Motivational interviewing (MI) can change the way patients view the treatment we recommend. This is a universal concept used in many other areas of health care and has proven to be a very effective method of communication to improve patient health outcomes.
To understand MI and help patients through change, dental hygienists must be familiar with the stages of change for patients: precontemplation, contemplation, preparation, action, and maintenance. Our role as clinicians is to guide patients toward the motivation they already have and take steps toward positive change.
The components of MI are the basic elements of guiding principles and implementation. Effective communication with patients relies on partnership, acceptance, compassion, and conversations that draw on their desire to change and motivate. Success relies on the ability to not only ask the right questions, but also master effective listening.
These skills are explored in the guiding principles of motivational interviewing. They are resisting the “righting” reflex, understanding the patient's motivation, listening to the patient, and empowering the patient.
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MI guiding principles
Clinician need to avoid the instinct to be the expert and try to fix what’s wrong for the patient instead of looking to the patient’s thoughts to ensure the focus remains on them. Digging further into these concepts, hygienists need to determine what the person values when it comes to their oral health, their concerns, and their motivation.
One of the easiest ways to explore these concepts is to ask, “What’s most important to you when it comes to your oral health?” This may be uncomfortable initially, as patients may not know how to answer. However, by giving them time to think, you can usually gauge whether they’re concerned about overall health, cosmetics, or nothing at all, and that’s OK too. The point is to remain patient-focused and determine their values.
Listening and empowering patients are two of the most important MI principles. Actively listening and demonstrating empathy toward patients is a game-changer when it comes to MI in hygiene. Instead wondering why a patient won’t accept treatment or doesn’t understand their periodontal disease, build your communication skills to gauge where they are, and then meet them with a plan to progress forward. When patients are empowered to decide for themselves, there’s respect and collaboration instead of them feeling attacked by our views and recommendations.
What do MI skills include?
MI skills include open-ended questions, affirmations, reflective listening, and summarizing. Open-ended questions cannot be answered with “yes” or “no” and evoke more of a response. When questions are used with reflective listening, more meaningful engagement happens. An open-ended phrase I use often is “Tell me more about ____.” This prompts the patient to expand on topics, whether it’s their medical history or homecare habits.
Throughout conversations with patients, simple affirmations can help them build confidence, whether it’s praising them for adding an extra day of flossing or positively reinforcing someone with high dental anxiety for showing up for their appointment.
As these conversations wrap up, summarize (state back to the patient in their words what was said) throughout to affirm the patient's thoughts and feelings so they know they were heard. MI is a powerful resource that can be used by hygienists to better communicate and provide the highest level of truly patient-centered care possible.