Engaging the Participants: Evidence-Based Strategies and Interventions

Mabruk Quabili, BS, MPHHealth Informatics Specialist

Health Services Advisory Group (HSAG)

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Trans-Theoretical Model: Stages of Change

Source: Prochaska, J. O. & Di Clemente, C. C., (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19(3), 276-288. Figure 2, p. 283.

Precontemplation

Relapse can occur at any time.

Contemplation

PreparationAction

Maintenance

Termination is the goal.

No recognition of need for or interest in change

Thinking about change

Planning for changeAdopting new habits

Ongoing practice of new, healthier behavior

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Motivational Interviewing: Primary Skills

• Express empathy• Develop discrepancy• Avoid argumentation• Roll with resistance• Support self-efficacy

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Motivational Interviewing: Other Skills

• Open-ended questions• Assess readiness• Reflective listening• Case Western

Reserve University– Am I Doing This Right?

• http://www.centerforebp.case.edu/client-files/pdf/miremindercard.pdf

– Readiness/Importance Ruler • http://

www.centerforebp.case.edu/client-files/pdf/readinessruler.pdf

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Motivational Interviewing: Frames

• Feedback: Personalized information• Responsibility: Freedom of choice• Advice: Need for change• Menu: Strategies for change• Empathy: Supportive, reflective style• Self-efficacy: Participant belief

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Centers for Medicare & Medicaid Services (CMS) Definitions

• Effective for services on or after January 1, 2008:– Smoking and tobacco-use cessation counseling

visit; intermediate, greater than three minutes and up to ten minutes

OR– Smoking and tobacco-use cessation counseling

visit; intensive, greater than ten minutes

Source: CMS MLN Matters; http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5878.pdf

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Brief Provider Motivation Tips:The Five R’s of Enhancing Motivation

• Relevance to them personally• Risk of their use• Rewards gained from smoking cessation• Roadblocks or barriers• Repetition during each visit

RRR RR

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Brief Provider Cessation Tips:The Five A’s of Tobacco Cessation

• Ask about tobacco use• Advise patient to quit• Assess readiness to quit• Assist patient with their quit attempt– Set a target date, Tell family and friends,

Anticipate challenges, Remove tobacco products (STAR)

• Arrange follow-up encounters

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Thank you!Mabruk Quabili, BS, MPH

HSAG Health Informatics Specialist614.301.3902

This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare &

Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication

No. OH-11SOW-B.1 06092015-02

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