Inspiring change: what motivational Interviewing can teach us about communicating herd health advice

The past 25 years have seen a major shift in the health management of dairy cattle. Veterinarians and farmers have moved their focus from individual animals to groups and herds, shifted from disease treatment to prevention, and are now equipped with extensive scientific knowledge and complex monitoring tools on both risk factors and management strategies associated with disease (LeBlanc et al., 2006). However, despite these extensive scientific advances, the implementation of changes in on-farm housing and management of many diseases still appears to be inadequate; for example, lameness prevalence rates in the UK have changed little over the past two decades (Whay and Main, 2010). To make meaningful advances in preventative herd health, the real challenge now resides in finding methods to effectively and consistently encourage the implementation of hard-earned scientific knowledge on farms (LeBlanc et al., 2006). But how can we inspire farmers to engage with change?

When it comes to advising on matters of herd health, veterinarians instinctively seek to ensure that the scientific quality and accuracy of their recommendations is optimised, and that these recommendations meet practical considerations such as being specific, measurable, achievable and relevant (Sibley, 2006). There is intuitive logic to the conviction that if we can just provide the ‘right’ choices in our recommendations and facilitate their implementation practically, change should follow. However, whilst these features may be necessary for change, they are far from sufficient for it to occur. Negative psychological reactance to constrained choice and persuasion is well documented (Dillard and Shen, 2005) as this conflicts with the ambivalence common in contemplating change. Psychological theories of motivation, on the other hand, suggest that our drive to change needs three core conditions to flourish, namely the experiences of autonomy (self-determination in choices), relatedness (connection to others through respect, care and understanding) and competence (confidence in one’s ability to change) (Ryan et al., 2008). Advocating practical choices underpinned by scientific research is therefore simply not enough; we must connect with an individual’s motivational needs to ensure engagement with, and implementation of, the advice provided.

At the University of Bristol, we are currently investigating communication as a tool for engaging with these motivational attributes. In any interaction on herd health - whether over a specific incidence of disease or the broader process of planning - communication acts as the bridge between veterinarian and farmer in understanding and implementing recommendations. Attending to and enhancing clinical communication skill to address motivational needs could, we hypothesise, facilitate the uptake of advice on herd health. This workshop presents an opportunity to learn about the methodology of Motivational Interviewing, an evidence-based communication approach, that is the focus of our research in this context.

Motivational Interviewing (MI) is a collaborative conversation style developed in the medical sciences for strengthening a person’s own motivation to change (Miller and Rose 2009). MI specifically explores and resolves ambivalence to influence the motivational processes that facilitate change, by evoking a client’s own desires, reasons and willingness to do so as a means of clarifying and strengthening their positive intent. Critical to this process is the relational context of empathy, acceptance and partnership, which facilitates the spontaneous emergence of client language of change, combined with technical communication skills that shape and enhance it (Moyers, 2014). Empirical studies indicate that MI communication outperforms traditional advice-giving in the treatment of a broad range of behavioural problems and diseases, improving client behavioural and medical outcomes (Lundhal et al., 2013; Rubak et al., 2005).

This workshop will offer participants the opportunity to gain an understanding of the verbal skills and communication processes that underpin the practice of MI, in addition to the ‘spirit’ of the methodology that informs its use. This will be achieved through a mix of experiential exercises, group discussion and presentation. Research at the University of Bristol on Motivational Interviewing in the context of herd health advice (specifically lameness and mastitis), combined with wider research on human behaviour change and motivation, will support and inform the experience. Participants can expect to take away communication skills to support their advisory interactions on farm, and ways to practice and learn more about the MI methodology.

Acknowledgements
The author would like to acknowledge the support of her supervisory team during the research and training that underpinned the development of this workshop, and the British Veterinary Association Animal Welfare Foundation for funding her postgraduate studies.

Supervisory Team

The University of Bristol
Dr Kristen Reyher, Dr Helen Rebecca Whay, Professor David Main and Dr Anne Haase

The University of Southampton
Dr Emma Roe

References

Dillard JP and Shen L (2005). On the nature of reactance and its role in persuasive health communication. Communication Monographs. 72(2): 144-168.

Le Blanc SJ, Lissemore KD, Kelton DF, Duffield TF and Leslie KE (2006) Major Advances in Disease Prevention in Dairy Cattle. Journal of Dairy Science 89(4); 1267-1279.

Lundahl B, Moleni T, Burke BL, Butters R, Tollefson D, Butler C and Rollnick S (2013). Motivational Interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials. Patient Education and Counselling. 93(2), 157-68.

Miller WR and Rose GS (2009). Toward a theory of Motivational Interviewing. American Psychologist. 64(6): 527-537.

Moyers T (2014). The relationship in Motivational Interviewing. Psychotherapy. 51(3): 358-363.

Rubak S, Sandbæk A, Lauritzen T and Christensen B (2005). Motivational Interviewing: A systematic review and meta-analysis. British Journal of General Practice.55: 305-312.

Ryan, RM, Patrick H, Deci EL and Williams GC (2008). Facilitating health behaviour change and its maintenance: Interventions based on Self-Determination Theory. The European Health Psychologist. 10: 2-5.

Sibley R (2006). Developing health plans for the dairy herd. In Practice. 28: 114-121.

Whay HR and Main DCJ (2010). Improving animal welfare: practical approaches to achieving change. In: Grandin T, ed. Improving Animal Welfare A Practical Approach. United Kingdom: CAB International.