By Evan Draper and Thomas R. Goyne
This article is a part of the September/October 2017, Volume 29, Volume 5, Audiology Today issue.
How often have you been flossing? Haven’t you been meaning to exercise? Why aren’t you eating better? There are many things we know we should be doing about our health—but aren't. It’s not that we haven’t been told about them many times and in many ways. We are just ambivalent about change. Perhaps we don’t have the desire, ability, reasons, or need to change our behavior.
Why then, should we be surprised when patients do not accept our recommendations for amplification? According to the MarkeTrak IX survey (Abrams, 2015), hearing aid adoption rate among adults with perceived hearing difficulty is approximately 30.2 percent. The study also found that patients often view their initial visit to a hearing care provider as an information gathering appointment and will visit more than one before moving forward with amplification and hearing rehabilitation (Abrams, 2015).
It is tempting to view patients who refuse amplification as “resistant to change,” “in denial,” and “non-compliant.” Instead, we should realize from these low adoption rates—and our own experiences as patients—that such resistance is part of a normal process. Better understanding this process and how to accelerate it can increase adoption rates, thereby improving our patients’ quality of life and our bottom line.
The intention of this article, then, is to introduce audiologists to a method of counseling and begin a conversation about how it might be successfully used in any clinical setting. Patient-centered approaches to care and self-motivation are familiar concepts in the field of audiology. Motivational interviewing is a set of concrete techniques that can make those concepts a reality.
Theory and Phases of Motivational Interviewing
Motivational interviewing (MI) was developed to work with another highly “change resistant” population: substance abusers. Alcoholics and drug addicts know very well about the negative consequences of their behavior, and yet they persist. The theory behind motivational interviewing is that the strongest motivations for behavioral change are the ones patients develop for themselves. But “waiting” for patients to develop their own resources can be a difficult task for a clinician. When a counselor sees a patient in difficulty, it is all too tempting to label the problem and offer a quick fix. William Miller, founder of motivational interviewing (2012), calls this the “righting reflex,” our natural tendency to offer help to others by solving their problems.
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