BC ADM Behavior Change Counseling & Motivational Interviewing — Questions and Answers
Question 1: Motivational interviewing (MI) is best described as which of the following?
- A directive approach in which the clinician persuades the patient to adopt healthier behaviors
- A collaborative, person-centered counseling style that elicits and strengthens a patient's own motivation for change (Correct answer)
- A structured behavioral therapy focused on identifying and correcting cognitive distortions
- A standardized education program covering the core components of diabetes self-management
Correct answer: A collaborative, person-centered counseling style that elicits and strengthens a patient's own motivation for change
Motivational interviewing is defined as a collaborative, person-centered form of guiding communication that elicits and strengthens a person's own motivation and commitment to change. It explicitly avoids the 'righting reflex' (telling patients what to do) and instead explores ambivalence to help patients discover their own reasons for change.
Question 2: A patient with type 2 diabetes says: 'I've been thinking about checking my blood sugar more regularly, but I just haven't gotten around to it yet.' According to the Transtheoretical Model (Stages of Change), which stage best describes this patient?
- Precontemplation
- Contemplation
- Preparation (Correct answer)
- Action
Correct answer: Preparation
The patient is in the Preparation stage — they have moved beyond contemplation (just thinking about it) and are intending to take action soon but have not yet begun. Preparation is characterized by intent to act in the near future and often small preparatory steps. The Contemplation stage involves thinking about change but without clear intent to act soon.
Question 3: Which of the following is an example of an open-ended question consistent with motivational interviewing principles?
- 'Are you taking your medications every day?'
- 'Did you check your blood sugar at least once this week?'
- 'What concerns do you have about starting insulin therapy?' (Correct answer)
- 'Have you tried walking for 30 minutes a day?'
Correct answer: 'What concerns do you have about starting insulin therapy?'
Open-ended questions cannot be answered with a simple yes or no and invite patients to share their perspective in their own words. 'What concerns do you have about starting insulin?' is open-ended and invites the patient to express ambivalence and explore their own values. The other options are closed-ended questions that can be answered with a single word.
Question 4: The ADCES 7 Self-Care Behaviors framework is a foundational model for diabetes self-management education. Which of the following is NOT one of the seven behaviors?
- Problem solving
- Reducing risks
- Healthy coping
- Medication reconciliation (Correct answer)
Correct answer: Medication reconciliation
The ADCES 7 Self-Care Behaviors are: Healthy Eating, Being Active, Monitoring, Taking Medication, Problem Solving, Reducing Risks, and Healthy Coping. 'Medication reconciliation' is a clinical safety process, not one of the seven self-care behaviors. 'Taking Medication' is the behavior in this framework, which encompasses adherence and proper administration.
Question 5: After a patient rates their readiness to improve dietary habits as a 5 out of 10, the diabetes care specialist asks: 'Why did you choose a 5 and not a 2?' This technique in motivational interviewing is designed to elicit what?
- Sustain talk — reasons the patient has for maintaining the status quo
- Reflective listening to mirror the patient's feelings
- Change talk — the patient's own reasons and motivations for change (Correct answer)
- Developing discrepancy between the patient's values and current behavior
Correct answer: Change talk — the patient's own reasons and motivations for change
Asking 'Why not a lower number?' after a readiness ruler elicits change talk — it invites patients to articulate the reasons they already have for wanting to change. This is a core MI technique because hearing themselves voice reasons for change strengthens intrinsic motivation. Asking 'Why not a higher number?' would elicit sustain talk.
Question 6: A patient with type 2 diabetes repeatedly misses insulin doses and minimizes the issue when it is raised in clinic visits. Which response is most consistent with motivational interviewing principles?
- Provide written materials outlining the medical consequences of missed insulin doses
- Explore the patient's ambivalence about taking insulin by asking open-ended questions and reflecting their responses (Correct answer)
- Firmly advise the patient that continued non-adherence will lead to serious complications
- Simplify the insulin regimen without discussing the adherence issue to reduce barriers
Correct answer: Explore the patient's ambivalence about taking insulin by asking open-ended questions and reflecting their responses
MI principles call for exploring ambivalence rather than confronting or lecturing. By asking open-ended questions and reflecting the patient's responses, the clinician helps the patient articulate their own barriers, values, and motivations. Warning about consequences (option C) triggers resistance; providing information without dialogue (option A) is not MI; changing the regimen without addressing the issue (option D) avoids the behavior change work.
BC ADM Behavior Change Counseling & Motivational Interviewing
Motivational interviewing (MI) is best described as which of the following?