Select a fellow classmate, friend or relative with an unhealthy lifestyle behavior that they would like to change and that they would feel comfortable speaking with you about.Make sure to tell them that their identity will remain anonymous (for the purposes of this assignment, just provide the alias Joe/Jane and provide their age, gender and the habit they would like to change).The attached file is a template of interview questions that you can ask your client to determine where they are in the process of change while coaching them towards better habits.Record their answers to the questions on the Word document and then copy and paste it into the assignment field.Under "Case Note", briefly summarize how receptive the client was to your coaching and the likelihood that they will begin to make changes.Read through the FRAMES method of motivational interviewing (summarized at the end of the attachment) and use it to guide the dialogue.

Instructions:

This assignment will be graded on completeness of the task; recording client answers and Case Note summary.Your grade will NOT depend on whether or not you were successful in motivating change.Some people are not ready to change their habits and we can learn from that resistance to help others.Please be as truthful and accurate as you can in assessing your ability to motivate change.

Motivational Interviewing for Lifestyle Changes

Motivational interviewing aims to enhance self-efficacy and personal control for behavior change. It uses an interactive, empathic listening style to increase motivation and confidence by specifically emphasizing the discrepancy between personal goals and current health behaviors.

Here are some examples of thetypes of questions to askusing a motivational interviewing style when assessing ambivalence and motivation for lifestyle changes in patients:

• How ready do you feel to change your lifestyle behaviors?
• How is your current behavior affecting your life right now?
• What kinds of things have you done in the past to change your habits?
• What strategies have worked for you in the past?
• Some people talk about part of them wanting to change their patterns, and part of them not really wanting to change. Is this true for you?
• On a scale from 1-10, how ready are you to make changes in your patterns?
• How much does it worry you that you might return to old patterns?
• What makes you feel like you can continue to make progress if you decide to?
• What are your hopes for the future if you are able to become healthier?

Questions to Assess Readiness, Importance, Confidence and Barriers

Readiness to change:

• How do you feel about changing your behaviors?
• How ready to change are you?
• How would you like your health to be different?
• People differ in how ready they are to make these kinds of changes. What about you?
• Some people don't want to talk about their habits at all, where as some people don't mind at all. How do you feel about this?

Importance of change:

• Tell me how things would be different for you if you _______ (were at a healthier place etc.)
• What do you think would happen if your habit doesn't change?
• What are the most important things to you? What impact does your habit have on that?
• What would have to happen before you seriously considered changing?
• What are the good things about ________ (being healthier, exercising more)?
• What concerns do you have about _________ (being healthier, exercising more)?
• If you were to change, what would it be like?

Building confidence:

What would make you more confident about making these changes? How can I help you succeed? Are there things that you have found helpful in previous attempts to change?

If you decided to change, what might your options be? What are some practical things that you need to do to achieve this goal?

Barriers:

• What things stand in the way of your taking a first step?
• What barriers might impede success? (e.g., child care, transportation, distance, cost, accessibility)

Motivational Interviewing Exercises to do with Patients

1) Readiness assessment

_________________________________________________________________________

0 5 10

If "0" is not ready to make changes (in your health related habit) and "10" is ready to make changes, what score would you give yourself?

You gave yourself a score of X. Why do you think you are X, and not ___ (a lower number)?

OR

You gave yourself a score of X. What would have to happen to move up to ___ (higher #)?

2) Decisional balance

Discuss with the patient what he/she perceives to be the short-term and long-term benefits and drawbacks of making healthy changes. Encourage the client to generate personal costs and benefits, and then openly discuss these to identify barriers and goals.

Short Term Costs

1) 2) 3)

4)

5)

Long Term Costs

1) 2) 3)

4)

5)

Short Term Benefits

1) 2) 3)

4)

5)

Long Term Benefits

1) 2) 3)

4)

5)

Case Note:

KeyFRAMESto Motivation for Change

F: Feedback

Present feedback to the patient in a way that is respectful and has impact. This can include providing feedback about how unhealthy behaviors are harming the individual but ensuring that your communication reflects the patient's statements of concern. Feedback should be based on information gathered in patient interviews, reports, and objective measures. It can be helpful to present this data to the patient and elicit his or her opinions from this information.

R: Responsibility

Emphasize that the patient has the responsibility and freedom to make the choice to change. This is not a decision that can be made by anyone else, and it is really up to the patient to decide what decisions to make.

A: Advice

Provide clear and direct advice about the importance of making lifestyle changes and suggest different ways that this can be accomplished. Advice should reinforce that the patient makes the ultimate choice.

M: Menu

Offer different alternatives that the patient can choose from. For example, "There are different ways that people successfully change their lifestyle behaviors. Perhaps we can spend a few moments talking about this so that I can tell you some of these strategies, and you can tell me which of these might make the most sense for you."

E: Empathy

It is important to listen to and reflect the patient's statements and feelings. This ensures that you understand the patient, and that the patient feels understood by you, both of which foster productive communication. Expressing empathy to your patient involves communication that is warm and supportive and demonstrates that you are paying attention to the patient's verbal and nonverbal communication.

S: Self-efficacy

Part of your goal in motivational interviewing is to help instill optimism and confidence in your patient that he/she can make meaningful behavior changes. You want to communicate to your patient that "you can change."