1. Motivational Interviewing for Promoting Physical Activity
Kenneth Brummel-Smith, MD
Charlotte Edwards Maguire Professor of Geriatrics
Florida State University College of Medicine

2. The “Spirit” of MI Collaborative Evocative Honors autonomy
Partnership with patients
Joint decision-making
Evocative
Activates their own motivation
We don’t “motivate” patients
Honors autonomy
People resist when they are told what to do
Some detachment required
Try to get someone to buy something example in class
MI deals with precontemplation and contemplation

3. Guiding The guide doesn’t decide where you want to go
A guide helps you find your way
“I can help you solve this for yourself”
Not, “I’ll solve this for you.”
Explores options
Synonyms – encourage, support, take along, accompany, elicit, enlighten
Letting go of control doesn’t mean lack of influence

4. Ambivalence There are always disadvantages to change
Some healthy behaviors are seen as unpleasant, hard, or distasteful
Many people enjoy the status quo
How to recognize ambivalence? – look for the “but” in the middle
Status quo
Pros (toward change)
Cons (no change)

5. Ambivalence People Have Big “Buts”
I know I need to lose weight, but I hate exercising.
I’d like to start walking, but I just don’t have any time to do it.
I used to love swimming, but all those young women in their bathing suits make me feel self-conscious.

6. Exploring Ambivalence
Starts the process of change
Patients review all their reasons surrounding a behavior
Reasons to change
Reasons to not change
In talking about reasons, the patient decides what is really important to them
Beware of stopping exploration TOO SOON

7. Listening For Change Talk
“I don’t know, I might be able to do it.”
“I wish I could.”
“I’ll try to do it.”
“I’ll think about it.”
Often culture specific
You’re on the right track when you hear this!

8. Themes of Change - DARN Desire – want to, like to, wish
Ability – can, could, able
Reasons – specific outcomes
Need – need, have to, should, ought to
Ambivalence involves conflict in the four themes

9. Listening Interventions
Reflect change talk
“Ahh, so you think you need to change.”
(Single sided reflection)
Reflect resistance or ambivalence
“So, you’d like to quit smoking, and know the risks, and you’re not sure you’ll be able to do it.”
Downward inflection of your voice at the end
(Double sided reflection)
Use their change words
Following

10. Using a Ruler (or Scale)
How strongly do you feel about starting an exercise program?
0 – not at all interested, 10 – totally committed
How important do you think it is for you to stop smoking?
The answer to this question is change talk. Another way to ask, if, for instance, a 5 was given, is, “What would it take to move to a 6?”
Not important at all
Really, really important
Then ask why she didn’t give a lower number….
Guiding

11. Two Important Questions
How important is it for you to _____?
0 – not important at all
10 – extremely important
How confident are you that you could do it?
0 – not at all confident
10 – I’m certain I can do it
What would it take to move from a 3 to a 4?
Guiding

12. Ways to Ask Permission Simple question First choice Prefacing
“Would you like to know some things that you could do?”
First choice
“Which of these options would you like to talk about first?”
Prefacing
“This may or may not worry you, but…”
Can combine them too
Informing

13. Summary Guiding Principles Listen for Themes of Change
Resist trying to fix them – you can’t motivate them!
Help the patient discover their motivation
Listen for Themes of Change
DARN – desire, ability, reasons, need
Explore (don’t negate) ambivalence – celebrate it!
Guide more than you inform
People who are ambivalent have opened the door to change.

14. Evidence
Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract 2005 Apr;55(513): (Level B)
Knight KM, McGowan L, Dickens C, & Bundy C. (2006). A systematic review of motivational interviewing in physical health care settings. British Journal of Health Psychology, 11,
Schroeder, K., Fahey, T., & Ebrahim, S. (2004). How Can We Improve Adherence to Blood Pressure-Lowering Medication in Ambulatory Care? Systematic Review of Randomized Controlled Trials. Archives of Internal Medicine, 164(7),

15. Learning More
Motivation Interviewing in Health Care, Rollnick S, Miller WR, Butler CC, 2008, Guilford Press, NY
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