Motivational Interviewing for Dietary Clinicians

To help clinicians put motivational interviewing into practice and in particular, help them reduce patient resistance, Miller and Rollnick²³ have summarised some key conversational skills that can help, in the “OARS” acronym:

O = Open ended questions
A = Affirm change
R = Reflectively listen
S= Summarise

It is important to remember that as the clinician when you are using motivational interviewing you shouldn’t be talking too much. The conversation should flow back and forth but don’t be tempted to take over. You want to evoke and build upon the patient’s confidence and skill set to help build their motivation and to help them move forward in a positive way.

Open Ended Questions

Asking open ended questions is phrasing questions in a way that cannot be answered with a simple yes or no but that require a reasoned and developed response. For example:

• “Please tell me a bit about your current diet.”
• “How do you feel about your weight at the moment?”
• “What can you tell me about the importance of increasing your physical activity?”
• “How could your life be different if you were to lose some weight?”
• “If you were to make some changes to your diet, what might get in the way?”

Affirmations for Effective Weight Control

Affirmations involve making direct statements that are supportive and focused on a positive element of an individual’s effort, commitment or strength. It encourages patients to try and continue with the new/preferred behaviour.

Affirmations help to show your patient that you are trying to understand what they’re going through and that you appreciate their efforts²³.

By making an affirmation, it helps to limit the patient’s defensiveness, and helps to promote an accepting and open dialogue. For example:

• “I believe this is possible for you.”
• “It’s terrific that you’re willing to give this diet a go.”
• “So, it sounds like you have been really determined and committed to reducing the fizzy drink you used to have with lunch. Well done on achieving this.”
• “It sounds like the strategies you developed are working well for you! Great work!”

Affirmations made by the clinician need to be genuine and sincere.

Reflective Listening

Reflective listening is listening with intent. It can simply involve repeating the patient’s key words or statements, or paraphrasing/rephrasing the patient’s main points, by using your own words or similar words. It allows you to confirm your understanding of what the individual has shared with you and helps to build trust and engagement with them.

Reflections can also help to reduce defensiveness and prompt or reinforce, change talk. For example:

• “So from what you’re saying, it sounds like you don’t like carrying that extra weight, but after a long day at work, all you really fancy is a comfort meal, is that it?”
• “It sounds like you want to address/make a change…, but this concern (name it) is getting in the way. Am I hearing that correctly?”

Summarise

Summaries are used at the end of the conversation and consultation, to draw together different aspects of what has been presented by the patient and to start to close the session and plan for the future. For example:

• “So, to summarise, you don’t really like being above a healthy weight range and you’ve made some really positive changes reducing your intake of sugary drinks but you’re still having a bit of trouble making healthy choices for dinner after a long day of work. Does that sound right?”

If the patient agrees with your summary, you could then proceed to ask:
“Would you like to talk more about how we could help you overcome that challenge?”