Helping Patients Make and Sustain Healthy Changes: A Brief Introduction to Motivational Interviewing in Clinical Diabetes Care

The Challenge of Diabetes Self-Management Counseling in Busy Office Visits

Diabetes self-management refers to the full range of activities (or “behaviors”) in which patients care for their illness and promote their health. The three broad self-management tasks include 1) managing the disease (taking medications, following a diet, engaging in physical activity, self-monitoring); 2) maintaining one's daily life while living with chronic illness; and 3) dealing with emotional aspects of the disease, such as anger, fear, frustration, and depression.^1,2

There is consensus on the key preconditions for effective diabetes self-management. These include 1) sufficient knowledge of the condition and its treatment; 2) skills to manage the condition and to maintain functioning (ability to identify problems, barriers, and supports and to generate solutions); 3) internal, or autonomous, motivation (belief in treatment effectiveness and its relevance to one's goals, values, and priorities);^3,4 4) confidence in one's ability to successfully execute specific tasks (self-efficacy);⁵ 5) adequate environmental support to initiate and sustain behavioral changes (assistance to overcome obstacles, reminders, encouragement, and support from valued people at appropriate times and places); and 6) effective affect management (coping with possible depression and other emotional responses to living with diabetes).^2,6

Primary care providers can play a key role in multiple ways to help their patients manage their condition, offering informational (therapeutic advice, education), behavioral (realistic self-management goals), emotional (empathy, acceptance, assessment and treatment of depression, recommendation for support groups), and tangible (insulin, test strips) support.⁷ Many physicians, however, are more comfortable in their role providing information and education than they are providing emotional support and facilitating behavioral changes.⁸ Although knowledge and information are necessary for patients to manage their disease effectively, they are not sufficient to motivate them to make and sustain behavior changes.^9,10

As Robert M. Anderson, PhD, an internationally recognized diabetes …