Health Care Quarterly:

Motivating patients to change

Many common health problems, such as heart disease and diabetes, can be treated in part by patients themselves who are motivated to kick unhealthy habits. Patient choices to give up smoking, lose weight, exercise and take prescribed medications as directed are essential in achieving better health and quality of life.

Unfortunately, patients are often the biggest obstacle to their own health, because unhealthy habits are hard to change, said Dr. Thomas Hunt, chairman of the department of family medicine at Roseman University’s College of Medicine.

Physicians such as Hunt use a variety of communication strategies to help patients make lasting changes.

“In order to be successful in helping motivate a patient to change unhealthy habits and adopt new, healthier ones, we must offer less instruction and more practical, easily understood information, ask more questions and offer encouragement,” Hunt said.

Changing habits begins with education. “Helping patients understand how an unhealthy habit, such as poor diet or smoking, relates to their primary health problem is the first step in persuading a patient to make changes,” said Hunt. “Patients need to know that a specific habit is detrimental to their health and changing it will truly make a difference in their health and quality of life.”

Hunt embraces a collaborative approach to help patients face what can often seem like a daunting challenge. He uses motivational interviewing, an increasingly common technique in medicine that involves asking and listening to a patient, rather than directing a patient on what they need to do.

“Motivational interviewing helps establish a starting point,” says Hunt.

“Asking questions like, ‘What is the one thing you can do right now to help facilitate change?’ can lead to the creation of patient-directed goals. Sometimes it’s just one small goal, but during follow-up appointments, when the goal is achieved and the patient has built confidence, new and more ambitious goals can be formulated with the patient that build upon the previous accomplishments.”

This approach, researchers say, can reduce a patient’s resistance to change by allowing the patient to voice their uncertainty. Physicians who empathize with a patient’s reluctance can build trust and help the patient better explore achievable steps.

Motivational interviewing works in concert with the Stages of Change model for changing behavior. Understanding this model helps physicians recognize what patients are experiencing and how to help them move along what can be a long and cyclical process to achieve new, healthy habits.

The Stages of Change model includes the precontemplation stage, where a patient starts out as uninterested, unaware or unwilling to consider a change. Through motivational interviewing, the patient enters the contemplation stage where his or her reluctance is often voiced and where a physician’s encouragement is crucial. “The patient has both real and perceived barriers that prevent him or her from changing a habit,” Hunt said. “At this stage, a physician is able to talk through these barriers and help the patient realistically assess the barriers and potential ways to break through.”

Next, the patient enters the preparation stage, where he or she prepares to make a specific change. This is where the patient may experiment with small, more attainable goals to build confidence, says Hunt. “This is where the patient may experience an ‘ah ha’ moment and be motivated to try new things,” adds Hunt.

Eventually, the patient reaches the action stage, where he or she acts on their decision to make significant lifestyle changes. Over time, the patient will work to maintain the changes. Relapses are common, but are a necessary part of the process of achieving lifelong change.

Hunt said, “Changing unhealthy habits is rarely achieved at a single appointment with a patient. It does not rely on a physician making the correct diagnosis and directing the patient on what needs to be done, but rather on a patient’s willingness to take the necessary steps to maintain or improve their health and a physician’s thoughtful intervention and guidance to help the patient through the process of change.”

Patient education on how habits affect overall health combined with the right approach to helping patients positively change their habits not only creates productive physician-patient relationships, but helps patients overcome some of today’s most common health problems.

Jason Roth is the vice president of communications at Roseman University of Health Sciences.