conversation, namely:

1) Open questions – questions that encourage a longer answer ie. not yes/no. Some less open questions may be necessary during a consultation but should be limited during early conversation. 2) Affirmations – may include compliments or statements of understanding and appreciation. Timing and delivery is critical to appropriately affirm the client’s strengths and efforts without sounding condescending. 3) Reflections – arguably one of the most central components of MI. Reflections allow a practitioner to check that they have heard and understood exactly what the client intended, and create the opportunity for elaboration. Common reflective statements include repetition of statements, substitution of new words or offering an explanation of what has been heard and understood. 4) Summaries – are usually integrated towards the end of a consultation and have a number of roles including demonstrating to the client that the practitioner has been listening carefully, reinforcing what has already been said (including an emphasis upon change talk) and providing an opportunity for elaboration. Integrating the four main methods of MI into a consultation

allows a practitioner to explore and elaborate upon individual reasons for behaviour change and strengthen those reasons with the aim of eliciting change talk. These are often remembered by the acronym OARS. For a more detailed description of MI principles and methods see references 2 and 3.

Communication style Central to our understanding of how MI fits into everyday practice is the consideration of three communication styles. Generally, throughout the course of a conversation we are able to identify the style in which verbal exchanges are made and typically these often fall into either: l Guiding l Following l Or directing approaches. Generally, an MI practitioner’s approach is often in the style

of guiding. A skilful practitioner will shift this style to more of a following or directing style as they move through a collaborative conversation with a client.

How can MI help within physical activity promotion settings? Physical activity counselling is becoming increasingly more common, and the use of brief interventions within primary care has received a favourable response from the National Institute for Health and Clinical Excellence (NICE) (4). The integration of MI into routine conversations with individuals has a significant role to play in helping people change physical activity behaviours. Many individuals working within settings that aim to support individuals to change physical activity behaviour will recognise some of the descriptions of MI as something with which they are already familiar. There may be some elements that exercise professionals recognise as being methods they already find useful, and in some respects MI is nothing new. Indeed, MI training is becoming increasingly more popular within health and exercise settings.

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One of the most effective ways of enhancing our ability

to help individuals change behaviour is to increase our mindfulness of how well we engage with the spirit of MI. For those who are new to MI, simply increasing awareness of the style of communication used during routine conversations with clients can be helpful. It is all too easy to adopt a more directive style of communication when time is limited. Couple this with the common expectation that certain client information needs to be collected for routine auditing, health and safety, and evaluation purposes, and it is not difficult to understand why conversations may become more directive. Perhaps we need to ask ourselves and the people we help,

how can we best make use of the time we have together? We know that individuals are more likely to at least initiate behaviour change if the reasons for behaviour change are identified by the client. Exercise and health professionals are ideally placed to elicit these reasons and strengthen the motivation for change through integrating MI into existing practice.

Initial MI training Introductory training in MI usually lasts a minimum of two full days, although it is not uncommon to find taster sessions that are shorter. In order to have sufficient opportunity to learn about the principles and methods of MI and provide adequate opportunity to practice, a full two-day course as a minimum is desirable. Follow-on training or ‘advanced’ training is available and some MI trainers may design a course for the needs of attendees. Wherever possible, appropriate supervision for those newly trained and those developing their MI skill set should be sought. Integrating MI-consistent practice into consultations frequently is advisable. At present, there is no official accreditation for MI although membership of the Motivational Interviewing Network of Trainers (MINT) requires a competent level of proficiency in MI. A list of MINT trainers is available on the MI website (motivationalinterview.org).

Two recent examples of integrating MI into public health practice LEAPs

In early 2004, the Local Exercise Action Pilots (LEAP) (5) went live. LEAP, a £2.6 million programme jointly funded by the Department of Health, the Countryside Agency and Sport England was designed to investigate innovative ways of encouraging people to be more active, especially those who do little exercise and those at risk of health problems. Ten primary care trusts (PCTs) were selected to take part in LEAP of which Wandsworth PCT was the only one from London. The interventions tested in LEAP ranged from physical activity campaigns to senior peer mentoring and from GP exercise on referral to community walks. Two PCTs, East Midlands and Wandsworth, included in their

LEAP programmes interventions based on MI. In Wandsworth, the intervention was called a Physical Activity Clinic (PAC) and comprised a 30-45 minute one-to-one consultation between the client and an exercise specialist also trained in MI. The underpinning concept was to provide GPs and practice nurses, whose consultation times with patients are often extremely restricted, with a referral pathway through which achieving physically active lifestyles could be discussed at some length.

The REPS Journal 2009;00(Month):00-00 The REPs Journal 2010;16(March):19-22