Motivational Interviewing for disease management

Motivational Interviewing (MI) is a counseling style that uses a patient-centered approach to support positive lifestyle changes. Rather than giving direct advice, MI allows the registered dietitian nutritionist (RDN) to guide an individual to address a health concern by exploring the problem, eliciting change talk, and choosing an action plan. In addition, this process encourages the individual to explore personal motivation and readiness to change by identifying the necessary steps to reach a health goal.  

Experts emphasize the use of the OARS (open-ended questions, affirmation, reflection, summarization) technique by the RDN to make Motivational Interviewing a success. This not only promotes building rapport with the client but also supports patient self-efficacy in creating small changes to reach a goal. When applying this type of counseling to nutrition, MI can be used in various areas to benefit diet, weight, disease management, and overall health.   

Benefits of MI with nutrition care  

Successful behavior changes in nutrition, weight, and lifestyle can be difficult. Resistance from the individual may stem from intrinsic barriers such as age, motivation, and a lack of perceived benefit in reaching a health goal. Extrinsic barriers may also be a factor and include limited finances, lack of support, food insecurity, or poor access to healthcare services. Addressing these challenges with the use of MI by an RDN can make a difference.  

Compared to other types of counseling, MI is a more collaborative approach. Instead of the RDN pointing out the problem and giving specific nutrition advice to fix it, the discussion is patient-driven. Conversations should promote change talk from the client.

The use of reflections as a response from the RDN can help dig deeper into the health concern and determine motivation and readiness to set steps towards achieving a desired health target. Ideally, this shift in responsibility to the patient will help to drive individual goals and success.  

Understanding reflections with examples

Reflective listening is an essential component of MI. Beyond gathering information, the RDN’s reflection statements can help better understand what the client is saying. In general, there are six types of reflections. As confidence grows with the use of MI, each can be comfortably added to conversations. 

The six types of reflections are:    

1. Content reflection: This type of reflection uses active listening to build rapport while gathering client information. The response from the RDN is factual and should mention what was said without repeating details word for word.   

2. Feeling/meaning reflection: A technique used to tie an emotion to a certain behavior.   

3. Rolling with resistance: Instead of confronting the patient, this reflection type avoids using pressure or judgment to make a change.  Instead, the response acknowledges the reasoning for an individual to avoid change.     

4. Amplified negative reflection: A method used to counter patient resistance to change by highlighting the perceived benefits and minimizing risks of current behavior.  Maintaining a neutral tone with the response is important to avoid sounding sarcastic.  

5. Double-sided reflection: An approach which acknowledges to the client that the complex reasons for or against change are recognized.    

6. Action reflection: Responses include client-suggested ideas or steps to overcome barriers to make a desired change.   

Patient application  

Encouraging patient-driven health goals is a necessary part of disease management. With motivation and confidence to make these changes, goals set are more likely to be incorporated into a healthy lifestyle. The RDN has a unique opportunity with patients to support beneficial changes using MI.

Approaching each patient with empathy, building rapport, using different reflections, and supporting client motivation and confidence to reach a goal are all important to successfully implementing Motivational Interviewing in practice.   

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References

Resnicow K, Delacroix E, Chen G, et al. Motivational interviewing for genetic counseling: A unified framework for persuasive and equipoise conversations. J Genet Couns. 2022;31:1020-1031.   

Rutgers University. Motivational Interviewing-Cheat Sheet. https://rutgerstraining.sph.rutgers.edu/Fiveminutes/download/mi_strategies_cheat_sheet.pdf. Accessed January 22, 2025.  

Hunt K. Counseling and Communication Skills for the Renal Dietitian. In: Gonyea J, Phillips S, eds. In: Clinical Guide to Nutrition Care in Kidney Disease. 3rd ed. Academy of Nutrition and Dietetics; 2023.