Motivational Interviewing in Primary Care
By Chloe Pertierra
Many evidence-based behavioral and cognitive interventions are used in primary care to treat mental health issues. Interventions include mindfulness exercises, cognitive disputation, relaxation techniques, and motivational interviewing (MI) strategies (Hunter et al., 2024). Given the brevity of appointments (one to four 30-minute sessions) with the behavioral health consultant (BHC), the patient’s time with the BHC should be viewed as a coaching appointment. Hunter et al. (2024) explain that the BHC first teaches the patients interventions while refining and monitoring the skills as needed. The patient is expected to practice the interventions on their own while the BHC attempts to decrease barriers and increase motivation. Motivational interviewing is one way the BHC can encourage change.
MI is a collaborative process where the patient and behavioral health consultant (BHC) identify barriers to medical adherence and lifestyle changes. Hunter et al. (2024) report various factors contribute to nonadherence such as patient understanding, communication issues, treatment side effects, and psychosocial factors (e.g. financial strain). MI interviewing resolves ambivalence toward behavioral change and uses techniques such as open-ended questions, affirmations, reflective listening, and evaluating the pros and cons of change (Hunter et al., 2024). Three specific MI strategies are used to enhance motivation: examining the patient’s readiness to change, the importance of change, and the pros and cons of change.
Examine Readiness to Change
One strategy to enhance motivation is to assess the patient's readiness to change. This may be helpful before altering the patient's thinking patterns or behaviors. The BHC can ask the patient to rate their willingness to change on a scale of 1 (not ready) to 10 (ready). Explicitly asking patients to quantify their readiness to change provides the patient with insight and awareness and allows the BHC to brainstorm ways to increase their motivation if provided a low score. For example, a patient may be unwilling to monitor their alcohol intake but after discussing with the BHC their mental and physical barriers, their score may increase by one to two points.
Importance of Change
Another strategy to enhance motivation is to assess the importance of change. The BHC can ask the patient to rate the importance of change on a scale of 1 (not important) to 10 (most important). Follow-up questions like “what would have to happen or change for this to be more important?” or “what keeps you from moving up to a higher number on this importance scale?” (Hunter et al., 2024, p. 43) can be administered by the BHC to decrease hesitation.
Pros and Cons of Change
The BHC can ask the patient to identify pros and cons of the change. It’s important that the patient, not the BHC, make the argument for why it would be in their best interest to change (Hunter et al., 2024). The BHC can assist the patient in identifying additional benefits of change if needed.
The utilization of MI in primary care can be effective in enhancing the patient’s motivation to change. The three MI strategies are relatively easy to administer and allow for greater patient awareness and understanding.
For more information, check out APA’s MI guide:
https://www.apa.org/obesity-guideline/motivational-interviewing-guide.pdf
References
Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2024). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention, 3rd ed. American Psychological Association. https://doi-org.alliant.idm.oclc.org/10.1037/0000380-000