Motivational Interviewing-Helping Patients Take Control of Their Health

I was a good child in every aspect except one. When it came to practicing piano, I would do anything to get out of it. Even when I did practice, my heart was not in it. The notes on the page always sounded monotonic instead of a string of melodies that evoked a feeling.

Not surprisingly, I never became an accomplished pianist. In fact, when I went off to college, I never touched a piano again. I lacked the intrinsic motivation to learn and practice piano. This resulted, to my mom's dismay, the loss of an artistic talent.

When I started my year of service as a community health worker, I kept thinking back to my lack of motivation while learning how to play piano. What if my patients lacked the motivation to make lifestyle changes in order to get well? If so, how could I, as a community health worker, motivate them to take charge of their health? As my service year is coming to an end, I have noticed this lack of intrinsic motivation countless times. Luckily, I have also been taught ways to promote intrinsic motivation through a method called motivational interviewing.

A lack of motivation to make any lifestyle changes was very apparent when I went out into the community to do free health screenings for cholesterol, blood pressure, and glucose. I have gotten every imaginable excuse from people on why they have not seen a primary care doctor in years, or why their blood pressure is skyrocket high. One gentleman, who was supposed to have a bypass surgery, was unfazed when his blood pressure reading was considerably higher than the normal value. Despite urgent nudging for him to see a doctor, he seemed reluctant to go. Even when he promised to do so I was left with the sense he was not going to follow through.

At an in-service day with NHC Chicago, I learned about motivational interviewing, an interviewing method that promotes intrinsic motivation within the client in order to promote behavior changes. It tries to change how a health care provider asks questions and delivers health care information. The core principles of motivational interviewing are engaging, focusing, evoking, and planning. Through these steps, autonomy over a person's health is given to the individual.

At the next health fair, I decided to try motivational interviewing. The first step was engaging the patient. Instead of telling them what cholesterol was, I asked,'What do you know about cholesterol?" The next step was focusing. I began asking open ended questions and summarizing what patients have told me to gear the discussion towards why their cholesterol or blood pressure may be high. After focusing on the problem, we transitioned into evoking, trying to help the patient come to a realization why a lifestyle change is important and feel motivated to do so. I began to ask'What would you like to see changed in your cholesterol or blood pressure levels? What would be good about changing your cholesterol level?  Once they thought this over, we moved on to planning, coming up with a plan, whether it is exercising 30 more minutes a week or scheduling a doctor's appointment by the end of the day.

I often wonder what would have happened if my mom decided to use motivational interviewing to get me practice piano. Would I have become a piano prodigy? This will remain a mystery, but for the patients I see every day, motivational interviewing has helped them realize the importance of taking control of their health and begin making steps towards that goal.

This post was written by NHC Chicago member Hannah Lo.

Hannah serves as a Community Health Worker at Advocate Trinity Hospital.