NUTRITION

MI and physical

activity

Motivational interviewing (MI) was initially developed as a useful method to help individuals change problem drinking behaviour. Historically MI has an impressive history in helping individuals to change various addictive behaviours. However, since the 1990s, MI has developed an increasingly diverse profile with positive trials of MI being documented in the management of various chronic diseases such as cardiovascular disease and hypertension. This article looks at what MI is and how it can be used to help people become more physically active.

www.exerciseregister.org By Charlotte Hilton and Edward Poulter

What is motivational interviewing? The method of MI is often confused with the stages of change component of the transtheoretical (TTM) theory of behaviour change (1). However, it is important to note that, although the TTM theory and MI method have developed at roughly the same time, the two are completely independent of one another. The TTM may help us to understand the processes of behaviour change, while MI should be considered as contributing to our understanding of how we go about facilitating behaviour change in practice.

The spirit of MI MI is not a technique that is used on someone or applied as a method of persuasion to those that are particularly resistant or considered completely unmotivated. Indeed, as individuals involved in the role of helping people, perhaps it is far more productive to consider that everyone has motivation for change. The role of a skilfull practitioner is to elicit these motivations in a manner that is collaborative, evocative and honours patient autonomy (2). This is referred to as the spirit of MI and is considered fundamental to the integration of MI into everyday practice. Attempting to integrate MI using the guiding principles and methods of MI without the spirit are often referred to as being like ‘dancing without music.’

The guiding principles of MI Underpinning MI as a method are four guiding principles, namely: 1) To resist the righting reflex 2) To understand and explore a person’s own motivations 3) To listen with empathy 4) To empower the client, encouraging hope and optimism.

1. The righting reflex. The righting reflex refers to our innate desire to direct someone away from harm. In the helping professions, it is particularly easy to fall into the trap of identifying those factors that indicate an unhealthy lifestyle and proceed to explain how an alternative behaviour could contribute to improvements in health. The intention is to help clients understand how they may choose alternative health behaviours and to offer them advice and knowledge in the hope that they may understand things differently. However, the difficulty with this response is that it tends to increase the likelihood of resistance to change. 2. Understanding an individual’s own motivation. Identifying individual reasons for behaviour change allows a practitioner to understand a person’s own motivations and strengthen statements that suggest an individual is ready, willing and able to undertake behaviour change. MI refers to these statements as ‘change talk’. 3. Listen with empathy. Collaborative, empathic discussions strengthen a person’s perception of their ability to change behaviour. 4. Empowering the client. A skilfull practitioner should empower the client to make changes.

O.A.R.S Four methods form the typical style of an MI consistent

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