In order for a provider to be successful at motivational interviewing, four basic interaction skills should first be established. 2
- An ability to ask open ended questions
- An ability to provide affirmations
- A capacity for reflective listening
- An ability to periodically provide summary statements to patients.
These basic skills are essential to all effective communication between providers and patients. Good cross-cultural communication hinges on them too, but cross-cultural interactions introduce even more conversational complexity. Success using the motivational interviewing strategies with people from different cultures- especially those who speak a different native tongue- will also depend on understanding culturally-based expectations of physicians.
A heightened awareness of how interview questions are phrased is similarly essential because MI questions are often not phrased in a way that people from other cultures can easily relate to them. For those who aren’t yet familiar with the way motivational interview questions sound, these examples may be helpful. In parenthesis, possible cross-cultural considerations are noted.
“You are right. I am concerned about your ____, but you are the one in control.”
(This is very much at odds with people who believe destiny is NOT in their control. Also might confuse people who expect the doctor to TELL them what to do.)
“The fact that you are sharing with me indicates that you are interested in learning about ____. Why do you want to learn about it?”
(The phrasing suggests the patient has arrived at a decision, and that may be a premature assumption. It might put the patient on the spot if he has been nodding in agreement mostly to please the doctor.)
“What makes you think that you need to make a change?”
(Again, the patient may be confused because he expects the doctor who is the authority figure to be more authoritative and TELL rather than ask this kind of leading question.)
“What concerns do you have about making changes?”
(This might be a question where family dynamics affect the patient’s answer – in ANY culture. People may feel very protective of their family’s privacy and not want to answer honestly about mismatched agendas and priorities.)
“What things make you think that this is a problem?”
(This is convoluted phrasing, especially for someone who does not understand English. Does this mean there really isn’t a problem?)
CONCLUSION
Motivational Interviewing is only a successful tool to increase patient engagement if the person using the technique has taken into consideration the culturally-based communication patters of the patient/family.
‘Four Basic Interaction Skills for ALL Cultures’ by Marcia Carteret. Copyright © 2017. All rights reserved.
