MI Training and Method

Motivational Interviewing training

Clinicians involved in home based pulmonary rehabilitation programs can learn the technique of Motivational Interviewing online or by attending a course, preferably designed for health professionals.

An example of an online course can be found at the Pacific Centre for Motivation & Change – MI in Healthcare Online is an introductory level course suitable for medical and allied health practitioners working in healthcare settings with patients who have chronic conditions.

To become skilled at this technique, practice and feedback is very important. Interview a colleague and discuss the process afterwards.

Motivational Interviewing method

Once a course is completed, the following guidelines will assist with the weekly telephone calls with the patients.

Structured telephone modules are used, with written prompts for the interviewer to explore and build motivation for change, then move towards commitment and action.

Core Communication Skills

Asking

Listening

Informing

ASKING

Ask open ended questions and try not to ask two questions in a row.

Open questions:

allow more room to respond

invites relationship

perceived as showing interest and caring

allows patient more active involvement in and influence over the course of the consult

See Interview Examples for “asking” questions.

LISTENING

By listening a clinician is more likely to be be present with the patient and understand their perspectives and experiences.

Allow time for silence.

See Interview Examples for “Listening”.

Reflection

A period of listening is followed by reflection:

a short summary of what you think is happening at that moment

patient confirms or disagrees with your hypothesis

statements (not questions) so that patient feels more comfortable and keeps talking

INFORMING

The aim of informing is to improve information exchange with the patient.

It is important that:

The clinician asks the patient’s permission to be informed

Messages are phrased in a positive fashion

The patient isn’t overloaded with information

Management options are provided

See Interview Examples for “Informing”

Change Talk

Aim to elicit change talk from the patient.

When you hear change talk, you are doing it correctly. When you find yourself arguing for change and the patient defending the status quo, you know you’re off course.

The first four statements below (DARN) are pre-commitment forms of change talk.

Six kinds of Change Talk

1. Desire – statements about preference for change; wish / want /like
2. Ability – statements about capability; can / could / able
3. Reasons – specific arguments for change
4. Need – statements about feeling obliged to change; ought to / have to./should
5. Commitment – statements about likelihood of change; will / intend /am going to
6. Taking steps – statements about action taken; I started / I went out and

See Interview Examples for:

Change Talk

Agenda Setting

Using a Ruler

Resolving Ambivalence