What Are Some Key Elements in Motivating Clients to Improve Health Behaviors and Outcomes?
Creating a diagnosis and appropriate treatment plan is only half the battle for doctors; actually getting patients to follow through is its own beast. Providers can better achieve overall patient wellness by using a set of patient motivation techniques that drive better health behavior. In all of healthcare, but especially in chronic disease management, it is important for patients to be active participants in their own wellness journey. Patients are the sole drivers of health behavior change, care management activities, and medication adherence. And while some patients may be intrinsically motivated to improve their health, others may require provider encouragement.
Many common diseases affecting women’s health can be moderated or controlled by “behavior change.” However, promoting changes in a patient’s dietary habits, alcohol use, or sexual practices usually is daunting to the obstetrician–gynecologist. The practice of motivational interviewing is emerging as an effective and efficient catalyst for behavior change. Motivational interviewing tactics have been successfully used within the clinical setting to promote weight reduction, dietary modification, exercise, and smoking cessation, thus having a potential profound impact on heart disease, hypertension, and diabetes mellitus. Prompting patients to use safe sex practices and to use contraception more consistently also has been achieved through motivational interviewing techniques. Communication with patients that indicates sensitivity and empathy is an approach used successfully by obstetrician–gynecologists. Whereas the traditional manner by which physicians give advice often is enough to motivate some patients to adopt more healthy behaviors, advice alone has little impact for those engaged in risky health behaviors. This resistance to change may be associated with the patient’s misunderstanding of the connection between the activity and the health risk. The resistance also may be associated with minimizing the risk, valuing a social connection associated with the behavior, or even addiction. Evidence suggests that motivational interviewing is one technique that can be used to break through this resistance and achieve behavior change within the constraints of an active clinical practice. The American College of Obstetricians and Gynecologists (ACOG) encourages the use of motivational interviewing as one effective approach to elicit behavior change.
Other perspectives on changing behavior in individuals that are unmotivated to engage in health behaviors come from dual-process theories of action. According to this perspective, behavior is driven by two processes: conscious consideration of the pros and cons or expectancies of the value of engaging in the behavior relative to potential costs of doing so, and non-conscious processes that are spontaneous, impulsive, and occur with little deliberative thought (e.g., Strack and Deutsch, 2004; Hagger and Chatzisarantis, 2014, 2015 Hagger et al., 2015). Many unhealthy behaviors including unhealthy eating, smoking, and drinking excess alcohol have been conditioned by cues in the environment paired with the concomitant reward-based outcome, usually determined by dopaminergic pathways in the brain which serve as powerful reinforcers of the cued-up behavior (Rebar et al., 2015). As such, exerting conscious control to override these strong neural relations between cue and action is difficult and requires considerable cognitive resources and motivation.
In brief, patients can ensure that legislative, regulatory, and funding priorities reflect their needs. Patient engagement for research can help to frame research questions, select outcomes, develop study protocols, support recruitment, interpret results, translate research findings into lay language, disseminate results, and even sustain interventions. Efforts will be needed to help patients realistically participate in these activities. Patient engagement will need to become the cultural norm. Patients will need training and support to meaningfully participate. Yet collectively, these higher levels of patient engagement can improve our very systems for promoting health.
Hagger M. S., Rebar A. L., Mullan B. A., Lipp O. V., Chatzisarantis N. L. D. (2015). The subjective experience of habit captured by self-report indexes may lead to inaccuracies in the measurement of habitual action. Health Psychol.
Strack F., Deutsch R. (2004). Reflective and impulsive determinants of social behavior. Pers. Soc. Psychol. Rev. 8, 220–247.
Hagger M. S., Chatzisarantis N. L. D. (2015). The trans-contextual model of autonomous motivation in education: conceptual and empirical issues and meta-analysis.
Orbell S., Sheeran P. (1998). ‘Inclined abstainers’: a problem for predicting health related behaviour. Br. J. Soc. Psychol.