Motivational interviewing to change dietary behavior

HANDS ON Behavior Motivational interviewing to change dietary behavior Background.—Direct links have been established between the increases in obesity and chronic noncommunicable diseases (eg, cardiovascular disease, diabetes, hypertension, stroke, dental caries, and certain cancers) and diet and lifestyle patterns. Most patients, however, do not heed the suggestions offered by clinicians concerning changes in these areas, especially when the suggestions are offered as advice. The use of effective interpersonal skills should improve patient satisfaction and avoid the barriers to behavior change that accompany ineffective communication techniques. Making Changes.—Change has been conceptualized according to various models. Stage-based approaches to changing dietary behavior, such as the transtheoretical model, focus on the patient’s decision-making process. These approaches suggest that the individual is at a particular stage in a cycle of ‘‘readiness to change.’’ Any dietary counseling must be customized to the patient’s needs at that stage. These tailored messages have proved effective in smoking cessation programs and physical activity counseling. Motivational Interviewing.—Eating behavior results from a complex interplay of social, cultural, and biological influences. Changes therefore affect both lifestyle and identity. To facilitate change, motivational interviewing (MI) was developed. In MI, the dental health professional and patient collaborate in the change process. The professional draws on personal perceptions, goals, and values to motivate the patient to change. The patient remains responsible for making the changes, but this approach helps to resolve ambivalence issues, which can be a key obstacle to change. The transtheoretical model helps provide a framework for understanding the process of change, whereas MI provides a way to facilitate change. Combining the two promotes dietary change, delivering a tailored message in a way that motivates the patient to alter dietary habits. With MI, patients may come to better understand a chronic condition and explore their ambivalence toward the work of change and the loss of favorite, but less healthy, food choices. MI mandates a more facilitative and collaborative role for the dental health professional. Time to fully explore ambivalence issues and come to a resolution has been a limiting factor in MI approaches, so brief MI techniques have been developed for use in the health care setting. In addition, an MI menu was developed listing techniques in order of readiness to

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change. The dental health professional can use the tool but must remain flexible in approach, aiming for a collaborative conversation about making dietary behavioral changes. Application.—Begin with open-ended questions to establish the patient’s current dietary patterns. Use further probing to put these patterns into context in relation to the patient’s oral and/or general health status. It is wise to ask the patient’s permission to discuss the topic. A good beginning is to talk through a ‘‘typical day;’’ this not only puts eating behavior into context but also builds rapport between you and the patient. It is then easier to assess the pros and cons of changes in behavior, which addresses the patient’s ambivalence toward change. You can offer information with sensitivity rather than just giving advice, which often falls on deaf ears. The two methods for giving advice are providing information and using persuasion; neither is particularly effective in bringing about changes in dietary behavior. Reflective listening and summarizing are useful in a collaborative conversation. These show that you are actively listening to the patient’s concerns. Making statements of your understanding further underscores that the interchange is a collaborative exercise and helps in clarifying the thoughts and feelings the patient is trying to convey. You can help the patient in making decisions by presenting options for bringing about dietary changes. Ultimately it is the patient who chooses dental goals, but you can describe strategies and provide information about what has worked. The goals that are set should be as specific as possible, then detailed plans are developed to achieve the goals. Patients can identify specifics, such as where and how often, and outline their support options in these plans. Clinical Significance.—No one likes to hear good advice, and mostly, no one takes it. How then to help patients alter potentially damaging dietary and other habits? Discussed are ways to avoid merely preaching and giving information. Lake AA: Changing dietary behavior. Quintessence Int 37:788-791, 2006 Reprints not available.