Interviewing techniques keep patients on track

Ways to identify pitfalls in advance

Motivating patients and keeping them motivated to stay with their diabetes management plans is the biggest challenge of the Diabetes Prevention Program (DPP). It’s a challenge that translates to virtually every aspect of treating diabetes.

A technique called motivational interviewing is used by DPP recruiters to find motivated study participants. This technique could be helpful for anyone working with patients facing major lifestyle changes, says Richard Rubin, PhD, CDE, a psychologist at Johns Hopkins University School of Medicine in Baltimore. The behavioral scientist is working with the Johns Hopkins DPP program and is national chairman of the behavioral sciences working group with the DPP.

Clinicians may ask a question such as: "And so, Mr. Jones, why do you want to lose weight?" The patient with diabetes may reply: "Because I want to stay alive to see my grandson."

The answer is then used six months later, when the patient is struggling with his exercise program and feeling discouraged because he hasn’t met his weight goal.

The clinician can ask, "Remember six months ago when you said you wanted to lose weight because you wanted to see your grandchild grow up?"

It’s a simple technique, Rubin says: First, assess a motivation for a behavior change; second, help the patient set realistic goals; and third, re-motivate the patient to stick with the original goal.

"Participation in the DPP requires a really big commitment, especially for those who might be placed in the intensive lifestyle intervention group," says Rubin.

"I want to be sure they are really motivated, that they understand how much this commitment entails and that they will stick with it."

He gives an example of a woman who wants to lose weight because a spouse thinks she should. "This may not be the best motivation, so I might help her find another motivation, like feeling healthier," Rubin says.

He also cautions clinicians to help patients form realistic goals so they have the best possible chance of success. "If a patient tells me he will exercise an hour and a half a day seven days a week, I might suggest he start out with 30 minutes of exercise three days a week."

Finally, Rubin suggests helping a patient identify personal barriers to compliance by asking, "Do you think it might be too much for you?" or "Do you think you would have trouble maintaining your weight loss?"

"If we look at the things that get in the way of success, we can address those problems before they start," Rubin says.

[Richard Rubin can be reached at (410) 243-6565.]