Insights

Driving Improvement with Motivational Interviewing 

ConversationImproving children’s health outcomes often relies on supporting and inspiring a behavioral change. This change might be in the population we’re seeking to support (helping pregnant mothers quit smoking) or in the systems we’re seeking to improve (getting buy-in from care teams on an improvement initiative).

This change is most effective, and most sustainable, when individuals choose to make the change because they’ve realized it supports their goals. While eliciting that realization isn’t always easy, drawing on motivational interviewing (MI) can help, says NICHQ Project Director, Zhandra Levesque, MPH.

What is motivational interviewing?

MI is an evidence-based, people-centered approach to behavioral change. It engages individuals in conversations that help them decide to change their behavior based on what matters most to them.

“Rather than tell individuals to change, MI helps individuals choose a new approach that better aligns with what they want to achieve,” explains Levesque. “Inspiring self-motivation does more to prompt change than a directive ever could.”

Leveraging the fundamentals of MI in your change initiative can be a powerful tool for helping you align your improvement team’s efforts and energies around a shared goal. Below, we’ve provided three strategies to get your team started on using this technique.

Three ways to incorporate motivational interviewing in your change initiative  

Not sure how to respond with reflective statements?
Pull from the examples below:

  • You have some concerns about ....

  • You’ve tried to…

  • You are pretty frustrated because …

  • It sounds like you…

  • So what I hear you saying is…

  • You’re wondering if…

  • You feel…and that makes you want to…

First, keep empathy at the center of every conversation, accepting and respecting each individual’s feelings, experiences and viewpoints. By exhibiting openness and compassion, and acknowledging their lived experiences, you build a foundation for a genuine conversation. Reflective listening—where you summarize what you hear the individual say to check for inconsistencies in your interpretation—can help facilitate empathy. By reflecting back what you hear, you give individuals the opportunity to clarify misinterpretations and assumptions, while helping elicit relevant information they may not have thought to share, such as a personal barrier or bias. Moreover, reflective listening assures the individual that you are not basing your interaction off false assumptions about them or their experiences.

    Second, work to help individuals recognize when what they want is not compatible with what they are currently doing. During your conversation, listen for where the desired behavior (the behavior that aligns with their goals or personal values) differs from their actual behavior; then use reflective statements to highlight that discrepancy, thus ensuring that you are speaking from that foundation of empathy. Once you have identified the inconsistency, spend time reviewing the pros and cons of changing their approach to one that better supports their goals, always acknowledging that new behaviors are often difficult to adopt.

    Looking for more strategies to supercharge your change efforts? Learn about strategies to ensure successful collaboration and break down silos with NICHQ’s Essentials of Collaboration e-course.

    Finally, help individuals assess their readiness to change by determining how important the individual believes a change is and how confident they feel in their ability to make that change. Scaling questions—where individuals use a scale of 1-10 to rate their perception of the change’s importance and how prepared they feel to make it—can be a valuable tool for assessing readiness. Once an individual provides a rating, you can probe their answer for further meaning. Why did they rate the importance as a 5? What would it take to move it to a 6 or a 7? Their answers can help you identify barriers and ultimately enhance their belief that they can make a change.

    Interested in learning more? Check out the MI slide deck in our early childhood resource packet to review the major principles of MI and uncover additional strategies. Or, read an article about how MI helped support smoking cessation in pregnant women.