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Empower health behavior change through effective communication and motivational interviewing

This is an excerpt from Obesity and Weight Management by Alexios Batrakoulis.

By Rachelle Acitelli Reed and Susie Reiner

Communication Skills and Motivational Interviewing Principles

A well-developed, science-based program is important, but communication is essential to facilitate health behavior change, including long-term weight loss. Communication is a skill that develops over time from working with others, and self-awareness is required to consider others’ thoughts and needs while expressing information and ideas. An essential attribute of effective communication is empathy, the ability to understand and identify with others’ perspectives and experiences without bias (Elliott et al. 2011). An empathetic, person-centered approach to training helps to build trust within the practitioner–participant relationship across health disciplines.

Motivational interviewing (MI) is an approach developed by Miller and Rollnick (2012) that helps an individual define their current and ideal selves and isolate the behaviors that would influence movement toward the ideal self. MI considers decisional balance and autonomous decision-making to help individuals self-regulate their behaviors. MI takes a collaborative approach and follows the strategies outlined in table 4.3 to provide support and facilitate change.

Coaches can use a variety of MI strategies to allow a client’s ideas and perspective to lead the conversation. These include open-ended questions, affirmations, reflective listening, and summaries of the conversation points to ensure clients feel they have been heard and understood.

• Open-ended questions are questions that cannot be answered with a simple yes or no, provoking a deeper thought process about the issue. These questions normally start with how or what, such as “What have you tried before to manage your weight?” instead of “Have previous weight loss interventions worked for you?” The former example evokes abundantly more information than the latter.
• Affirmations help to acknowledge positive behaviors and build a client’s self-efficacy. For example, saying “You’ve already taken the hardest step in coming in today. You’re clearly a determined and resourceful person” provides encouragement and recognizes the work the client has already accomplished toward their weight loss goal.
• Reflective listening is a way for coaches to show they are truly listening and understanding a client’s words and actions. Eye contact, body language, nodding, and verbal cues such as “OK, I see” help clients know they are being heard.
• Summaries are a form of reflective listening in which a coach collects key points from the conversation and explains them back to the client to indicate understanding and correct any misunderstandings. Summarizing can also help identify probing questions that will provide a deeper exploration of a topic such as weight loss.

It is important to note that communication extends beyond verbal interactions and includes nonverbal cues that can indicate a practitioner is listening and attentive during the conversation. Nonverbal cues include an open and receptive posture, eye contact, gestures such as nodding, and facial expressions that coincide with what a participant is expressing. One of the easiest ways to observe one’s own body language or nonverbal cues is to practice parts of a conversation in a mirror, observe the physical movement of the body, and adjust accordingly in interpersonal interactions.

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