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In 2019, 30.3 million US adults were reported to have diabetes—an epidemic according to some public health experts.1,2 Even more sobering, an estimated 84.1 million (or more than 1 in 3) American adults have prediabetes.1 Diabetes is associated with multiple complications, including an increased risk for heart disease or stroke.3 In 2015, it was the seventh leading cause of death and a major cause of kidney failure, lower limb amputations, stroke, and blindness.2,4
As clinicians we often ask ourselves, “How can I help my patients become more effective managers of their diabetes, so that they can maximize their quality of life over both the short and long term?” Unfortunately, management of diabetes is fraught with difficulty, both for the provider and the patient. Medications for glycemic control can be expensive and inconvenient and can have adverse effects—all of which may lead to inconsistent adherence. Lifestyle changes—including diet, regular physical activity, exercise, and weight management—are important low-risk interventions that help patients maintain glycemic values and reduce the risk for diabetic complications. However, some patients may find it difficult to make or are ambivalent to behavioral change.
These patients may benefit from having structured verbal encouragement—such as motivational interviewing (MI)—incorporated into their visits. The following discussion will explain how MI can be an effective communication tool for encouraging patients with diabetes or prediabetes to make important behavioral changes and improve health outcomes.
Q What is MI?
First created by William R. Miller and Stephen Rollnick in the 1980s as a counseling method to help patients with substance use disorders, MI was eventually expanded to address other clinical challenges, including tobacco cessation, weight management, and diabetes care. MI helps patients identify their motivations and goals to improve long-term outcomes and work through any ambivalence to change. It utilizes an empathic approach with open-ended questions.5 This helps reduce the resistance frequently encountered during an average “lecture-style” interaction and facilitates a collaborative relationship that empowers the patient to make positive lifestyle changes.
MI affirms the patient’s experience while exploring any discrepancies between goals and actions. Two important components for conducting MI are (1) verbally reflecting the patient’s motivations and thoughts about change and (2) allowing the patient to “voice the arguments for change.”6 These components help the patient take ownership of the overarching goal for behavioral change and in the development of an action plan.
MI involves 4 primary processes: engaging, focusing, evoking, and planning (defined in the Table).7 MI begins with building rapport and a trusting relationship by engaging with empathic responses that reflect the patient’s concerns and focusing on what is important to him or her. The clinician should evoke the patient’s reasons and motivations for change. During the planning process, the clinician highlights the salient points of the conversation and works with the patient to identify an action he or she could take as a first step toward change.7
Table
Motivational Interviewing Processes
Engaging: Demonstrating empathy |
Focusing: Identifying what is important to the patient |
Evoking: Eliciting patient’s internal motivations for change |
Planning: Reinforcing the patient’s commitment to change |
Source: Arkowitz H, et al. Motivational Interviewing in the Treatment of Psychological Problems. 2015. 7
Continue to: Q How can I use MI with my patients with diabetes?
Q How can I use MI with my patients with diabetes?
MI can be used in a variety of clinical settings, including primary care and behavioral health, and can be effective when employed even in short periods of time.8,9 This communication style can be incorporated into regular follow-up appointments to help the clinician and the patient work toward better glycemic control and improved long-term outcomes.
For clinicians who are new users of MI, consider the mnemonic OARS (Open-ended questions, Affirmations, accurate empathic Reflections, Summarizing) to utilize the core components of MI.10 The OARS techniques are vital MI tools that can help the clinician explore the patient’s motivation for pursuing change, and they help the clinician recognize and appreciate the patient’s perspective on the challenges of initiating change.10 The following sample conversation illustrates how OARS can be used.
Open-ended question:
Clinician: What do you think are the greatest challenges when it comes to controlling your diabetes?
Patient: It’s just so frustrating, I keep avoiding bad food and trying to eat healthy, but my sugar still goes up.
Affirmations:
Clinician: Thank you for sharing that with me. It sounds like you are persistent and have been working hard to make healthier choices.
Patient: Yes, but I’m so tired of trying. It just doesn’t seem to work.
Accurate empathic reflections:
Clinician: It is important for you to control your diabetes, but you feel discouraged by the results that you’ve seen.
Patient: Yeah, I just don’t know what else to do to make my sugar better.
Continue to: Summarizing
Summarizing:
Clinician: You’ve said that controlling your blood sugar is important to you and that you’ve tried eating healthily, but it just isn’t working well enough. It sounds like you are ready to explore alternatives that might help you gain better control of the situation. Is that right?
Patient: Well, yes, it is.
Here the patient recognizes the need for help in controlling his or her diabetes, and the clinician can then move the conversation to additional treatment options, such as medication changes or support group intervention. Using OARS, the provider can focus on what is important to the patient and evaluate any discrepancies between the patient’s goals and actions.
Q Does the research support MI for patients with diabetes?
Many studies have evaluated the efficacy of MI on behavioral change and health care–related outcomes.8,11-15 Since its inception, MI has shown great promise in addictive behavior modification.16 Multiple studies also show support for its beneficial effect on weight management as well as on physical activity level, which are 2 factors strongly associated with improved outcomes in patients with prediabetes and diabetes.8,11-15,17 In a 2017 meta-analysis of MI for patients with obesity, prediabetes, and type 2 diabetes, Phillips and Guarnaccia found significant support for behavioral change leading to improvements in quantifiable medical measurements.18
Systematic reviews of MI in health care settings have produced some conflicting findings. While there is evidence for the usefulness of MI in bringing about positive lifestyle changes, data supporting the effective use of MI in specific diabetes-related outcomes (eg, A1C levels) have been less robust.8,11-15,19 However, this is a particularly challenging area of study due in part to limitations of research designs and the inherent difficulties in assuring high-quality, consistent MI approaches. Despite these limitations, MI has significant positive results in improving patient adherence to treatment regimens.9,16,20,21
Conclusion
MI is a promising method that empowers patients to make modifications to their lifestyle choices, work through ambivalence, and better align goals with actions. Although the data on patient outcomes is inconclusive, evidence suggests that MI conducted across appointments holds benefit and that it is even more effective when combined with additional nonpharmacologic techniques, such as cognitive behavioral therapy.17,22 Additionally, research suggests that MI strengthens the clinician-patient relationship, with patients reporting greater empathy from their clinicians and overall satisfaction with interactions.23 Improved communication and mutual respect in clinician-patient interactions help maintain the therapeutic alliance for the future. For additional guidance and resources on MI, visit the Motivational Interviewing Network of Trainers website at motivationalinterviewing.org.
1. CDC. About diabetes. www.cdc.gov/diabetes/basics/diabetes.html. Reviewed August 6, 2019. Accessed December 2, 2019.
2. World Health Organization. Diabetes. www.who.int/news-room/fact-sheets/detail/diabetes. Published October 3, 2018. Accessed December 2, 2019.
3. CDC. Put the brakes on diabetes complications. www.cdc.gov/features/preventing-diabetes-complications/index.html. Reviewed October 21, 2019. Accessed December 2, 2019.
4. CDC. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed December 2, 2019.
5. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23(4):325-334.
6. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527-537.
7. Arkowitz H, Miller WR, Rollnick S, eds. Motivational Interviewing in the Treatment of Psychological Problems. 2nd ed. New York, NY: The Guilford Press; 2015.
8. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2014;37(4):768-780.
9. Palacio A, Garay D, Langer B, et al. Motivational interviewing improves medication adherence: a systematic review and meta-analysis. J Gen Intern Med. 2016;31(8):929-940.
10. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: The Guilford Press; 2013.
11. Armstrong MJ, Mottershead TA, Ronksley PE, et al. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709-723.
12. Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One. 2018;13(10):e0204890.
13. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843-861.
14. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305-312.
15. Hardcastle S, Taylor A, Bailey M, Castle R. A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Educ Couns. 2008:70(1):31-39.
16. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.
17. Morton K, Beauchamp M, Prothero A, et al. The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health Psychol Rev. 2015;9(2):205-223.
18. Phillips AS, Guarnaccia CA. Self-determination theory and motivational interviewing interventions for type 2 diabetes prevention and treatment: a systematic review. J Health Psychol. 2017:135910531773760.
19. Mathiesen AS, Egerod I, Jensen T, et al. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes. 2018;12:19-33.
20. Skolasky RL, Maggard AM, Wegener ST, Riley LH 3rd. Telephone-based intervention to improve rehabilitation engagement after spinal stenosis surgery: a prospective lagged controlled trial. J Bone Joint Surg Am. 2018;100(1):21-30.
21. Schaefer MR, Kavookjian J. The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: a systematic review. Patient Educ Couns. 2017;100(12):2190-2199.
22. Barrett, S, Begg, S, O’Halloran, P, et al. Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses. BMC Public Health. 2018;18:1160.
23. Wagoner ST, Kavookjian J. The influence of motivational interviewing on patients with inflammatory bowel disease: a systematic review of the literature. J Clin Med Res. 2017;9(8):659-666.
Clinician Reviews in partnership with
Courtney Bennett Wilke is an Assistant Professor at Florida State University College of Medicine, School of Physician Assistant Practice, Tallahassee.
Clinician Reviews in partnership with
Courtney Bennett Wilke is an Assistant Professor at Florida State University College of Medicine, School of Physician Assistant Practice, Tallahassee.
Clinician Reviews in partnership with
Courtney Bennett Wilke is an Assistant Professor at Florida State University College of Medicine, School of Physician Assistant Practice, Tallahassee.
In 2019, 30.3 million US adults were reported to have diabetes—an epidemic according to some public health experts.1,2 Even more sobering, an estimated 84.1 million (or more than 1 in 3) American adults have prediabetes.1 Diabetes is associated with multiple complications, including an increased risk for heart disease or stroke.3 In 2015, it was the seventh leading cause of death and a major cause of kidney failure, lower limb amputations, stroke, and blindness.2,4
As clinicians we often ask ourselves, “How can I help my patients become more effective managers of their diabetes, so that they can maximize their quality of life over both the short and long term?” Unfortunately, management of diabetes is fraught with difficulty, both for the provider and the patient. Medications for glycemic control can be expensive and inconvenient and can have adverse effects—all of which may lead to inconsistent adherence. Lifestyle changes—including diet, regular physical activity, exercise, and weight management—are important low-risk interventions that help patients maintain glycemic values and reduce the risk for diabetic complications. However, some patients may find it difficult to make or are ambivalent to behavioral change.
These patients may benefit from having structured verbal encouragement—such as motivational interviewing (MI)—incorporated into their visits. The following discussion will explain how MI can be an effective communication tool for encouraging patients with diabetes or prediabetes to make important behavioral changes and improve health outcomes.
Q What is MI?
First created by William R. Miller and Stephen Rollnick in the 1980s as a counseling method to help patients with substance use disorders, MI was eventually expanded to address other clinical challenges, including tobacco cessation, weight management, and diabetes care. MI helps patients identify their motivations and goals to improve long-term outcomes and work through any ambivalence to change. It utilizes an empathic approach with open-ended questions.5 This helps reduce the resistance frequently encountered during an average “lecture-style” interaction and facilitates a collaborative relationship that empowers the patient to make positive lifestyle changes.
MI affirms the patient’s experience while exploring any discrepancies between goals and actions. Two important components for conducting MI are (1) verbally reflecting the patient’s motivations and thoughts about change and (2) allowing the patient to “voice the arguments for change.”6 These components help the patient take ownership of the overarching goal for behavioral change and in the development of an action plan.
MI involves 4 primary processes: engaging, focusing, evoking, and planning (defined in the Table).7 MI begins with building rapport and a trusting relationship by engaging with empathic responses that reflect the patient’s concerns and focusing on what is important to him or her. The clinician should evoke the patient’s reasons and motivations for change. During the planning process, the clinician highlights the salient points of the conversation and works with the patient to identify an action he or she could take as a first step toward change.7
Table
Motivational Interviewing Processes
Engaging: Demonstrating empathy |
Focusing: Identifying what is important to the patient |
Evoking: Eliciting patient’s internal motivations for change |
Planning: Reinforcing the patient’s commitment to change |
Source: Arkowitz H, et al. Motivational Interviewing in the Treatment of Psychological Problems. 2015. 7
Continue to: Q How can I use MI with my patients with diabetes?
Q How can I use MI with my patients with diabetes?
MI can be used in a variety of clinical settings, including primary care and behavioral health, and can be effective when employed even in short periods of time.8,9 This communication style can be incorporated into regular follow-up appointments to help the clinician and the patient work toward better glycemic control and improved long-term outcomes.
For clinicians who are new users of MI, consider the mnemonic OARS (Open-ended questions, Affirmations, accurate empathic Reflections, Summarizing) to utilize the core components of MI.10 The OARS techniques are vital MI tools that can help the clinician explore the patient’s motivation for pursuing change, and they help the clinician recognize and appreciate the patient’s perspective on the challenges of initiating change.10 The following sample conversation illustrates how OARS can be used.
Open-ended question:
Clinician: What do you think are the greatest challenges when it comes to controlling your diabetes?
Patient: It’s just so frustrating, I keep avoiding bad food and trying to eat healthy, but my sugar still goes up.
Affirmations:
Clinician: Thank you for sharing that with me. It sounds like you are persistent and have been working hard to make healthier choices.
Patient: Yes, but I’m so tired of trying. It just doesn’t seem to work.
Accurate empathic reflections:
Clinician: It is important for you to control your diabetes, but you feel discouraged by the results that you’ve seen.
Patient: Yeah, I just don’t know what else to do to make my sugar better.
Continue to: Summarizing
Summarizing:
Clinician: You’ve said that controlling your blood sugar is important to you and that you’ve tried eating healthily, but it just isn’t working well enough. It sounds like you are ready to explore alternatives that might help you gain better control of the situation. Is that right?
Patient: Well, yes, it is.
Here the patient recognizes the need for help in controlling his or her diabetes, and the clinician can then move the conversation to additional treatment options, such as medication changes or support group intervention. Using OARS, the provider can focus on what is important to the patient and evaluate any discrepancies between the patient’s goals and actions.
Q Does the research support MI for patients with diabetes?
Many studies have evaluated the efficacy of MI on behavioral change and health care–related outcomes.8,11-15 Since its inception, MI has shown great promise in addictive behavior modification.16 Multiple studies also show support for its beneficial effect on weight management as well as on physical activity level, which are 2 factors strongly associated with improved outcomes in patients with prediabetes and diabetes.8,11-15,17 In a 2017 meta-analysis of MI for patients with obesity, prediabetes, and type 2 diabetes, Phillips and Guarnaccia found significant support for behavioral change leading to improvements in quantifiable medical measurements.18
Systematic reviews of MI in health care settings have produced some conflicting findings. While there is evidence for the usefulness of MI in bringing about positive lifestyle changes, data supporting the effective use of MI in specific diabetes-related outcomes (eg, A1C levels) have been less robust.8,11-15,19 However, this is a particularly challenging area of study due in part to limitations of research designs and the inherent difficulties in assuring high-quality, consistent MI approaches. Despite these limitations, MI has significant positive results in improving patient adherence to treatment regimens.9,16,20,21
Conclusion
MI is a promising method that empowers patients to make modifications to their lifestyle choices, work through ambivalence, and better align goals with actions. Although the data on patient outcomes is inconclusive, evidence suggests that MI conducted across appointments holds benefit and that it is even more effective when combined with additional nonpharmacologic techniques, such as cognitive behavioral therapy.17,22 Additionally, research suggests that MI strengthens the clinician-patient relationship, with patients reporting greater empathy from their clinicians and overall satisfaction with interactions.23 Improved communication and mutual respect in clinician-patient interactions help maintain the therapeutic alliance for the future. For additional guidance and resources on MI, visit the Motivational Interviewing Network of Trainers website at motivationalinterviewing.org.
In 2019, 30.3 million US adults were reported to have diabetes—an epidemic according to some public health experts.1,2 Even more sobering, an estimated 84.1 million (or more than 1 in 3) American adults have prediabetes.1 Diabetes is associated with multiple complications, including an increased risk for heart disease or stroke.3 In 2015, it was the seventh leading cause of death and a major cause of kidney failure, lower limb amputations, stroke, and blindness.2,4
As clinicians we often ask ourselves, “How can I help my patients become more effective managers of their diabetes, so that they can maximize their quality of life over both the short and long term?” Unfortunately, management of diabetes is fraught with difficulty, both for the provider and the patient. Medications for glycemic control can be expensive and inconvenient and can have adverse effects—all of which may lead to inconsistent adherence. Lifestyle changes—including diet, regular physical activity, exercise, and weight management—are important low-risk interventions that help patients maintain glycemic values and reduce the risk for diabetic complications. However, some patients may find it difficult to make or are ambivalent to behavioral change.
These patients may benefit from having structured verbal encouragement—such as motivational interviewing (MI)—incorporated into their visits. The following discussion will explain how MI can be an effective communication tool for encouraging patients with diabetes or prediabetes to make important behavioral changes and improve health outcomes.
Q What is MI?
First created by William R. Miller and Stephen Rollnick in the 1980s as a counseling method to help patients with substance use disorders, MI was eventually expanded to address other clinical challenges, including tobacco cessation, weight management, and diabetes care. MI helps patients identify their motivations and goals to improve long-term outcomes and work through any ambivalence to change. It utilizes an empathic approach with open-ended questions.5 This helps reduce the resistance frequently encountered during an average “lecture-style” interaction and facilitates a collaborative relationship that empowers the patient to make positive lifestyle changes.
MI affirms the patient’s experience while exploring any discrepancies between goals and actions. Two important components for conducting MI are (1) verbally reflecting the patient’s motivations and thoughts about change and (2) allowing the patient to “voice the arguments for change.”6 These components help the patient take ownership of the overarching goal for behavioral change and in the development of an action plan.
MI involves 4 primary processes: engaging, focusing, evoking, and planning (defined in the Table).7 MI begins with building rapport and a trusting relationship by engaging with empathic responses that reflect the patient’s concerns and focusing on what is important to him or her. The clinician should evoke the patient’s reasons and motivations for change. During the planning process, the clinician highlights the salient points of the conversation and works with the patient to identify an action he or she could take as a first step toward change.7
Table
Motivational Interviewing Processes
Engaging: Demonstrating empathy |
Focusing: Identifying what is important to the patient |
Evoking: Eliciting patient’s internal motivations for change |
Planning: Reinforcing the patient’s commitment to change |
Source: Arkowitz H, et al. Motivational Interviewing in the Treatment of Psychological Problems. 2015. 7
Continue to: Q How can I use MI with my patients with diabetes?
Q How can I use MI with my patients with diabetes?
MI can be used in a variety of clinical settings, including primary care and behavioral health, and can be effective when employed even in short periods of time.8,9 This communication style can be incorporated into regular follow-up appointments to help the clinician and the patient work toward better glycemic control and improved long-term outcomes.
For clinicians who are new users of MI, consider the mnemonic OARS (Open-ended questions, Affirmations, accurate empathic Reflections, Summarizing) to utilize the core components of MI.10 The OARS techniques are vital MI tools that can help the clinician explore the patient’s motivation for pursuing change, and they help the clinician recognize and appreciate the patient’s perspective on the challenges of initiating change.10 The following sample conversation illustrates how OARS can be used.
Open-ended question:
Clinician: What do you think are the greatest challenges when it comes to controlling your diabetes?
Patient: It’s just so frustrating, I keep avoiding bad food and trying to eat healthy, but my sugar still goes up.
Affirmations:
Clinician: Thank you for sharing that with me. It sounds like you are persistent and have been working hard to make healthier choices.
Patient: Yes, but I’m so tired of trying. It just doesn’t seem to work.
Accurate empathic reflections:
Clinician: It is important for you to control your diabetes, but you feel discouraged by the results that you’ve seen.
Patient: Yeah, I just don’t know what else to do to make my sugar better.
Continue to: Summarizing
Summarizing:
Clinician: You’ve said that controlling your blood sugar is important to you and that you’ve tried eating healthily, but it just isn’t working well enough. It sounds like you are ready to explore alternatives that might help you gain better control of the situation. Is that right?
Patient: Well, yes, it is.
Here the patient recognizes the need for help in controlling his or her diabetes, and the clinician can then move the conversation to additional treatment options, such as medication changes or support group intervention. Using OARS, the provider can focus on what is important to the patient and evaluate any discrepancies between the patient’s goals and actions.
Q Does the research support MI for patients with diabetes?
Many studies have evaluated the efficacy of MI on behavioral change and health care–related outcomes.8,11-15 Since its inception, MI has shown great promise in addictive behavior modification.16 Multiple studies also show support for its beneficial effect on weight management as well as on physical activity level, which are 2 factors strongly associated with improved outcomes in patients with prediabetes and diabetes.8,11-15,17 In a 2017 meta-analysis of MI for patients with obesity, prediabetes, and type 2 diabetes, Phillips and Guarnaccia found significant support for behavioral change leading to improvements in quantifiable medical measurements.18
Systematic reviews of MI in health care settings have produced some conflicting findings. While there is evidence for the usefulness of MI in bringing about positive lifestyle changes, data supporting the effective use of MI in specific diabetes-related outcomes (eg, A1C levels) have been less robust.8,11-15,19 However, this is a particularly challenging area of study due in part to limitations of research designs and the inherent difficulties in assuring high-quality, consistent MI approaches. Despite these limitations, MI has significant positive results in improving patient adherence to treatment regimens.9,16,20,21
Conclusion
MI is a promising method that empowers patients to make modifications to their lifestyle choices, work through ambivalence, and better align goals with actions. Although the data on patient outcomes is inconclusive, evidence suggests that MI conducted across appointments holds benefit and that it is even more effective when combined with additional nonpharmacologic techniques, such as cognitive behavioral therapy.17,22 Additionally, research suggests that MI strengthens the clinician-patient relationship, with patients reporting greater empathy from their clinicians and overall satisfaction with interactions.23 Improved communication and mutual respect in clinician-patient interactions help maintain the therapeutic alliance for the future. For additional guidance and resources on MI, visit the Motivational Interviewing Network of Trainers website at motivationalinterviewing.org.
1. CDC. About diabetes. www.cdc.gov/diabetes/basics/diabetes.html. Reviewed August 6, 2019. Accessed December 2, 2019.
2. World Health Organization. Diabetes. www.who.int/news-room/fact-sheets/detail/diabetes. Published October 3, 2018. Accessed December 2, 2019.
3. CDC. Put the brakes on diabetes complications. www.cdc.gov/features/preventing-diabetes-complications/index.html. Reviewed October 21, 2019. Accessed December 2, 2019.
4. CDC. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed December 2, 2019.
5. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23(4):325-334.
6. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527-537.
7. Arkowitz H, Miller WR, Rollnick S, eds. Motivational Interviewing in the Treatment of Psychological Problems. 2nd ed. New York, NY: The Guilford Press; 2015.
8. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2014;37(4):768-780.
9. Palacio A, Garay D, Langer B, et al. Motivational interviewing improves medication adherence: a systematic review and meta-analysis. J Gen Intern Med. 2016;31(8):929-940.
10. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: The Guilford Press; 2013.
11. Armstrong MJ, Mottershead TA, Ronksley PE, et al. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709-723.
12. Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One. 2018;13(10):e0204890.
13. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843-861.
14. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305-312.
15. Hardcastle S, Taylor A, Bailey M, Castle R. A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Educ Couns. 2008:70(1):31-39.
16. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol. 2005;1:91-111.
17. Morton K, Beauchamp M, Prothero A, et al. The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health Psychol Rev. 2015;9(2):205-223.
18. Phillips AS, Guarnaccia CA. Self-determination theory and motivational interviewing interventions for type 2 diabetes prevention and treatment: a systematic review. J Health Psychol. 2017:135910531773760.
19. Mathiesen AS, Egerod I, Jensen T, et al. Psychosocial interventions for reducing diabetes distress in vulnerable people with type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr Obes. 2018;12:19-33.
20. Skolasky RL, Maggard AM, Wegener ST, Riley LH 3rd. Telephone-based intervention to improve rehabilitation engagement after spinal stenosis surgery: a prospective lagged controlled trial. J Bone Joint Surg Am. 2018;100(1):21-30.
21. Schaefer MR, Kavookjian J. The impact of motivational interviewing on adherence and symptom severity in adolescents and young adults with chronic illness: a systematic review. Patient Educ Couns. 2017;100(12):2190-2199.
22. Barrett, S, Begg, S, O’Halloran, P, et al. Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses. BMC Public Health. 2018;18:1160.
23. Wagoner ST, Kavookjian J. The influence of motivational interviewing on patients with inflammatory bowel disease: a systematic review of the literature. J Clin Med Res. 2017;9(8):659-666.
1. CDC. About diabetes. www.cdc.gov/diabetes/basics/diabetes.html. Reviewed August 6, 2019. Accessed December 2, 2019.
2. World Health Organization. Diabetes. www.who.int/news-room/fact-sheets/detail/diabetes. Published October 3, 2018. Accessed December 2, 2019.
3. CDC. Put the brakes on diabetes complications. www.cdc.gov/features/preventing-diabetes-complications/index.html. Reviewed October 21, 2019. Accessed December 2, 2019.
4. CDC. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2017. www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Accessed December 2, 2019.
5. Rollnick S, Miller WR. What is motivational interviewing? Behav Cogn Psychother. 1995;23(4):325-334.
6. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527-537.
7. Arkowitz H, Miller WR, Rollnick S, eds. Motivational Interviewing in the Treatment of Psychological Problems. 2nd ed. New York, NY: The Guilford Press; 2015.
8. VanBuskirk KA, Wetherell JL. Motivational interviewing with primary care populations: a systematic review and meta-analysis. J Behav Med. 2014;37(4):768-780.
9. Palacio A, Garay D, Langer B, et al. Motivational interviewing improves medication adherence: a systematic review and meta-analysis. J Gen Intern Med. 2016;31(8):929-940.
10. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: The Guilford Press; 2013.
11. Armstrong MJ, Mottershead TA, Ronksley PE, et al. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709-723.
12. Frost H, Campbell P, Maxwell M, et al. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: a systematic review of reviews. PLoS One. 2018;13(10):e0204890.
13. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843-861.
14. Rubak S, Sandbaek A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract. 2005;55(513):305-312.
15. Hardcastle S, Taylor A, Bailey M, Castle R. A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Educ Couns. 2008:70(1):31-39.
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