Take a new path to help employees change
September 1, 2012 4 minutes read
Take a new path to help employees change
‘Motivational’ interviewing
It takes a small step to make a big change. That is the essential truth behind a motivational method that is reshaping wellness promotion.
Changing unhealthy behavior is always difficult, whether you’re trying to convince people to quit smoking or to increase their physical activity and improve their diet. The Veterans Health Administration is focusing on a coaching program that seeks incremental change that stems from the employee herself.
“Motivational interviewing is like a dance,” says Ebi Awosika, MD, MPH, director of the VHA’s Employee Health Promotion Disease Prevention program. “You’re leading the person to make the changes themselves. They think it’s their idea but you’re really leading them down this path.”
Here’s how it differs from the traditional counseling approach. Let’s say you want to convince an employee who is a longtime smoker to quit. You might initially offer smoking cessation classes and a financial incentive, such as insurance discounts for non-smokers.
Some smokers might take the bait – but eventually still fail to quit. “There’s no doubt that incentives have been found to be useful,” says Awosika. “But there is more literature now that incentives may not necessarily bring about long-term change in behavior.”
Counseling typically focuses on the harmful effects of smoking. But most health care workers are already well aware of the health impact of smoking.
Motivational interviewing takes a different tack. Coaches seek to guide, not dictate to the employee. “What would it take for them to take a step forward? You’re not telling them what to do. Everything is going to be coming from them,” says Awosika.
The coach might ask, “Where would you rate yourself on a scale of one to 10 on quitting?
What would it take for you to shift your number? There’s that dance that goes on, leading the person to the stage where they realize I could do a little bit to make a change. They take that step,” she says.
Practice ‘reflective listening’
Motivational interviewing is a technique developed by psychologists William R. Miller, PhD, and Stephen Rollnick, PhD. They describe it as “a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.”1
Acknowledging ambivalence means addressing the reasons that a patient might choose to continue a behavior they know to be harmful. For example, some people are reluctant to quit smoking because they believe they will gain weight.
Rather than directing the patient to take steps to change, motivational interviewers encourage clients to talk about their ambivalence. “Direct persuasion, aggressive confrontation, and argumentation are the conceptual opposite of motivational interviewing and are explicitly proscribed in this approach,” Rollnick and Miller wrote. “More aggressive strategies, sometimes guided by a desire to ‘confront client denial,’ easily slip into pushing clients to make changes for which they are not ready.”
Motivational interviewing uses “reflective listening” to help people resolve their ambivalence to change. It asks people to take ownership of their problem — and the solution, says Awosika.
The VHA uses the technique in its employee health promotion program. “We’ve incorporated motivational interviewing as the preferred way of coaching with really great results,” she says.
In coaching sessions, employees identify their own goals, timeline and barriers to achieving their goals. Here are some steps the coach would take to guide employees to better health habits:
Explain the concepts of motivational interviewing (MI): building motivation and commitment to change.
• Express understanding of the participant’s perspective.
• Explore the discrepancy between the participant’s current behavior and what they want their lives to be like.
• Accept that resistance to change is natural.
• Support the participant’s self-efficacy and self-responsibility for change.
• Help set goals and strengthen the commitment to change.
Evaluate barriers and motivations for change.
• Review each goal and help the participant understand their own mind set.
• Ask the participants open-ended questions, for example:
What type of support do you have at home for improving how your family eats? How can your family help with improvements to the family diet? Are there ways to involve your spouse or partner in your exercise program?
• Active listening – the most important aspect of coaching might be how well the coach listens.
• Help the participant summarize their feelings and consolidate their goals.
Understand the participant’s learning needs. Are knowledge gaps creating a barrier to the participant?
• Examples might include:
Does the participant understand how to manage their diabetic diet? Does the participant recognize different portion sizes? Is the participant familiar with different forms of exercise?
Provide information or appropriate referrals to the participant.
• Examples might include:
Referral to a dietician to review nutritional parameters for diabetes. Referral for a stress test if the participant has cardiac disease and is concerned about complications. Written information on portion sizes.
Editor’s note: For more information see the VA/VHA Employee Health Promotion Disease Prevention Guidebook: http://ow.ly/d2mCb
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