficacy and validating their feelings. Look for past experiences that demonstrate their strengths and successes, and highlight them. Affirming often goes hand-in-hand with reflective listening.
Reflective listening requires being actively engaged in conversation, having a genuine interest in the person you are speaking to, and desiring a true understanding of their experience. Mirroring, or reflecting back what you have heard, demonstrates your interest and allows you to verify that your understanding is accurate. Reflecting feelings you have observed is the most involved application of reflective listening.
- It sounds like you have faced some challenges in keeping up with exercise, like having some tough medication side-effects and feeling kind of sluggish. I’m impressed that you make the effort to walk to the grocery store once a week.
Summaries are often helpful at a turning point or toward the end of a conversation. Summaries reinforce what has been said, show that you have been listening carefully, and prepare the client to move on. Summarizing can help potential group members clarify their goals and values related to joining the group, as well as highlighting feelings of ambivalence and helping potential participants to recognize discrepancies.
- I’ve heard that you think a walking group could be a good way to get some exercise, but you have a difficult time with mornings.
Four Principles of Motivational Interviewing
Keep these principles in mind when trying to engage group members:
1. Express Empathy
Be sure to convey to potential participants that you understand that joining the group may be challenging or intimidating for them, and acknowledge their struggles. Empathy needs to be genuine and rooted in respect for your potential participants.
2. Develop Discrepancy
You want potential participants to become aware of their own decision-making process, and recognize whether their current behaviour aligns with their values and goals. It can be helpful to explore the pros and cons of joining your walking group, or the likely effects upon them of joining the group versus not joining the group. You might help potential participants identify small steps they could take in order to eventually join the group.
3. Roll with Resistance
Avoid being prescriptive or giving unsolicited advice. Do not argue with potential members, as arguing in favour of a position leads to an increased commitment. For example, if a potential member tells you he cannot join the group because he doesn’t have time (although you know that he does), acknowledge that he is feeling busy and avoid sharing observations that contradict him. Your goal is for him to recognize that he needs to change and to make his own argument to do so, perhaps by supporting him in recognizing that his health is very important to him.
4. Support Self-Efficacy
Communicate that joining your group is an attainable, realistic goal. Be optimistic that change is possible and highlight past successes, while acknowledging that change may be difficult. Try to help potential participants recognize strengths and supports that may help their efforts.
Source: What are you willing to change to promote your patients’ oral health? Find out how Motivational Interviewing can help you help your patients. Clive S. Friedman, Don Morrow, & Jennifer D. Irwin, 2013, Ontario Dental Journal.