Motivational Communication In Health

The World Health Organisation (WHO) define health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO, 1948). This differs amongst the health service users and healthcare professionals. Well-being can be broadly defined as viewing life positively, feeling good and physical well-being (Centre of Disease Control and Prevention, 2014). Health promotion is the process of facilitating individuals to improve control over their health. It includes not only an individual’s behaviour but the social and environmental situations that affect health (NICE, 2014; WHO 2015). There are three definitions of motivational interviewing (MI). For a layperson, MI is a cooperative communication style

The purpose of evoking is to promote change and is appropriate for use when the healthcare provider aims to help clients thought ambivalence towards change (Miller and Rose, 2013). Ambivalence is the synchronised process of conflicting motivations, which is the norm, rather than the exception on one’s path towards change (Miller and Rollnick, 2013). In hindsight, during my scenario the patient displayed what I now know is ambivalence. I felt I was pushing the patient to talk about something they didn't want to talk about. The patient did use both change talk and sustain talk, I kept using the righting reflex, possibly leading to information overload. Recognizing change talk is a crucial step in enabling patients to change, and the OARS skills help in responding to change talk. The healthcare worker needs to listen for the cues in change talk. The following mnemonic assists with this: DARNCAT. Desire-statements about preference for change e.g. I would like too, Ability-capability, e.g. I can, Reasons-arguments for change, e.g. I would feel better if I, Need-feeling obliged e.g. I really should, Commitment-the probability of change, e.g. I am going to, Activation-I am ready, Taking steps-e.g. I started exercising. Along with the patients change talk, there was a blend of sustain talk. This is the essence of ambivalence. I should have responded to the resistance

MI is done for or with someone, not to them. The practitioner should be guided by the client. Partnership, acceptance, compassion and evocation are central to this. MI is about evoking what the patient has rather than fixing what they do not have. Whether change happens is ultimately a person’s own choice, no matter how much the ‘righting’ reflex is used, the autonomy of the person must be respected. For all the merits of MI, it is not simply just being nice to people, nor is it a technique (Miller and Rollnick, 2013). It is a style of integrating clinical skills to motivate change. MI should be utilised to facilitate health promotion when the opportunity arises. Resistance may be one of the greatest obstacles to change, but through the core skills and processes practitioners are better equipped for these difficulties (Johnston and Stevens, 2013). MI shifts from persuasion and giving advice to helping the patient understand their own reasons for a change, their own inner strength. This paper has discussed the use of MI through a practical example of obesity, demonstrating where the core skills (‘OARS’) and processes should be