Motivational Interviewing in Patients with Diabetes
This short video illustrates a clinical scenario using the correct process of motivational interviewing. In this video, a clinician discusses obesity management with their patient, providing a non-judgmental approach to diabetes self-management while also learning more about the patient’s lifestyle habits and providing solutions to manage a healthy lifestyle.
Diabetes is a chronic medical condition affecting all social and economic sectors of our society. However, public housing residents are three times more likely to suffer from this condition than the general population, according to the U.S. Department of Housing and Urban Development. Community- based, patient-oriented Public Housing Primary Care health centers have developed strategies to mitigate the impact of diabetes in public housing residents by addressing the social determinants of health (SDOH), delivering medication management, and promoting healthy lifestyle changes including dieting, exercising, smoking cessation, and behavioral services for patients with diabetes. Evidence-based counseling approaches on lifestyle modifications are a supplementary tool used by primary care providers and internists to address the health care needs of patients with diabetes.
There are several effective, structured counseling strategies developed for use in primary care settings.
- The transtheoretical model, for example, is a counseling strategy that assumes that the patient has no knowledge of how risky health behaviors (i.e., lack of exercise) can affect them and allows the patients to respond to direct advice.
- The five (5) A’s (Ask, Advise, Assess, Assist, Arrange), is a counseling strategy that is commonly used for smoking cessation, reducing/eliminating alcohol use, and weight loss.
- FRAMES (Feedback, Responsibility of patient, Advice to change, Menu of options, Empathy, Self-efficacy enhancement) is a structured sequential approach that has been used to reduce alcohol-related risk behavior and cannabis use.
- The BATHE (Background, Affect, Troubles, Handling, and Empathy) counseling strategy has also been used to help people with psychosocial problems and their social, emotional, and cognitive dimensions.
One counseling strategy that has been highly effective for patients looking to make lifestyle changes is motivational interviewing (MI). MI is a counseling technique that allows patients to become aware of potential health issues that could affect their ability to live a healthy lifestyle. This is useful for patients with diabetes, especially since adhering to prescription medicine is not the only step that patients need to take to manage their diabetes.
The National Center for Health in Public Housing (NCHPH) had the opportunity to interview Frank Vitale, National Director of Pharmacy Partnership for Tobacco Cessation and Clinical Assistant Professor at Purdue College of Pharmacy, on motivational interviewing in patients with diabetes along with discussing the motivational interviewing process and its overall impact.
WHAT IS MOTIVATIONAL INTERVIEWING?
According to Vitale, MI is a way of talking to patients that engenders change, so that they can perceive their condition differently and reach positive behavioral and physical changes. MI allows the clinician to provide powerful information and ask provocative questions, which allows for patients to tell the medical practitioner that they want to make a lifestyle change instead of only telling patients that they must make the change. In his own experience, Vitale has seen patients make lifestyle changes while participating in MI. Studies have shown that MI has had profound positive effects on changing any kind of health behavior.
WHO CAN PROVIDE MOTIVATIONAL INTERVIEWING?
One does not have to be a practitioner perform MI since it is just a way of talking, communicating, and connecting with people. Vitale stated that any health professional or health educator at health centers could do it. However, Vitale advises, health center professionals do need to know certain information such as knowing the ideal diet, medications, and exercise patients require. Even though health centers are familiar with general MI processes, some health centers have indicated that additional training is needed to include this strategy specifically during diabetes consultation, according to his conversations with some health centers.
WHAT ARE SOME TOOLS TO HELP WITH MOTIVATIONAL INTERVIEWING?
Vitale suggested that patients could create a food and/or exercise diary (Such as MyFitnessPal) in which they will keep track of what they are currently eating and/or the time they are spending on physical activity. This strategy allows the patient to obtain a better understanding of their eating and exercise habits.
WHAT ARE THE CHALLENGES IN MOTIVATIONAL INTERVIEWING?
While MI is effective, some clinicians have limited time in appointments, which can make it difficult for them to do MI with patients. However, there are strategies to incorporate MI in appointments. One strategy is to include open-ended questions in their conversation with the patient. One literature study showed that motivational interviewing conducted by registered dietitians and clinicians resulted in lower BMI in patients. This allows patients to give more in-depth answers to the questions that they are asked. Another strategy that has been used is to have more of a conversational styled appointment in which they go through the patient’s electronic medical records (EMRs) together, making the medical records the central point of the conversation.
CONCLUSION
Studies have shown that MI can have profound positive effects on changing any kind of negative behavior and also increase positive behaviors and health outcomes. Though MI can be difficult to introduce in appointments at times, there are flexible ways for clinicians and other health professionals to incorporate open-ended questions into their conversations with patients to explore challenges and promote changes. MI is a highly effective tool for patients with diabetes and encourages both patient and clinician collaboration. By learning more about the patient’s habits and the impact of the habits on their diabetes, it allows patients to make modifications to their lifestyle to help achieve their personal health goals. The overall goal is not to heal, but to help. It is not to solve the patients’ problems, but to help them solve their own problems.
ADDITIONAL RESOURCES
1. Every Person with Diabetes Needs Ongoing Self-Management Education and Support
https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-self-management-education-support
2. Unstable Housing and Diabetes-Related Emergency Department Visits and Hospitalization: A Nationally Representative Study of Safety-Net Clinic Patients
https://pubmed.ncbi.nlm.nih.gov/29301822/
3. Motivational Interviewing: Obesity
https://www.youtube.com/watch?v=24NV35rKl5I&feature=youtu.be
DISCLAIMER
This blog post is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $2,006,400 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.