5 pearls for supporting healthy behaviours through motivational interviewing

As frontline, easily accessible healthcare professionals, pharmacists are perfectly positioned to engage patients in discussions about healthy behaviours that can prevent or help manage chronic disease. Even in a short interaction, specific communication strategies such as those used in motivational interviewing can help prompt patients to change their habits.Motivational interviewing, originally developed as a mechanism to support people with alcohol use disorder, is now recognized as a useful method to encourage changes that can benefit many chronic diseases (including diabetes and cardiovascular disease) and improve adherence with medication therapy.1 The key to success is understanding what’s important to the patient, and then using the four principles of motivational interviewing—compassion, acceptance, partnership and empowerment—to help them make changes aligned with their priorities (Figure 1).2 Following this model encourages collaboration, helping the pharmacist and patient form a partnership to determine how the patient’s priorities can be used as the motivation for positive change.We have daily opportunities to implement motivational interviewing into our practice, and help patients make choices that could benefit their health. Let’s look at five tips to help you get started.1. Spot opportunities to engageBecause motivational interviewing can be of particular benefit to patients who are ambivalent to change, identifying opportunities to engage these patients is an excellent way to start honing your skills.3 Patients often want to make a change, but struggle with how to start. Providing them with the opportunity to express their challenges in a safe space, where their concerns are accepted and received with empathy, builds the foundation of connection and trust that’s fundamental to the process of motivational interviewing. Consider engaging with patients who are consistently late refilling their regular prescriptions, are seeking treatment for difficulty with sleep or for smoking cessation, or are feeling discouraged with the addition of yet another medication to manage their condition (e.g., diabetes).2. Build conversations with “OARS”Time for patient interaction is often limited, but even with a small amount of time, community and hospital pharmacists can draw on all or some of the skills of motivational interviewing to engage and focus the patient. You can use the technique described as “OARS”—Open-ended questions, Affirmations, Reflections and Summaries (Figure 2). The first step in the motivational interviewing process is to ask open-ended questions to build trust and a connection. Second, use affirmations to help validate the steps the patient has already taken toward changing and improving their health, and to demonstrate that you are actively listening. Third, reflect back what you have heard, creating an opportunity for further questioning to explore the root cause of their challenge. Finally, summarize what the patient has expressed to focus on a potential solution.3. Ask–Share–AskOnce the patient’s perspective and priorities are understood—for example, their frustration with being prescribed an additional medication for diabetes—you can work to focus the patient on an opportunity for change using the “Ask–Share–Ask” technique. This can also be used as an opportunity for patient education. For example, you could introduce the idea of healthy food choices by first asking if they would be open to talking about how food affects their blood glucose and hemoglobin A1C. After engaging the patient on the topic, take the opportunity to provide some brief education on healthy diet choices, then ask the patient if they observe a connection between what they eat and their blood glucose results. Ensure your conversation has the spirit of acceptance and empathy, as patients may feel judged while discussing potentially stigmatizing subjects.4. Gauge patient motivationNow that you have the patient engaged in conversation about change and focused on a specific opportunity aligned with their priorities, their openness to change can be assessed by asking them to rank the importance of the proposed change on a scale of 1 to 10.4 If a patient ranks the importance as low, they are likely not ready and need time to contemplate what you have discussed. On the other hand, if the patient ranks the importance as high, you can next explore how to make the change a reality.5. Turn goals into actionFor a patient who is ready to make a change and create a new habit, capitalize on the opportunity by working with them to create a plan for action. Make a plan that’s specific and achievable, likely focused on a single change in behaviour the patient could build on in the future.In his book Atomic Habits, James Clear summarizes the keys to success for a new habit as making the habit obvious, easy and satisfying, and making bad habits unattractive and difficult.5 Work with your patient to incorporate these elements into their action plan. For example, if the patient would like to decrease the sugar in their diet, suggest they stop keeping sugary snacks in their home (make it difficult) and prepare healthy snacks for the week in individual containers kept in the front of their fridge (make it easy and obvious).Finally, commit to following up with the patient to check on their progress, discuss challenges and celebrate successes. Document your own plan for follow up in your clinical services platform, along with next steps for when the patient is ready for further change.SummaryIncorporating motivational interviewing into your approach to pharmaceutical care can be effective for helping patients find the self-motivation to implement change into their lives. Consider creating a team-building exercise with your staff and colleagues by practising the four skills of motivational interviewing—open-ended questions, affirmations, reflections and summaries—and applying these skills in your day-to-day practice to engage your patients in achieving their goals.Sarah Snobelen (sarah.snobelen@icloud.com) writes continuing education content for pharmacists and is a clinical pharmacist at St. Michael’s Hospital, Unity Health Toronto, in Toronto, Ont. References:Cole SA, Sannidhi D, Jadotte YT, et al. Using motivational interviewing and brief action planning for adopting and maintaining positive health behaviors. Prog Cardiovasc Dis 2023;77:86-94. doi:10.1016/j.pcad.2023.02.003.Gutnick D, McNeilly S. Motivational Interviewing is “doing” what matters: integrating motivational interviewing spirit and skills into What matters to you? Conversations. J Patient Exp 2025;12:23743735251317041. doi:10.1177/23743735251317041.Bischof G, Bischof A, Rumpf HJ. Motivational interviewing: an evidence-based approach for use in medical practice. Dtsch Arztebl Int 2021;118(7):109-15. doi:10.3238/arztebl.m2021.0014.Luty J, Iwanowicz M. Motivational interviewing: living up to its promise? BJPsych Advances 2018;24:46-53. doi:doi:10.1192/bja.2017.7.Clear J. Atomic habits: an easy & proven way to build good habits & break bad ones. Avery; 2018.

5 pearls for supporting healthy behaviours through motivational interviewing

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