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Helping patients reduce sexual health risk using a Motivational Interviewing approach

Helping patients reduce sexual health risk using a Motivational Interviewing approach. STIF workshop 15.9.08. Objectives. Summarise the NICE recommendations for reducing STI/HIV Consider the primary HCW role in helping people reduce sexual health risk

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Helping patients reduce sexual health risk using a Motivational Interviewing approach

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  1. Helping patients reduce sexual health risk using a Motivational Interviewing approach STIF workshop 15.9.08

  2. Objectives • Summarise the NICE recommendations for reducing STI/HIV • Consider the primary HCW role in helping people reduce sexual health risk • Introduce Motivational Interviewing (MI) (Miller 1983) • Introduce the Stages of Change model (Prochaska & DiClemente 1986) • Consider feasibility of integrating into practice • Review local service provision

  3. Prevention of STI and under 18 conceptions (NICE 2007) • Recommendations 1 & 2 • One to one structured discussions with individuals at high risk of STIs… • structured on the basis of behaviour change theories. … • address factors that can help reduce risk-taking and improve self-efficacy and motivation. • each session …15–20 minutes. • The number of sessions will depend on individual need.

  4. Challenges with risk reduction • What difficulties have you encountered? • What has worked well? • Have you avoided such discussions – if so, why?

  5. Process of Change ModelAdapted from Prochaska & DiClemente (1986) Stable, ‘safer’ lifestyle Maintenance Action Relapse Preparation Contemplation Pre-contemplative

  6. What is MI? “A person-centred, goal-orientated approach for facilitating change by exploring & resolving ambivalence” Miller (2006) “a skilful clinical style for eliciting the patient’s own good motivations for .change” (Rollnick, Miller & Butler 2008)

  7. The spirit of MI • “Dancing rather than wrestling” • Collaborative • conversation between equals; working together; joint decision making • Evocative • Elicits patients own motives and resources for change • Honouring patient autonomy • Emphasise patient choice and control • Avoid creating resistance through coercion

  8. RULE Guiding Principles • Resist the righting reflex • Understand your patient’s motivations • Listen with empathy • Empower your patient

  9. Opening strategies - OARS • Open questions • Affirmations • Reflective listening • Summarise

  10. Exploring ambivalence • Good things / not so good things • ‘Decisional Balance’ demonstration • Good things about unprotected sex • Not so good things about unprotected sex • Good things about condom use • Not so good things about condom use

  11. Decisional balance demonstration Patient 18 year old female Presents with PID symptoms 2 previous episodes of chlamydia 3 casual partners in past 6 months All unprotected vaginal sex

  12. Assessing readiness to change • Importance • Confidence (self-efficacy) 10 1 IMPORTANCE 1 10 CONFIDENCE

  13. Giving information • Wait for client to ask or / seek permission • Offer choices / what other do • Elicit- provide- elicit

  14. Roll with resistance • Avoid arguing - may increase resistance to change • Resistance cue to change strategies • It is for the client to make decisions about change • The client is the primary resource in finding answers and solutions

  15. Group practice exercise Patient 18 year old female Presents with PID symptoms 2 previous episodes of chlamydia 3 casual partners in past 6 months All unprotected vaginal sex What would you not say? What might you say, in the spirit of MI?

  16. Let me explain just how serious chlamydia /PID is, and why you need to avoid it in future! You need to start using condoms! I know you are in a hurry but this won’t take long! What do you know about chlamydia / PID? Would it be helpful if I gave you a bit more information? How do you feel about using condoms? You seem in a hurry. ..is there anything you need to talk about before you go ? MI in practice

  17. What next? • Goal setting: “What could you do to reduce your risk for STDs/HIV/pregnancy?” (Examples of goals: condom use, reducing number of sexual partners, safer sex, contraception, partner testing.) • Action Plan: “How would you go about that?” “What would be the difficult thing about that?” “How would you overcome it?”

  18. Summary • Spirit of MI - collaborative, evocative, respect for autonomy • RULE- Resist the righting reflex, understand, listen with empathy, empower • Information giving - elicit – provide – elicit • Exploring ambivalence – decisional balance (pros and cons) • Importance and confidence • Roll with resistance

  19. Further reading • Rollnick, Mason and Butler (1999) Health Behaviour Change: A Guide for Practitioners. • Rollnick, Miller and Butler (2008) Motivational Interviewing in Health Care • Miller & Rollnick (1991) Motivational Interviewing

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