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Motivational interviewing in primary care a quick start guide

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  • DM patients refer suffering and revolt due to restrictions imposed by diet, physical activity and medication. several difficulties related to the treatment follow up,suffering and revolt due to restrictions imposed by the diet, physical activity and medication. It is possible to infer that the focus of the education approach should not be restricted to the transmission of knowledge; it should also include emotional, social and cultural aspects that also influence in the treatment follow up.
  • If there is discordance, people decide how to behave based upon cost and benefits of ascribing more weight to either one´s attitude or attitudes of others
  • Individuals tend to reduce psycological disconfort (produced if the Dissonance is of a strong magnitude) by changing one element to make it more consonant, adding consonant cognitions, or changing the importance of cognitions
  • It is also a useful question. We usually think that people don´t change; but change also occurs, even naturally, without treatments. These are brief statements about it Hope: Perceived prognosis is a good predictor Natural change: most people who quit smoking do so without assistnace
  • It is also a useful question. We usually think that people don´t change; but change also occurs, even naturally, without treatments. These are brief statements about it Natural change: most people who quit smoking do so without assistnace
  • . Your doctor have diagnosized you a diabetes and tells you how you should eat. What ideas and feelings appear when you think in diet? Let´s do a brain storming. Share with your neighbour some of this ideas and feelings. Maybe some of this appeared. But also no change (imagine that at home you have a child with diabetes and everyone eat the same. Usually positive aspects are not remembered but they exist.
  • . Your doctor have diagnosized you a diabetes and tells you how you should eat. What ideas and feelings appear when you think in diet? Let´s do a brain storming. Share with your neighbour some of this ideas and feelings. Maybe some of this appeared. But also no change (imagine that at home you have a child with diabetes and everyone eat the same. Usually positive aspects are not remembered but they exist.
  • As we have seen, sometimes people doesn´t change their behaviour even if it´s necessary for them and our arguments doesn´t succeed to convince them. Why does that happen? First we are considering what happens when we give advice with our patient ambivalence. As we are arguing in favour of one of the sides of ambivalence our patient will answer explaining why she or he has not changed yet, the reasons to stay as they are. This is caused by psychological reactance. This term means that when people feel that their freedom to decide is frightened they oppose to that arguments. Usually, after agreeing with the statements they have heard, a but introduces the ideas against them. That ideas could refer to their values, their feelings about what change supposes and their ability to afford it or even questioning the right that we have to give them that advice in that moment. In some way the current patient position have been developed opposing other people arguments. Think of a smoker and how their relatives or friends advice influence their ideas. Maybe they agree with them but they become irritated or in bad mood.
  • What happens when the patient refers his o her reasons against changing as result of our advice? In his Self perception theory, Bem explains something very simple: people use to believe what they say. If they hear themselves claiming that change is not interesting, very difficult or it is not what they really like they believe that as their own position. It is very difficult to motivate yourself to do something that you are saying that you don´t desire.
  • When patients speak freely about a behaviour they are ambivalent they have to types of talk reflecting both sides of ambivalence. As we have seen sustained talk shows the reasons to stay as they are and the difficulties they see when they consider changing. On the other side they can talk about the positive aspects of changing. For exemple - - - - Some phrases show both sides.
  • It is also a useful question. We usually think that people don´t change; but change also occurs, even naturally, without treatments. These are brief statements about it Natural change: most people who quit smoking do so without assistnace
  • Changing talk is about the needs, reasons, desires and abilities the patient have about changing his/her behaviour.
  • When patients hear themselves arguing the positive aspects of changing, including their abilities to afford it they become more motivated. But when this changing talk have been analysed has no been predictive of behaviour change. Only when patient expresses statements that show commitment with change or starting to do small steeps changes is more probable.
  • If we see the amount of both change talk and sustained talk in people that at the end of the interview made a change plan and the ones that do not made it, in the beginning both types appear but if the patient reduce sustained talk and increased change talk then is more probable that change plan is made.
  • Motivational interviewing is a method that tries to enhance patient’s motivation considering this ideas. Let’s see a definition: Collaborative means that we work with the patient, guiding them in the way they are deciding. I don´t think necessary to explain what people centered means here. Elicit and strength motivation because the fuel of motivation is the patient ambivalence and motivation arises from their needs, reasons and desires considering their abilities to get his/her targets Motivational interviewing is not neutral, we work in the way of improving our patients’ health.
  • As you could notice from the definition MI is very close to general practice. Most of their basis respond to a patient centered model of clinical practice like listen to patients and understand their motivations. But also reflect that we are going to work with the words that we have listened and the arguments that they show. The righting reflex is what mice do when we place them with their legs up, they inmediately turn down. And it is what we do when we see something wrong (think for example in what you feel looking to an inclined picture . We try to fix it. If we try to cure our patient behaviour we boost his/her resistance showed as sustained talk and lower probability of change. If we don´t show that we are desiring their change we avoid resistances and permit that both sustained and changing talk emerge. The last point highlights the importance of reinforcing the self-image of a person in order to enhance his or her ability to afford the change.
  • Last slide just to explain that MI is very new and it is developing. If you try MI and MI and PC you get this numbers in groups of five years.
  • I would like to consider the results of this method. Lundhal and Burke have published the last methanalisis of MI. In it they have included studies about substance problems, health behaviour change and treatment adherence.
  • We can divide the comparison groups in the ones with a demonstrated efectivity and other not specific. MI is equivalent in efectivity to the specific methods and better than usual care in a moderate way. And is shorter in time that the specific methods compared.