Building Competency in Diabetes Education THE ESSENTIALS

11-22 | CHAPTER 11

All these reasons are related to either the importance of the health issue for the person (relative to other issues) or to his/her level of confidence/self-efficacy and, thus, to his/her stage of change. These are the factors responsible for the person’s current readiness or intention to make self-care behaviour changes. Objectives must be written with the knowledge of where the patient is in their readiness to change. Let’s investigate how MI can help identify goals and assist in the writing of behavioural objectives. Motivational interviewing (34) Motivational interviewing is a collaborative, patient-centered interviewing/counseling style for behaviour change. It is particularly useful to patients who are starting to recognize the need to change but have not engaged in any movement or planning to do so. This ‘stage’ corresponds to pre-contemplation and contemplation as per the TTM model. It is used to solicit ‘self-talk’ to strengthen the patient’s motivation and commitment to change by exploring and resolving their ambivalence. Collaboration, acceptance, evocation and compassion underlie the spirit of motivational interviewing. The counselor uses specific skills to elicit “change talk” which is directed towards a patient selected goal. Four specific processes that are used in motivational interviewing are: 1. Engaging: A therapeutic relationship is the basis of all counselling and must be established in order to proceed. 2. Focusing: Provides a direction in the conversation towards a patient-derived goal. 3. Evoking: Elicit patient’s own motivation for change; patients develop their own arguments for change by eliciting and resolving their ambivalence. 4. Planning: Readiness needs action. When the patient makes a commitment to change, an action plan needs to be developed. The style of motivational interviewing encourages the use of several core interviewing skills throughout the four processes. Initially, these skills can help to engage the patient in their situation, but they will also facilitate the directional flow of the interview, allowing for a better focus on the patient’s ambivalence in regard to a particular behavior change. By evoking this ambivalence, the patient can be encouraged to engage in “change talk”, leading to a commitment to take action and the development of an action plan. The core interviewing skills are the use of the techniques of: