Talking about motivational interviewing : how do GPs use it in daily practice

Paul Aujoulat, Delphine Le Goff, Jean Yves Le Reste, Marie Barais

Keywords: motivational interviewing, addiction, mental health, relationship

Background:

Ambivalence is a recurrent theme in primary care, significantly impacting mental health issues like addiction and behavior change difficulties. Motivational interviewing is one of the most effective tools to address this ambivalence. By helping patients explore and resolve their uncertainties, this approach fosters the motivation needed to adopt healthier and more sustainable behaviors.

Research questions:

The objective of this study was to evaluate how general practitioners address ambivalence in their daily practice.

Method:

A qualitative study using semi-structured interviews was conducted, inspired by grounded theory. The target population was general practitioners in the Finistère region of France. A thematic analysis was performed.

Results:

Eleven interviews were conducted. GPs had some knowledge of motivational interviewing but lacked a strong theoretical foundation. The techniques used included open-ended questions, reformulation, and positive reinforcement. The scope extended beyond addictions to include vaccination, chronic diseases, and restoring trust in the doctor-patient relationship. General practitioners felt more valued and more satisfied when using motivational interviewing. Barriers to its use included physician-related factors, such as fatigue or difficulty changing their practice, and patient-related factors, such as language or comprehension difficulties.

Conclusions:

The unique aspect of primary care is the significant autonomy the patient possesses. Patients are free to discuss topics with their doctor, choose whether to take their medications, and change their lifestyle habits. In this context, a paternalistic approach is not only ineffective but also exhausting for the GP. Motivational interviewing becomes a considerable asset for improving both the patient's mental health and that of the GP. It is essential to continue implementing this technique in practice.

Points for discussion:

What are the key tools to convey to novice general practitioners in motivational interviewing?

What is the proportion of general practitioners who actually use motivational interviewing in their practice?

Are the mental health of the general practitioner and that of their patient correlated?

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