Motivational Interviewing: An Evidence-Based Approach to Changing Health Behavior

Motivational interviewing (MI) is a goal-directed, client-centered counseling approach designed to increase intrinsic motivation and strengthen commitment to change through exploration and resolution of ambivalence.  MI has been shown to be effective in fostering change across a wide range of health behaviors including glucose monitoring, exercise, dietary change, stress reduction, medication adherence, smoking cessation, and others. Evidence supporting the effectiveness of MI will be reviewed. MI is focused on the client’s concerns and perspectives and emphasizes personal choice.  Goals are collaboratively set and ambivalence is considered a normal part of the process. 

The spirit of MI is based on relational factors including accurate empathy, positive regard, collaboration, and honor of the client’s autonomy.  The client’s own motivation is evoked rather than attempting to install it.  MI is based on change theory and motivation or readiness to change is conceptualized as an ever-changing rather than a static state.  Interviewing style has a significant impact on the client’s readiness to change and long-term behavior. 

Underlying principles of MI include provision of empathy, development of discrepancy, ability to roll with resistance, and support of client self-efficacy.  Evidence supports that patients commit to change more readily when they are convinced of the value of change.  Technical strategies provide the nurse with skills to effectively obtain the patient’s story, assess readiness to change, evoke change talk, respond to resistance, and assist in development of a plan for change that addresses the patient’s concerns and emphasizes personal choice.  Collaboration to negotiate a specific change plan that is acceptable and appropriate to the patient is a critical element of MI.  Effective approaches to deal with common traps encountered in MI are provided.