Step by step motivational interviewing

Communication and Health Literacy

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1. Establish rapport1

Express empathy with the person's position and create an atmosphere in which the person can safely explore their position and options. Make it clear you are not going to lecture the person, but would like to understand their point of view. For example:

"You may be a little fed up with people lecturing you about . . .  I'm not going to do that, but it would help if I really understood how you feel about  . . ."

2. Assess the person's readiness to change1

People go through five stages of change when changing their health behaviours: pre-contemplation " contemplation "preparation "action " maintenance.

“Tell me what you think about quitting”

“What would you like to change about your lifestyle?”

3. Assess conviction, motivation and confidence1

It is important to know when a person thinks change is beyond their capabilities. For example,

"On a scale of 1 to 10, if 1 is not motivated to quit and 10 is totally motivated, what number would you give yourself right now? What would need to happen to get from 4 to 8?"

"If you decided to walk for 30 minutes every day, how confident are you of success?"

"If you decided to start eating more vegetables, how would it benefit you?"

"Can you give me an example of something you've done in the past that worked well for you?"

"What do you like about . . . ? Why do you dislike it? Where does that leave you?"

Encourage the person to talk

Continue to ask open-ended questions that explore the person's conviction, motivation and confidence.

Value the relationship

Be non-judgmental and avoid lecturing: For example, say "What have you heard about the risks of eating a lot of sugar?" instead of "Eating lots of sugar can increase your risk of diabetes"

Giving advice can reduce change and increase resistance. Ask permission to give expert information.

Discuss the good things about unhealthy behaviours. This will help reduce defensiveness and help you understand their point of view.

Roll with resistance. If the person presents barriers or arguments against change, explore them rather than dismiss them. Avoid arguments.

Paraphrase and clarify the person's statements to show you understand what they said.

Explore discrepancies

Explore the person's values and goals, and any inconsistencies between them and current behaviours that impact on health.

Link the potential health improvements from changing behaviours to the person's goals and values.

4. Brainstorm solutions1

Don't offer a single, simple solution. Encourage the person to say what could work; don't discourage wild speculation. Supplement their ideas with your ideas then let the person choose the best option.

If the person has no ideas, ask permission to offer suggestions. Focus on small, sustainable changes they can build on over time, and that matches their readiness to change. Encourage them to move through the stages of change, stage by stage. This will help strengthen rapport and avoid resistance to change.

5. Identify the next steps and follow-up1

Ask the person to identify what they are going to do. Aim for the next steps to be SMART (specific, measurable, action-oriented, realistic and time-limited). If the person is not ready to set a goal, keep communication open. For example, "Things change, can we agree to leave the door open on this one for now?"


1. C Cyr, Motivational Interviewing: Steps to Success! 2008, viewed 17 September, 2018, www.crnb-rcnb.ca/en/files/Motivational%20Interviewing%20Steps%20to%20Success.pdf

Updated December 2018