“If you want to change attitudes, start with a change in behaviour”
There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services. A vast number of applications already exist for different health conditions, but the majority offer similar functions and fail to include a comprehensive motivational framework and sufficient psychological parameters to ensure certain engagement and mid-long term adherence to the service.
Type 2 diabetes (T2D) is a complex disease with an increasing prevalence worldwide. Given this complexity, multifactorial intervention is necessary to improve long-term outcomes as stated in treatment guidelines. From a multidisciplinary perspective, psychological interventions have been utilized to favour better adjustment to the disease and all its implications. Among these psychological approaches, motivational interviewing (MI) has recently become a topic of great interest in the diabetes behavioural field, specifically, to address adherence to guidelines and behaviour change.
MI is a collaborative counselling strategy that engages people in “conversations” that guide them toward strengthening their motivation to change behaviours. It is based on the following assumptions:
- Ambivalence about change is normal and constitutes an important motivational obstacle in improvement or recovery from a certain situation.
- Ambivalence can be resolved by working with the individual’s intrinsic motivations and values.
- An empathic, supportive, yet directive, counselling style provides conditions under which change can occur.
Patients struggling with chronic diseases, such as T2D, require adherence to complex daily regimens and very often, they appear to be only weakly motivated by professionals’ suggestions or other significant ones. Similarly, they could appear poorly motivated to the lifestyle and self-management issues they should address and perhaps, they are not sure on how these improvements should be achieved. A healthcare provider might recommend something such as: “Why don’t you try to exercise a little more and to have lower intake of fats?” The patient response may be reject or resistance: “Yes, but…”, ambivalence: “I’m not sure about…” or hopefully, acceptance: “Yes, you are right, I should…” But despite an initial agreement, lower rates of mid-long term adherence to guidelines are usually observed.
MI could be very useful in helping patients to assess for themselves their own motives for behaviour change and ultimately, it has been described as a better predictor for final behaviour change. This patient-centred approach is a clear shift away from the previous (and sometimes, somewhere, still very present) paternalistic professional position of feeling responsible for “fixing” the patients’ problems. More and more, it has been described how chronic conditions require a great participation, willingness and self-management abilities from patients. Thus, the “spirit of MI” is more close to a patient empowerment approach, which works perfectly for T2D patients.
The field of technology-supported healthcare is growing rapidly and offers new ways of self-management education and support. Interventions that merge MI with interactive technology may be an efficient and innovative way to address some of these issues because they can be disseminated to new settings, populations, and areas that might not otherwise have the capacity for in-person evidence-based care. MI delivered by new technologies (e.g. mobile applications) can address these issues because the content is programmable and automated (personalized, though), which may be particularly important when disseminating MI in diverse populations and in different languages. This approach is also less expensive than one-on-one treatment, offers easy access, and the anonymity overcomes the stigma sometimes associated with formal treatment.
There are not too many mobile applications developed with a well-established and implemented motivational framework from the very initial phases of service design. PRECIOUS service is intended to overcome such limitation and is aimed to combine a multidisciplinary scientific corpus of knowledge, nurtured from information and technology communication, engineering, and psychology and mental health sciences. Available evidence-based MI interventions showing positive results will serve as a reference too.
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