Synthesizing MI and Stages of Change Theory… with insights from Highland Hospital Faculty

Life is almost always more complex than we expect it to be… What is presented in the Motivational Interviewing course on this site is actually a synthesis of different theories about how to promote behavioral change. This synthesis was adapted into a primary care focused curriculum at Highland by Sharone Abramowitz, MD (see www.miformds.com), a member of the Motivational Interviewing network of trainers.

 

Much of the material does come out of Motivational Interviewing theory, presented initially by Miller and Rollnick. For example, OARS techniques, eliciting and reflecting “Change Talk,” and respecting the patient’s values and opinions, all come from Motivational Interviewing theory.

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On the other hand, the Stages of Change theory was originally presented by Prochaska et al. Learning about these two theories together makes sense because while some patients may need help resolving their ambivalence and MI techniques are key, other patients may have already made a decision to change, and it is important to recognize this and direct efforts towards supporting their plan–or in other words–action planning. By recognizing the patient’s Stage of Change, the provider can efficiently and effectively focus counseling efforts based on what the patient needs.  This is where the flow chart comes in (see above).

Especially when it comes to weight loss, developing a strong and detailed action plan may be the key intervention the physician or health care coach provides. In this action plan it is important to have all of the details figured out. The who, what, when, where, and how all need to be laid out. For example, if a patient decides Overeaters Anonymous is something they will try, the plan does not end there. The patient is more likely to attend that first meeting if they have a meeting date and location picked out– with a plan of how they will get there and who will help watch the kids while they are out, etc. Once these have been laid out, it is also important to check in with the patient about their confidence in the success of the plan. On a scale of 1 to 10, a confidence score less than a 7 predicts failure. This may signal a need to make that initial goal more modest and achievable.

 

*Abramowitz S., Flattery D., Franses K., & Berry L. (2010). “Linking a Motivational Interviewing Curriculum to the Chronic Care Model.” J Gen Int Med, 4, 620-626.

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