MI in Primary Care: Examples Copy

Topic Progress:

Here is an example of using MI to provide feedback to a patient in a primary care setting.

MI-Consistent Screening and Feedback in a Primary Healthcare Setting

“Your PCP has suggested you come see me to explore some concerns about…I have a screening tool here, that we have found to be helpful in understanding this concern about…I know it has a lot of questions that ask for specific information. Some of the questions may be confusing or uncomfortable. Please stop me if you need clarification or would like to add anything. Would it be alright if we go over these questions together…?” (Asking Permission)

“Based on your answers I am concerned about [name the health risk behavior(s) — do not give a diagnosis].” (Informing)

“What does this information mean to you?” (Asking)

  • Follow this open ended question with 1–2 reflective listening responses to explore the person’s understanding of the information and what it means from his/her perspective. (Listening)

“What more would you like to know about…?” (Asking)

  • Follow with a short, clear chunk of information to clarify. (Informing)
  • Follow with another question to elicit the person’s understanding of the new information. “What do you make of the information I have just given you?” (Asking)
  • Follow with 1–2 reflective listening responses. (Listening)

“Based on our conversation and the results of the screening I would like to make a suggestion to you. Would that be alright?” (Asking Permission)

  • Give the recommendation then follow with another question then elicit the person’s understanding of your recommendation? What do you think about my suggestion? (Asking)
  • Follow with a summary and next step.

Motivational Interviewing: Adolescent Follow-Up on Positive Alcohol Screen

In this 3-minute video, the healthcare provider uses the MI guiding style of Asking, Listening and Informing with an adolescent who has a positive alcohol screening.

Here are some other examples of how MI can be integrated into brief, structured interviews in healthcare settings utilizing OARS and the guiding style of Asking, Listening, and Informing. As you watch each video make a note how the clinician(s) use these MI strategies to engage the “patient” and help him/her row the boat toward change. Also, make note of how the consumer/client/patient responds to the respectful guiding style of Asking, Listening and Informing.

MI and Diabetes Management

In this 11-minute video the Primary Care Physician discusses recent lab results of the “patient’s” blood glucose and discusses her concerns about taking the medication he had prescribed for her. The provider uses OARS, elicit-provide-elicit, double-sided reflections, looking back (what worked before), asking permission, informing, eliciting change talk, key questions, readiness ruler, confidence ruler, and eliciting commitment.

Motivational Interviewing and Hypertension

In this 19-minute video the Primary Care Physician discusses hypertension management and related health behaviors including losing weight, increasing exercise and decreasing alcohol intake with a “patient” who is initially angry and feels ambivalent about taking his blood pressure medication. The provider uses OARS, reflective listening to “role with resistance” by coming alongside the “patient,” elicit-provide-elicit about alcohol use, asking permission, setting the agenda, developing a change plan for losing weight and exercise, evoking change talk, readiness ruler, decisional balance regarding drinking, importance ruler, change planning, emphasizing personal choice, and eliciting commitment to change.

MI: Linking Alcohol Use and Risk of Pregnancy

In this 4-minute video the patient has just been screened as at risk for alcohol use and pregnancy. You will see the Nurse working together with the “patient” to both link the two behaviors and use the “patient’s” responses to her assessment to elicit change talk and action planning toward change behavior. This is a very structured interview and places a heavy emphasis on the importance ruler to elicit discrepancy and the confidence ruler to evoke change talk.