Can be used instead of teaching and directives
Evidence-based health coaching (EBHC), a novel approach to engaging patients, combined with motivational interviewing can produce lasting change because it delves into the reasons behind patients’ resistance, one expert says.
It produces health behavior changes that resonate with patients more effectively than the traditional approaches employed to convincing patients to change their health behavior, says Melinda Huffman, BSN, MSN, CCNS, CHC, co-founder of the National Society of Health Coaches, and principal, Miller & Huffman Outcome Architects in Winchester, TN.
“From my own experience and expertise in the field, if you do these you’ll have improved health,” Huffman says. “We know the better way of encouraging patients to change is to tap into their own motivation to act.”
For several years, Huffman has used motivational interviewing to help healthcare providers encourage patients’ behavior change.
“In the past, we told our patients what to do and didn’t treat them as true partners in health,” Huffman says. “What they bring to the table are their own personal values, beliefs, concerns, faith, and any health conditions they might have.”
When patients make healthcare decisions, they do it through the social context of their lives including all of those factors, she explains.
“How often have you ever not filled a prescription after taking the trouble of going to the doctor?” Huffman asks. “Sixty percent of us will have gone to the doctor’s office and yet not filled a prescription or followed their doctor’s plan.”
EBHC is a model for encouraging behavior change. “It’s all about guiding, partnering, tapping into your patient’s motivation or the patient’s family’s motivation to act,” she says. “It’s a 50-50 partnership, and to engage someone actively as a partner, that patient has to be involved to the point where the provider sees the patient as an active partner.”
Patient engagement tips
Here are some of Huffman’s tips on how to actively engage patients:
Do not think of patient engagement as compliance
Patient engagement is not a directive the patient follows. It’s the patient’s involvement in the process of improving the patient’s clinical care and health. Through collaboration, the patient becomes the expert in his or her own healthcare, and the foundation is built for behavior change, Huffman says.
Engage in skilled listening
Providers are accustomed to doing most of the talking. But EBHC/MI encourages case managers and other providers to learn listening skills, including asking open-ended questions and waiting for a response. A listening skills self-assessment is available at http://www.nshcoa.com/pdf/listen.pdf.
Guide the agenda
Case managers can ask the patient and the patient’s family about what most concerns them regarding the health behavior change that’s prescribed. First, all of their concerns should be considered, and then the case manager can guide the patient to identifying the concerns that have the most personal importance to him or her, Huffman says.
Address ambivalence
Ambivalence results from conflict that maintains the patient’s status quo. A case manager can have the patient list the reasons why he or she hasn’t changed the behavior in one column and list the reasons why the behavior needs to change in another column, Huffman says. The patient can decide which of those behaviors has priority.
Brief encounter motivational interviewing
Case managers can use motivational interviewing tactics to help the patient identify the real issue or dilemma, Huffman says. This tactic includes open-ended questions, statements, and responses, as well as empathy.
For example, one open-ended statement could be, “Tell me what concerns you about ____ (taking insulin, quitting tobacco, changing eating habits, losing 35 lbs).” The key is to avoid interrogating, and to adopt a tone that suggests exploring the root concerns, she says.
Give information the patient desires
Providers traditionally give information based on what they think the patient and family need to hear. They do not take time to find out what they already know or what their own immediate concerns are, she says. According to Huffman, the MI approach suggests asking permission from the patient to provide information, such as in this example: “What do you understand about high blood pressure? Would you like some more information about it?”
