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tance of counseling families onadopting healthier lifestyles andinvolves behavior change. Thepurpose of this article is to de-scribe the process of motivationalinterviewing (MI) as a strategy tofacilitate compliance with treat-ment recommendations in pediat-

ric clients and their families.Lack of compliance with recom-

mendations for behavior changemay occur for a variety of reasons,including difficulty with the rec-ommendations because of thechilds developmental level, lackof parental participation in formu-lating the treatment plan, parentaldoubt regarding the benefit and ef-ficacy of the recommendations forthe child, situational barriers to be-

havior change, demands on thefamily or child, and lack of neededsupport for the family. Qualitative

research suggests that self-image,the meaning of the medical condi-tion and treatment regimen,and/or behavior change are deter-minants of patient compliance (Di-Matteo et al., 2002).

The lack of both collaborativegoal setting and formulation of thetreatment plan leads to parentalreservations regarding the plan forcare. Health education that focuses

on direct persuasion often resultsin a defensive response on the partof the patient or parent. Traditionalhealth education may be insuffi-cient to change the parents behav-ior in relation to their children(Weinstein, Harrison, & Benton,2004).

Health educators have pro-posed a paradigm shift in the roleof the NP as health teacher: mov-ing from the authoritarian, pre-

scriptive, persuasive, and expertproviding general advice to a morecollaborative approach with pa-tients and families (Burke & Fair,2003; Rollnick, Mason, & Butler,1999). The NP can be more effec-tive in improving treatment adher-ence and behavior change by us-

ing a patient- or family-centeredapproach, with an emphasis on (a)empowering the child and parent;(b) focusing on the familys beliefs,

values, and health behaviors; and(c) enhancing the familys self-effi-cacy and life skills (Gance-Cleve-land, 2005). Research comparingthe traditional and behavioraltypes of health education in im-proving adherence to the healthcare plan showed a 64% success

rate when practitioners deliveredinformation and knowledge alone(the traditional role) and 85% suc-

cess rate for the more collaborativeapproach using behavioral strate-gies (Burke & Fair).

Researchers have shown thatMI is an effective strategy for de-creasing problems with sub-stance abuse and health-risk be-haviors and increasing adherenceto treatment regimens (Rubak,Sandbaek, Lauritzen, & Chris-tensen, 2005). Specifically, MI

has been shown beneficial incontrolling alcohol, heroin, mari-juana, tobacco, and opiate addic-tions (Berg-Smith et al., 1999;Sindelar, Abrantes, Hart, Lewan-der, & Spirito, 2004). In addition,tests of the effectiveness of MI incontrolling nonaddictive healthbehaviors also have been prom-ising, including studies evaluat-ing its effectiveness with decreas-ing high-risk behaviors in HIV

patients, treatment adherence indiabetics, medication regimens,pain treatment, and eating disor-ders (Berg-Smith et al.; Sindelaret al.). In 2005, Rubak and col-leagues published a meta-analy-sis of 72 randomized controlledtrials and concluded that MI ef-

fectively helped patients changetheir behavior and that it outper-formed traditional advice givenin approximately 80% of the stud-ies. This scientific evidence sug-gests that MI is a behavioral in-tervention that may be used byNPs to augment teaching strate-gies to improve treatment adher-ence by pediatric patients andtheir families.

TRANSTHEORETICAL MODELOF STAGES OF CHANGE

A model explaining the stagesof behavior change emergedfrom research in the field of ad-diction studies in the 1980s andhas been used widely with smok-ing cessation (Prochaska & Di-Clemente, 1982). The transtheo-retical model of the stages ofchange developed by Prochaskaand DiClemente is a framework

for understanding how peoplechange behavior and the theorybehind MI. When applied to pe-diatric health care, the premise ofthe model is that most families donot seek information from thehealth care provider expecting tochange patterns of behavior thatare well established. This modelfocuses on the process of becom-ing ready to make the necessarychanges to adhere to the treat-ment plan (seeTable 1). The pro-cess begins with precontempla-tion, in which the family is notready to change behavior; it thenmoves toward contemplation, in

which the family is aware a prob-lem exists but is ambivalentabout the need for change; fromthere, the family members moveinto preparation and action, in

which changes are made. Mainte-nance involves families adaptingto new behaviors and avoiding

Health education that focuses on direct

persuasion often results in a defensive response

on the part of the patient or parent.

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relapse. Termination may followif the treatment plan is not for anongoing medical condition. Therole of the NP is to assess thefamilys readiness for changeprior to discussing the health careplan. With this information, theNP is able to tailor interventionsto an individuals stages of

change, rather than expecting all

individuals to be ready for action-oriented strategies (Berg-Smith etal., 1999).

STEPS FOR USINGMOTIVATIONAL

INTERVIEWING IN PRIMARYCARE

MI, first described by Miller(1983) and elaborated upon byMiller and Rollnick (1991),is con-sistent with the stages of changeand offers a practical, brief coun-seling method for helping familiesincrease their motivation or readi-ness to change (Berg-Smith et al.,1999). The main goals of MI are toassist the family in workingthrough its ambivalence about be-havior change; assessing the im-portance of change, their confi-

dence in making change, andreadiness for change; and planningfor change if they are ready (Resni-cow et al., 2002; Rollnick et al.,1999). MI outlines approaches thatcan be used for patients and fami-lies in all stages of readiness forchange. In addition, MI has beenshown to be more effective than

traditional counseling for clients in

the precontemplation phase ofchange (Heather, Rollnick, Bell, &Richmond, 1996).

The features of MI include a fam-ily-centered, supportive, and empa-thetic approach. Although thesequalities are common principles ofnursing practice, NPs frequently donot go beyond giving advice, pre-scribing a treatment plan, and edu-cating families on why they shouldfollow the treatment plan. WhenNPs apply the principles of MI,

which include a nonjudgmental, un-derstanding, and encouraging inter-action, they assist family members in

verbalizing their health care goalsand asking for advice from practitio-ners when they need information.Discussion of the pros and cons ofbehavior change and use of reflec-

tive listening and reinforcing posi-tive behavior become importantstrategies. Another important strat-egy of MI is rolling with resistanceif families are ambivalent aboutchange, which means the NP allowsthe family members to chose not tochange and accepts their decision

without trying to persuade them totake action if they are not ready. Thestrategy is to offer their professionalopinion about the health conse-quences of the behavior in a non-judgmental fashion and leave thedoor open for discussion in the fu-ture if they change their minds.Other strategies include assessinginterest and confidence in change,eliciting change talk from the family,and improving self-efficacy (Resni-

cow et al., 2002; Schwartz, 2005).These strategies reflect the paradigmshift from the NP being the authori-tarian expert who gives advice andinformation to the family verbalizingthe need for change and their pref-erence for the approach to thechange.

Process

The process of MI is depicted inFigure 1.The components of the

process for MI are establishing arelationship; setting an agenda; as-sessing importance, confidence,and readiness; exploring impor-tance; and helping families select aplan of action and building theirconfidence in their ability tochange (Rollnick et al., 1999). Ap-proaches to interaction may in-clude asking permission prior toproviding information; eliciting thefamily members perception of thepros and cons of change; helpingfamilies explore ambivalence to-

ward behavior change; and ques-tioning discrepancies between val-ues and current behavior to havethe family members verbalize thedesire for change.

Establishing a relationship.The first step in motivating parentsor children to change behavior isdeveloping rapport with the family(Miller & Rollnick, 1991). An em-pathetic approach that affirms the

TABLE 1. Transtheoretical model of stages of change

Stages of change Process

Precontemplation Not ready to change

Contemplation Aware of problem, ambivalent about change

Preparation Intend to take action in near future

Action Involved in change

Maintenance Sustaining the change

Data fromProchaska & DiClemente, 1982.

When NPs apply the principles of MI, which

include a nonjudgmental, understanding, and

encouraging interaction, they assist family

members in verbalizing their health care goals

and asking for advice from practitioners when

they need information.

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families values and helps themverbalize their thoughts, feelings,and ambivalence toward the sug-gested behavior change are essen-tial in establishing a relationship,the first component of MI. Al-though most NPs establish rapport,MI takes this a step further and

encourages the NP to avoid theexpert role giving advice and al-lows the family to request informa-tion and advice before it is given.The family is viewed as the expert

who will verbalize the need forchange. The NP provides informa-tion in a nonjudgmental fashionand asks the family what theythink about the information. Be-cause MI involves the use of activelistening and establishing an em-

pathetic relationship rather thandirect questioning, persuasion, orgiving of advice, its use avoidsconfrontation and accepts the fam-ilys ambivalence or reluctance tochange.

Consideration of a hypotheticalscenario involving an overweight13-year-old adolescent boy at riskfor type II diabetes will illustratehow an NP might apply MI in aclinical situation. The NP begins by

counseling the overweight teenand showing the growth chart tothe teen. The NP explains thephysical assessment findings ofac-anthosis nigricans, suggesting thatthe teen is developing insulin re-sistance and remarking that weknow that many patients who havethese issues will go on to developdiabetes. The NP might then bringup family history, telling the teen,We know from your family his-tory that diabetes is common infamily members and we know that

you gained 10 pounds since yourlast visit. She then asks the teen,What do you think about this in-formation? The NP reassures theteen that she knows how difficultthe situation is and accepts the pa-tient wherever he is. If the teen isnot ready for change, he may re-spond that he is not worried aboutdeveloping diabetes; that happensonly to old people. The NP rolls

with the resistance and says, Asyour health care provider I have totell you that I think that you are atrisk and I know that you will beable to address this when you areready. Is there something else that

you are more concerned about thatwe should focus on today?

Setting an agenda.After es-tablishing rapport for this visit, theNP collaborates with the family to

set the agenda for the brief coun-seling session. (See the Box foruseful questions.) The brief coun-seling session is included in theanticipatory guidance portion ofthe regular health care visit. MI rec-ognizes that behavior change is theresponsibility of the patient/family.The treatment plan and advisingare no longer the strategy for the

visit. The goal is for the patient/family to verbalize the goal and thefocus of the visit. This process mayinclude several strategies, havingthe family express both positiveand negative aspects of their be-havior and eliciting how those as-pects might not be consistent withtheir current health goals.

The first strategy is to raise thesubject of behavioral change.The NP might ask the family todescribe a typical day and iden-tify problem behaviors, providinginformation about the problem

behavior in a nonjudgmentalfashion and asking the familymembers what they make of thehealth care issues. Families areasked to set the agenda and askthe practitioner for information.

Another approach to raising thesubject is to ask the family di-rectly about their desire tochange a problem behavior andtheir feelings about the change

process (Rollnick et al., 1999).In our scenario, the NP couldask the 13-year-old to describe atypical day to elicit his awarenessof his activity, inactivity, and stresseating that may be occurring.

When the teen describes the day,he can discuss things that made itdifficult for him to make healthierchoices and identify ways toimprove.

The agenda-setting chart is an-other strategy that can be used tohelp the child or family identify aplan. The agenda chart is a sheet ofpaper with circles, some emptyand some with suggested changes(e.g., diet, exercise, and decreas-ing television time) (see Figure 2)(Berg-Smith, 1999). The familymembers are asked to identify

which of the behaviors on thechart they are interested in chang-ing. They can identify things noton the chart that they can put into

FIGURE 1. The Process for Motivational Interviewing. (Adapted fromRollnick, Mason, & Butler, 1999.)

ESTABLISH A RELATIONSHIP

SET AN AGENDA

Strategy: Determine Multiple Behaviors in Need of Change

Strategy: Patient Decides on Single Behavior in Need of Change

Strategy: Administer Scaling Tools

Strategy: Ask Scaling Questions

(e.g., Why not a lower score? What would it take to make you move higher on the scale?)

BUILD CONFIDENCE IN THE ABILITY TO CHANGEBUILD CONFIDENCE IN THE ABILITY TO CHANGE

PLAN FOR CHANGE

Importance0 (not at all important) to 10 (very

important)

Confidence0 (not at all confident) to 10 (very

confident)

EXPLORE THEIMPORTANCE OF MAKINGA CHANGE BUILD CONFIDENCE IN THE ABILITY TO CHANGE

ASSESSIMPORTANCE+ CONFIDENCE + READINESSTO MAKE A CHANGE

Readiness0 (not at all interested) to 10 (very

interested)



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the empty circles. The child/familythen proceeds to articulate a planfor working on these goals.

Using the stress bucket (Rollnicket al., 1999)i s a third strategy thatmay be useful to help set anagenda if the behavior that needsto change is induced by stress. Thestress bucket is a tool used to helpfamilies identify levels of stress,causes of stress, and healthy solu-tions to dealing with stress. Thistool is particularly helpful for ado-lescent patients who are attempt-

ing to change behaviors that maybe induced by stress, such smok-ing, drinking or overeating. Theremight be several causes of stress,

which are represented as faucetsfilling the bucket at varying rates offlow. The level of water in thebucket relates to the level of stress.

The symptoms are things that youexperience as the water level rises(e.g., eating, smoking, and drink-ing). Solutions are things that lowerthe water level in the bucket (e.g.,relaxation, exercise, and counsel-ing). Discussion of the stress bucketmight lead to identification ofagenda items. The activity of creat-ing a stress bucket might lead to adiscussion of a behavior to changeor might just increase awareness re-

garding the triggers for stress andpossible strategies to consider.The NP may collaborate with

the family to identify a single be-havior change to target from themultiple behaviors that may im-pact the health of the child. Thefamily members decide which be-havior they would like to target forchange. The Box presents usefulquestions for setting an agenda

when there are multiple behaviors

or when there is a single behaviorthat needs to be changed. The fam-ily members are encouraged to se-lect a single behavior to address.

Using one or all of these strate-gies should result in a clearer un-derstanding of the agenda that willbe set. For the hypothetical 13-

year-old at risk for diabetes, the NPshares information about the riskfactors for diabetes that she identi-fies in his history and asks what hemakes of all of this information.The discussion should ideally leadthe teen to express worry aboutdeveloping diabetes and asking forsome suggestions for decreasinghis risk. The NP reviews with theteen the description of his typicalday, including meals and activity.The NP asks the teen what hethinks he could do to change theprocess, and she offers that diet,exercise, and limiting sedentarytime are all things that other teens

have done to help decrease theirrisk for diabetes. The discussion

would benefit from an assessmentof what this teen has done in thepast, how it worked, and what thebarriers were.

Assessing importance, confi-dence, and readiness for be-

havior change.The NP next at-tends to the family membersfundamental beliefs regardinghealth and illness, the importanceof making the change, their readi-ness to change, and confidence inmaking the change. Berg-Smithand colleagues (1999) suggestedusing a 12-inch ruler to have theparents describe their readiness tochange or comply with a sug-gested regimen that has jointly

been developed. Parents are askedto identify their readiness tochange on the ruler, with 12 indi-cating ready to change and 1 veryambivalent about making changes.The NP then uses that number totailor interventions based upon thefamilys readiness to change. Simi-larly, Schwartz (2005)used an in-dex card with a scale from 0 to 10to assess interest and confidence inmaking a change, with 0 indicating

not interestedornot confidentand10 indicating very interested orvery confident (see Figure 3).

The NP might assess impor-tance of changing by asking, Howdo you feel about getting more ex-ercise? How important is it to getmore exercise? Helping the familymembers list the pros and cons ofthe change can be useful to helpthem identify the importance ofthe change and the barriers tomaking the change (Table 2). Con-fidence can be assessed by asking,If you decided tomorrow that you

were going to get more exercise,how confident are you that youcould achieve that goal? Therecan be situations where it is usefulto assess readiness instead of or inaddition to importance and confi-dence (Rollnick et al., 1999). As-sessing readiness can be useful fortaking the discussion to the nextlevel if the family is ready to plan

BOX. Useful questionsfor setting an agenda

Multiple behaviors

1. What would you like to talk about

today? We could talk about de-

creasing sweets, watching less

TV, more activity, fewer sweet-

ened drinks. What do you think?Is there something more impor-

tant to discuss today?

2. Would you like to talk about

ways to improve your childs

health, like eating better, exer-

cising more, or more activity, or

is there something else that I

could help you with today?

3. Which diet or exercise do you

feel most ready to talk about?

4. Some people think that taking

the television out of the childs

bedroom helps them with over-weight. What do you think?

5. I am concerned about your

childs asthma. How do you feel

about your childs use of a pre-

ventive inhaler?

6. How do you think your smoking

affects his asthma?

Single behaviors

1. Some teenagers think that

smoking increases the recurrent

bronchitisproblem. What do you

think?

2. I am concerned about your be-ing expelled from school for

drinking. What do you think

about your drinking?

3. How does your useof alcohol af-

fect the fighting with your family?

Adapted fromRollnick, Mason, &

Butler, 1999.



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for change. A low level of readi-ness to change may explain theresistance of family members tochange their behavior.

The NP can use the scalingquestions to help the family pro-

vide more detail about the impor-tance, confidence, and readiness

for making a change. If the familymembers says a 4 on a 10-pointscale, they are saying they feel it issomewhat important to decreasethe childs exposure to second-hand smoke to help his asthma,the practitioner would ask, Whynot a 1 or 2? This question allowsfamily members to identify whatabout making a change in behav-ior is important to them. The NPcan also ask family members to

describe what it would take tomove them 1 point higher on thescale. These questions help familymembers verbalize what is impor-tant to them about the change andpossible strategies they could em-ploy to achieve the change.

Explore the importance ofmaking a behavior change.TheNP should avoid confronting thefamily about behavior, which maylead to resistance about changing

behavior. The NP needs to be ableto roll with the families resis-tance (i.e., accept that they are notready to change) while supportingtheir sense of self-efficacy. The fo-cus becomes to help family mem-bers explore the importance ofchanging behavior by describingthe discrepancy between desiredgoals and current behavior. Thegoal is for the patient/family mem-bers to state the need for a changein behavior to reach their statedgoal. This strategy is called elicit-ing the change talk from the fam-ily members, which increases thelikelihood that the family members

will act on what they have verbal-ized. The more they defend a po-sition, the greater their commit-ment to it (Resnicow et al., 2002).

The process is fluid and thepractitioner may fluctuate backand forth between readiness, im-portance, and confidence. Strate-

gies for success in using this tech-nique include the following:If importance is low (less than 4

on the scale), the NP focuses theintervention on increasing im-portance by giving the family

members information and byeliciting from them, with the useof scaling questions, the reasons

why they think it is important tochange (Rollnick et al., 1999).

If the numbers for importanceand confidence are equal, theNP focuses on the importancefirst (Rollnick et al.).

If there is a difference betweenthe importance and confidence,the NP focuses on the lowernumber first (Rollnick et al.).This is especially important ifthere is a large difference be-tween the two numbers.

If the family is at level 4 or lowerin importance, it is a signal thatthe members are not ready forchange. A beneficial approachfor the NP in this situation is ac-knowledging their uncertaintyand assuring them that she isconfident they will be able toachieve their goals by saying.

The NP might say, for example,I know you are going to be ableto figure this out when you areready.Build confidence in the abil-

ity to change.In a nonconfronta-

tional and supportive climate inwhich families feel comfortable ex-pressing both positive and negativeaspects of their current behavior,families are asked to elicit the prosand cons of change (Resnicow et al.,2002; see Table 2). As the familymembers verbalize the reasons forchange, they are more likely tomake the changes. By refrainingfrom giving advice until the familymembers have presented their ownunderstanding of the situation andtheir own suggestions for overcom-ing the obstacles to changing behav-ior, the NP can reinforce the familysarticulated plan. Ideally, the familyrather than the NP makes the argu-ment for change and describes thecourse of action (Rollnick et al.,1999). If the family needs more in-formation about the impact of cur-rent behavior on health, the NP asksthe familys permission to share in-formation, presents the information

FIGURE 2. Agenda-setting tool. Circles possible behaviors totarget; empty circles to be filled in by the patient. (Adapted fromRollnick, Mason and Butler, 1999.)

Playsoccer

Increaseveggies

DecreaseTV time

Playbasketball

Decreasecandy

Walk toschool

Increasefruits



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in a neutral manner, and leaves theinterpretation of the information upto the family (Resnicow et al., 2002).

Repeating scaling questions alsomay be useful. At this point, the NPcould ask the family, on a scale from0 (not at all) to 10 (very successful),how successful have they been in

changing behavior in the past. Usingthe scaling questions allows the NPto examine why the scores were notlower and identifies the familymembers previous success strate-gies. Recognizing past success and

verbalizing strategies that haveworked for them builds confidencein their ability to change behavior.

Plan for change.When the cli-ent verbalizes a readiness forchange, understanding the impor-

tance, and some confidence, the NPcan ask them to identify a plan forchange. The plan for change in-cludes the strategies the family

would like to use, identification ofthe barriers they may encounter,and problem solving ways to over-come the barriers. The NP sharesthat goal setting, self-monitoring,and supportive environments helpmany clients achieve success. Themaintenance phase is ongoing sup-

port and monitoring of the sustainedbehavior change and the impact onhealth. In our scenario, it would in-clude a follow-up visit with the teento monitor his eating, activity, and

weight to reinforce positive changesor identify and strategize aboutovercoming barriers.

SUMMARY

Strategies that might be usefulthroughout the ongoing process ofMI are exchanging informationand reducing resistance. The NPuses skillful listening, careful ques-tioning, and well-timed intervention(Rollnick et al., 1999). Questions tofacilitate the exchange of informa-tion include, Would you like toknow more about . . .? How muchdo you already know about? Thetest result is X, what do you make ofthis?

Challenging the patient about be-haviors is not the best way to reduce

resistance, because theNP wants thefamily to verbalize the reasons forchange, not the reasons for resis-tance or reluctance to change. If the

NP hears the family responding withresistance, it is useful if she asks her-self, Have I threatened the familyssense of personal freedom? Have Imisunderstood the familys feelingsabout their readiness, importance,or confidence? Have I jumped toofar ahead of the family on these di-mensions? This might be the pointat which the NP needs to reconsiderhow the family really feels aboutchange, asking herself, Am I beingtoo confrontational? Do I need tochange direction altogether? Thebest responses to the family mightbe, Perhaps now is not the righttime for us to talk about this orWhat do you make of all of this?

The 13-year-old in the hypothet-ical scenariomay state that hewouldlike to try toeat less fast foodand getmore exercise. The NP asks himhow important this goal is to him,how confident he is that he canachieve the goal, and how ready he

is to make the changes. The patientis asked to describe the plan for be-havior change and the NP supportsthe plan for change. The NP mightsuggest the patient seta specific goaland have the patient describe spe-cific steps to achieve the goal. TheNP asks the patient what barriersthey anticipate and how they plan tomanage the barriers. It may be use-ful for the patient to self-monitor toprogress toward the goal.

CONCLUSIONSIn these challenging times in

health care, when the NP treatsmany conditions by recommendingchanges in behavior, having an ef-fective counseling approach canhelp the NP collaborate with theirpatients and families to achieve suc-cess. MI is a patient counseling tech-nique that facilitates the interactionbetween the NP and the patient toachieve positive behavior change.The transtheoretical model forstages of change provides a frame-

work to guide the application of MI

FIGURE 3. Scales for assessment of importance, confidence, andreadiness for change. (Data fromSchwartz, 2005.)

Importance

On a scale from 0 to 10, with 10 being very important, how important to you is it to change

____?

0 1 2 3 4 5 6 7 8 9 10

Not at all Somewhat Very

Confidence

On a scale from 0 to 10, with 10 being very confident, assuming you wanted to change _____,

how confident are you that you would succeed?

0 1 2 3 4 5 6 7 8 9 10


Readiness for Change

On a scale from 0 to 10, with 10 being very interested, how interested are you in changing

____?

0 1 2 3 4 5 6 7 8 9 10




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in practice. It posits that for an indi-vidual to initiate and sustain achange in behavior, he or she maymove through stagesof low levels ofreadiness to change (precontempla-tion), to increased awareness of theneed for change but ambivalentabout the change (contemplation),to an intention to change (prepara-tion), to taking formal steps towardchange (action) and then optimallylead to sustaining the change(maintenance).

Research suggests that MI is anevidence-based approach that ef-fectively helps patients change be-havior (Resnicow et al., 2002;Rubak et al., 2005). MI has beenused in the treatment of variouslifestyle problems and diseases,both psychological and physiolog-

ical (Rubak et al.). Research showsthat it outperforms traditional ad-

vice giving and can be effective inbrief encounters of only 15 min-utes (Rubak et al.). Ongoing re-search is needed to further theknowledge regarding the benefitsof this promising counseling tech-nique. MI is a patient-centered ap-proach to counseling that is con-sistent philosophically with NPspractice and has a growing body of

evidence to support its effective-ness. NPs who counsel childrenand families on behavior changemay find it a beneficial strategy to

incorporate into their daily prac-tice (Dunn et al., 2001).

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TABLE 2. Pros and cons of change: Example of smoking

Pros Cons

No change Smoking helps me relax.

I enjoy smoking.

All my friends smoke.

Smoking is harming my health.

Cigarettes are expensive.

My kids will continue to complain about my smoking.

Change My health will improve.

Ill get fewer respiratory infections.

Ill save money.

I will gain weight.

It will be difficult to quit.

I will become irritable.

Adapted and reprinted with permission from Rollnick, Mason, & Butler, 1999.


Documents

Motivating Patients 1