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</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Pharmacy Communication Strategies</div><div class="j">StatPearls [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 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autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK603742_"><span class="title" itemprop="name">Pharmacy Communication Strategies</span></h1><p class="contribs">Nguyen KT, Warunek L.</p><p class="fm-aai"><a href="#_NBK603742_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="article-160730.s1"><h2 id="_article-160730_s1_">Introduction</h2><p>Motivational interviewing is a communication style characterized by its collaborative and goal-oriented approach to delving into underlying issues related to resistance or ambivalence toward behavior change.<a class="bibr" href="#article-160730.r1" rid="article-160730.r1">[1]</a> Motivational interviewing strategies have been incorporated into various realms of healthcare, including medical care, dentistry, physical therapy, and numerous other disciplines.<a class="bibr" href="#article-160730.r2" rid="article-160730.r2">[2]</a><a class="bibr" href="#article-160730.r3" rid="article-160730.r3">[3]</a><a class="bibr" href="#article-160730.r4" rid="article-160730.r4">[4]</a> This activity reveals the positive and beneficial effects of motivational interviewing in enhancing motivation for behavioral changes and improving medication adherence.<a class="bibr" href="#article-160730.r5" rid="article-160730.r5">[5]</a><a class="bibr" href="#article-160730.r6" rid="article-160730.r6">[6]</a></p></div><div id="article-160730.s2"><h2 id="_article-160730_s2_">Function</h2><p>Considering the deeply personal nature of behavior change, motivational interviewing emerges as a valuable tool for facilitating positive behavioral shifts. This skill proves particularly beneficial when addressing behaviors that individuals may find challenging to alter, with frequent references to its application in the management of addiction, obesity, and other chronic diseases. However, the utility of motivational interviewing extends beyond these domains, demonstrating relevance across a spectrum of therapeutic and counseling.</p><p>Motivational interviewing is often used alongside the transtheoretical model, which provides a systematic framework to comprehend and address the process of behavioral change.<a class="bibr" href="#article-160730.r7" rid="article-160730.r7">[7]</a> This model suggests that individuals progress through a series of stages toward behavior modification (see <b>Table 1. </b>Transtheoretical Model of Change). An accurate assessment and recognition of an individual's stage of change allows clinicians to encourage progression to the next stage or reinforce the maintenance of a changed behavior through motivational interviewing. This patient-centered therapeutic approach to communication involves gauging an individual's internal desire and willingness to make a positive change.<a class="bibr" href="#article-160730.r8" rid="article-160730.r8">[8]</a> Through these reflections, pharmacists and other healthcare professionals can better understand and explore personal motivations and obstacles to change, facilitating targeted counseling, education, and the provision of other resources.<a class="bibr" href="#article-160730.r9" rid="article-160730.r9">[9]</a></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table0"><a href="/books/NBK603742/table/article-160730.table0/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table0"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table0"><a href="/books/NBK603742/table/article-160730.table0/?report=objectonly" target="object" rid-ob="figobarticle160730table0">Table</a></h4><p class="float-caption no_bottom_margin">Table 1. Transtheoretical Model of Change. </p></div></div><p>Engaging in discussions about personal preferences, values, and belief systems necessitates establishing a trusting patient relationship. Motivational interviewing offers an empathetic framework for fostering trust and addressing ambivalence or resistance in a nonjudgmental manner using effective communication principles. Various techniques, such as reflective listening, open-ended questioning, and affirmation, contribute to creating a supportive environment that encourages understanding and meaningful discussion.</p><p>Overall, by establishing collaborative relationships, motivational interviewing allows practitioners to customize interventions according to each individual's distinct characteristics, values, and goals. This skill considers the readiness and willingness to change, providing a personalized approach to care that enhances the relevance and effectiveness of the intervention. </p></div><div id="article-160730.s3"><h2 id="_article-160730_s3_">Issues of Concern</h2><p>
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<b>Building Trusting Relationships</b>
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</p><p>Motivational interviewing is commonly acknowledged for fostering comprehension and facilitating behavior change in individuals who may be hesitant, ambivalent, or resistant to change.<a class="bibr" href="#article-160730.r5" rid="article-160730.r5">[5]</a> At its core, the spirit of motivational interviewing is defined by the cultivation of trusting, collaborative patient relationships, which necessitates the practice of accepting and empathizing with patient needs, beliefs, values, goals, readiness, experiences, and perspectives.<a class="bibr" href="#article-160730.r10" rid="article-160730.r10">[10]</a> Motivational interviewing enables practitioners to explore and strengthen an individual's intrinsic motivation to make positive changes in their behavior. Such conversations may reveal discrepancies between an individual's current behavior and their values and goals, which can be crucial points of reflection in considering change.<a class="bibr" href="#article-160730.r5" rid="article-160730.r5">[5]</a> Motivational interviewing provides a structured yet flexible framework that allows practitioners to engage patients in personalized discussions about change while steadfastly honoring the patient's autonomy in the decision-making process.<a class="bibr" href="#article-160730.r10" rid="article-160730.r10">[10]</a></p><p>
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<b>Specific Techniques</b>
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</p><p>Although motivational interviewing follows general principles, practitioners must adapt their communication strategies to suit each individual's specific needs, motivations, and circumstances. Considering the techniques used in motivational interviewing as a foundational guide rather than a rigid structure enables practitioners to customize their approach to fit the unique characteristics of their patients. </p><p>Motivational interviewing skills are captured in the OARS acronym, which includes open-ended questions, affirmation of strengths, reflective listening, and summarization (see <b>Table 2. </b>Motivational Interviewing Skills). Open-ended questions foster conversations that encourage patients to share and elaborate on their experiences and perspectives, particularly regarding health beliefs and barriers to change. Reflective listening is essential for acknowledging the patient's shared experiences. Repeating or rephrasing information provided by the patient enables them to rectify any misunderstandings on the listener's part.<a class="bibr" href="#article-160730.r11" rid="article-160730.r11">[11]</a></p><p>The practitioner should avoid interrupting or correcting the patient as they share their personal values and beliefs to build a nonjudgmental relationship. While similar to reflective listening, summarization is a skill that involves acknowledging several key concepts throughout the discussion rather than focusing on a single statement. Lastly, affirmation of strengths refers to acknowledging positive patient characteristics or past achievements, potentially boosting confidence or readiness to contemplate behavior change.<a class="bibr" href="#article-160730.r12" rid="article-160730.r12">[12]</a> </p><p>
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<b> Table 2.</b> Motivational Interviewing Skills</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table1"><a href="/books/NBK603742/table/article-160730.table1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table1"><a href="/books/NBK603742/table/article-160730.table1/?report=objectonly" target="object" rid-ob="figobarticle160730table1">Table</a></h4><p class="float-caption no_bottom_margin">Open-ended questions Encourage patients to share their experiences and perspectives</p></div></div><p>These skills are often associated with expressing empathy, which constitutes 1 of the 4 core principles of motivational interviewing (see <b>Table 3. </b>Motivational Interviewing Principles).<a class="bibr" href="#article-160730.r13" rid="article-160730.r13">[13]</a> As practitioners delve deeper into understanding the patient, differences between the individual's values and behaviors may become apparent. By acknowledging this discrepancy, practitioners can assist patients in identifying it and determining whether action should be considered. For individuals who exhibit ambivalence or reluctance toward behavior change, using the technique of "rolling with resistance" is essential to honor patient autonomy.<a class="bibr" href="#article-160730.r14" rid="article-160730.r14">[14]</a> Change talk using tools such as 10-point rulers to assess readiness, willingness, or confidence to change may be particularly beneficial in exploring reasons for ambivalence or reluctance. The fourth principle, supporting self-efficacy, incorporates the skill of affirming strengths and focuses on providing positive reinforcement as patients endeavor to change their behavior.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table2"><a href="/books/NBK603742/table/article-160730.table2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table2"><a href="/books/NBK603742/table/article-160730.table2/?report=objectonly" target="object" rid-ob="figobarticle160730table2">Table</a></h4><p class="float-caption no_bottom_margin">Table 3. Motivational Interviewing Principles. </p></div></div><p> <b>Challenges</b></p><p>Several perceived barriers to motivational interviewing exist, including the time needed to incorporate the skills and principles in practice. However, it is noteworthy that the benefits of motivational interviewing are not contingent on a specific amount of time for effective delivery. Another barrier involves a lack of confidence through inadequate training and comprehension of motivational interviewing concepts, which can be addressed through training and educational programs.<a class="bibr" href="#article-160730.r15" rid="article-160730.r15">[15]</a> In addition to challenges, common pitfalls associated with motivational interviewing exist (see <b>Table 4. </b>Common Pitfalls).<a class="bibr" href="#article-160730.r11" rid="article-160730.r11">[11]</a></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table3"><a href="/books/NBK603742/table/article-160730.table3/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table3"><a href="/books/NBK603742/table/article-160730.table3/?report=objectonly" target="object" rid-ob="figobarticle160730table3">Table</a></h4><p class="float-caption no_bottom_margin">Table 4. Common Pitfalls. </p></div></div></div><div id="article-160730.s4"><h2 id="_article-160730_s4_">Clinical Significance</h2><p>As accessible and trusted healthcare professionals, pharmacists are critical in promoting health and wellness. Equipped with training in screening, prevention, and management of chronic conditions, pharmacists utilize motivational interviewing skills to offer comprehensive education and counseling covering both medications and lifestyle behavior modifications.<a class="bibr" href="#article-160730.r16" rid="article-160730.r16">[16]</a> A primary focus lies in enhancing adherence, with challenges often arising in cases of time-consuming or complex regimens or those indicated for asymptomatic conditions.<a class="bibr" href="#article-160730.r17" rid="article-160730.r17">[17]</a> </p><p>Studies examining motivational interviewing as a patient-centered communication approach have suggested improved adherence rates for chronic conditions, including hypertension, diabetes, heart failure, and chronic pain, and improved acceptance rates for immunizations.<a class="bibr" href="#article-160730.r18" rid="article-160730.r18">[18]</a><a class="bibr" href="#article-160730.r19" rid="article-160730.r19">[19]</a><a class="bibr" href="#article-160730.r20" rid="article-160730.r20">[20]</a><a class="bibr" href="#article-160730.r21" rid="article-160730.r21">[21]</a><a class="bibr" href="#article-160730.r22" rid="article-160730.r22">[22]</a> Furthermore, motivational interviewing has also been associated with benefits in encouraging and maintaining lifestyle changes, including physical activity.<a class="bibr" href="#article-160730.r23" rid="article-160730.r23">[23]</a> As a result, motivational interviewing strengthens pharmacists' ability to engage in health promotion efforts. </p></div><div id="article-160730.s5"><h2 id="_article-160730_s5_">Other Issues</h2><p>
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<b>Health Literacy</b>
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</p><p>Pharmacists and other healthcare professionals care for people from all different backgrounds, beliefs, and health literacy levels. The Centers for Disease Control and Prevention (CDC) divides health literacy into personal and organizational definitions. Personal health literacy refers to finding, understanding, and using information to make health-related decisions. In contrast, organizational health literacy refers to how organizations enable individuals to find, understand, and use information for health-related decisions (CDC. Health Literacy Basics). These definitions emphasize the use of health information and acknowledge how health literacy impacts others. Health literacy significantly impacts medication understanding, including missed prescription refills and inappropriate dosing or timing of medications.</p><p>As a result, individuals with low health literacy are at higher risk of outcomes, including increased rates of hospitalizations and greater use of emergency care. Health literacy disparities are prevalent among vulnerable populations, contributing to the perpetuation of health disparities. Clear communication without medical jargon promotes health equity, and addressing health literacy is fundamental to improving health outcomes within and across communities. Several tools have been developed to examine or assess literacy, health literacy, and numeracy (see <b>Table 5. </b>Health Literacy Screening Tools).<a class="bibr" href="#article-160730.r24" rid="article-160730.r24">[24]</a><a class="bibr" href="#article-160730.r25" rid="article-160730.r25">[25]</a><a class="bibr" href="#article-160730.r26" rid="article-160730.r26">[26]</a><a class="bibr" href="#article-160730.r27" rid="article-160730.r27">[27]</a><a class="bibr" href="#article-160730.r28" rid="article-160730.r28">[28]</a><a class="bibr" href="#article-160730.r29" rid="article-160730.r29">[29]</a><a class="bibr" href="#article-160730.r30" rid="article-160730.r30">[30]</a></p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table4"><a href="/books/NBK603742/table/article-160730.table4/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table4"><a href="/books/NBK603742/table/article-160730.table4/?report=objectonly" target="object" rid-ob="figobarticle160730table4">Table</a></h4><p class="float-caption no_bottom_margin">Table 5. Health Literacy Screening Tools . </p></div></div><p>Certain factors such as age, education, and health insurance status may predispose individuals to low health literacy (NCES, National Assessment of Adult Literacy). Indications of low health literacy include frequently missed appointments, medication nonadherence, difficulty identifying medications or recalling their purpose and dosage, asking fewer questions, and failure to follow through on tests or referrals (AHRQ, The Agency for Healthcare Research and Quality. Health Literacy: Hidden Barriers and Practical Strategies). However, it is noteworthy that low health literacy cannot be discerned through appearances alone. As a result, universal precautions are recommended wherein care delivery should consider everyone to have limited health literacy. Successful implementation of motivational interviewing and effective communication involves several strategies to address varying levels of health literacy (see <b>Table 6.</b> Strategies for Addressing Health Literacy) (AHRQ. Health Literacy: Hidden Barriers and Practical Strategies).<a class="bibr" href="#article-160730.r31" rid="article-160730.r31">[31]</a><a class="bibr" href="#article-160730.r32" rid="article-160730.r32">[32]</a></p><p> <b>Table 6. </b>Strategies for Addressing Health Literacy</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figarticle160730table5"><a href="/books/NBK603742/table/article-160730.table5/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobarticle160730table5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="article-160730.table5"><a href="/books/NBK603742/table/article-160730.table5/?report=objectonly" target="object" rid-ob="figobarticle160730table5">Table</a></h4><p class="float-caption no_bottom_margin">Using plain, non-medical language Avoiding using medical jargon</p></div></div><p>
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<b>Documentation</b>
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</p><p>Documenting patient interactions in the medical record is important for follow-up and communicating changes with the medical team. Documentation should be clear, concise, and comprehensive. To mitigate the risk of misinterpretation, clinicians should adhere to the US Institute of Safe Medication Practices (ISMP) list of error-prone abbreviations, symbols, and dose designations. This list contains symbols and abbreviations commonly associated with errors or mistakes, which can have harmful results.</p><p>Medical documentation should include patient concerns and health beliefs. For patients who decline changes due to ambivalence or reluctance, their reasons should be noted in a nonjudgmental manner. Documentation should also be completed in a timely manner, ideally as soon as the encounter has ended. To this end, templates for common encounters could be established in the electronic medical record for efficiency. However, caution should be exercised when cutting and pasting information from previous notes to minimize the risk of perpetuating outdated or inaccurate information. Indeed, some institutions prohibit providers from using cut-and-paste functions within patient encounter notes to mitigate these errors. </p></div><div id="article-160730.s6"><h2 id="_article-160730_s6_">Enhancing Healthcare Team Outcomes </h2><p>Motivational interviewing is a communication strategy built upon collaborative relationships between the patient and practitioner. This strategy encourages using open-ended questions and reflective listening to foster a deeper understanding of patient experiences, perspectives, and beliefs. This understanding enables practitioners to tailor interventions to each patient's distinct characteristics, values, and goals.<a class="bibr" href="#article-160730.r10" rid="article-160730.r10">[10]</a> The structured yet flexible framework allows practitioners to engage patients in meaningful conversation while keeping patient autonomy at the forefront of the decision-making process.<a class="bibr" href="#article-160730.r10" rid="article-160730.r10">[10]</a></p><p>All members of the healthcare team can incorporate motivational interviewing into patient interactions. For example, physicians and advanced practitioners can use reflective listening to identify patient perspectives and beliefs when determining disease management strategies. Pharmacists can ask open-ended questions to engage patients in understanding medications and medication adherence. Nurses can demonstrate empathy to build and strengthen patient relationships. In addition, office staff and other healthcare team members can also incorporate aspects of motivational interviewing where appropriate. </p><p>Health systems and medical offices should incorporate training and support documents to educate team members on the successful implementation of motivational interviewing for every aspect of patient care. These training sessions should be conducted collaboratively with all healthcare team members to ensure each discipline comprehends how motivational interviewing can be integrated into their respective roles. Furthermore, motivational interviewing training should be incorporated into standard training programs for remote work and practitioners learning to interact with patients using web-based platforms.</p></div><div id="article-160730.s7"><h2 id="_article-160730_s7_">Review Questions</h2><ul><li class="half_rhythm"><div>
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</div></li></ul></div><div id="article-160730.s8"><h2 id="_article-160730_s8_">References</h2><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="article-160730.r1">Prescott DS. Motivational Interviewing: as Easy as It Looks? <span><span class="ref-journal">Curr Psychiatry Rep. </span>2020 May 28;<span class="ref-vol">22</span>(7):35.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32462490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32462490</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>2.</dt><dd><div class="bk_ref" id="article-160730.r2">Kaltman S, Tankersley A. Teaching Motivational Interviewing to Medical Students: A Systematic Review. <span><span class="ref-journal">Acad Med. </span>2020 Mar;<span class="ref-vol">95</span>(3):458-469.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31577585" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31577585</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>3.</dt><dd><div class="bk_ref" id="article-160730.r3">Kay EJ, Vascott D, Hocking A, Nield H. Motivational interviewing in general dental practice: A review of the evidence. <span><span class="ref-journal">Br Dent J. </span>2016 Dec 16;<span class="ref-vol">221</span>(12):785-791.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/27982007" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27982007</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>4.</dt><dd><div class="bk_ref" id="article-160730.r4">Jamil A, Javed A, Iqbal MA. 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Applications to addictive behaviors. <span><span class="ref-journal">Am Psychol. </span>1992 Sep;<span class="ref-vol">47</span>(9):1102-14.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/1329589" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1329589</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>10.</dt><dd><div class="bk_ref" id="article-160730.r10">Arbuckle MR, Foster FP, Talley RM, Covell NH, Essock SM. Applying Motivational Interviewing Strategies to Enhance Organizational Readiness and Facilitate Implementation Efforts. <span><span class="ref-journal">Qual Manag Health Care. </span>2020 Jan/Mar;<span class="ref-vol">29</span>(1):1-6.</span> [<a href="/pmc/articles/PMC6927483/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6927483</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31855929" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31855929</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>11.</dt><dd><div class="bk_ref" id="article-160730.r11"><span class="ref-journal">Enhancing Motivation for Change in Substance Use Disorder Treatment: Updated 2019 [Internet].</span> Substance Abuse and Mental Health Services Administration (US); Rockville (MD): 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/34106565" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34106565</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>12.</dt><dd><div class="bk_ref" id="article-160730.r12">Beckwith VZ, Beckwith J. Motivational Interviewing: A Communication Tool to Promote Positive Behavior Change and Optimal Health Outcomes. <span><span class="ref-journal">NASN Sch Nurse. </span>2020 Nov;<span class="ref-vol">35</span>(6):344-351.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/32338141" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32338141</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>13.</dt><dd><div class="bk_ref" id="article-160730.r13">Seven M, Reid A, Abban S, Madziar C, Faro JM. Motivational interviewing interventions aiming to improve health behaviors among cancer survivors: a systematic scoping review. <span><span class="ref-journal">J Cancer Surviv. </span>2023 Jun;<span class="ref-vol">17</span>(3):795-804.</span> [<a href="/pmc/articles/PMC10652272/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10652272</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36100801" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36100801</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>14.</dt><dd><div class="bk_ref" id="article-160730.r14">Wagner CC, Ingersoll KS. Beyond Cognition: Broadening the Emotional Base of Motivational Interviewing. <span><span class="ref-journal">J Psychother Integr. </span>2008 Jun 01;<span class="ref-vol">18</span>(2):191-206.</span> [<a href="/pmc/articles/PMC2903073/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2903073</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20631922" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20631922</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>15.</dt><dd><div class="bk_ref" id="article-160730.r15">Hatch MR, Carandang K, Moullin JC, Ehrhart MG, Aarons GA. Barriers to Implementing Motivational Interviewing in Addiction Treatment: A Nominal Group Technique Process Evaluation. <span><span class="ref-journal">Implement Res Pract. </span>2021 Jan-Dec;<span class="ref-vol">2</span></span> [<a href="/pmc/articles/PMC8865398/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8865398</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35211677" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35211677</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>16.</dt><dd><div class="bk_ref" id="article-160730.r16">White N. Lifestyle Medicine and Health and Wellness Coaching in Pharmacy Practice. <span><span class="ref-journal">Am J Lifestyle Med. </span>2018 Nov-Dec;<span class="ref-vol">12</span>(6):459-461.</span> [<a href="/pmc/articles/PMC6367873/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6367873</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30783398" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30783398</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>17.</dt><dd><div class="bk_ref" id="article-160730.r17">Jimmy B, Jose J. Patient medication adherence: measures in daily practice. <span><span class="ref-journal">Oman Med J. </span>2011 May;<span class="ref-vol">26</span>(3):155-9.</span> [<a href="/pmc/articles/PMC3191684/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3191684</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22043406" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22043406</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>18.</dt><dd><div class="bk_ref" id="article-160730.r18">Abughosh S, Wang X, Serna O, Esse T, Mann A, Masilamani S, Holstad MM, Essien EJ, Fleming M. A Motivational Interviewing Intervention by Pharmacy Students to Improve Medication Adherence. <span><span class="ref-journal">J Manag Care Spec Pharm. </span>2017 May;<span class="ref-vol">23</span>(5):549-560.</span> [<a href="/pmc/articles/PMC10398180/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10398180</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28448784" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28448784</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>19.</dt><dd><div class="bk_ref" id="article-160730.r19">Aubeeluck E, Al-Arkee S, Finlay K, Jalal Z. The impact of pharmacy care and motivational interviewing on improving medication adherence in patients with cardiovascular diseases: A systematic review of randomised controlled trials. <span><span class="ref-journal">Int J Clin Pract. </span>2021 Nov;<span class="ref-vol">75</span>(11):e14457.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/34105858" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34105858</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>20.</dt><dd><div class="bk_ref" id="article-160730.r20">Cole JW, M H Chen A, McGuire K, Berman S, Gardner J, Teegala Y. Motivational interviewing and vaccine acceptance in children: The MOTIVE study. <span><span class="ref-journal">Vaccine. </span>2022 Mar 15;<span class="ref-vol">40</span>(12):1846-1854.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/35153096" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35153096</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>21.</dt><dd><div class="bk_ref" id="article-160730.r21">Poudel N, Kavookjian J, Scalese MJ. Motivational Interviewing as a Strategy to Impact Outcomes in Heart Failure Patients: A Systematic Review. <span><span class="ref-journal">Patient. </span>2020 Feb;<span class="ref-vol">13</span>(1):43-55.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31502239" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31502239</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>22.</dt><dd><div class="bk_ref" id="article-160730.r22">Crawley A, Murphy L, Regier L, McKee N. Tapering opioids using motivational interviewing. <span><span class="ref-journal">Can Fam Physician. </span>2018 Aug;<span class="ref-vol">64</span>(8):584-587.</span> [<a href="/pmc/articles/PMC6326773/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6326773</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30108077" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30108077</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>23.</dt><dd><div class="bk_ref" id="article-160730.r23">Suire KB, Peart A, Kavookjian J, Wadsworth DD. Impact of motivational interviewing as a follow-up to an exercise intervention among women with or at risk for metabolic syndrome: A randomized controlled trial. <span><span class="ref-journal">SAGE Open Med. </span>2022;<span class="ref-vol">10</span>:20503121211073434.</span> [<a href="/pmc/articles/PMC8771748/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8771748</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35070315" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35070315</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>24.</dt><dd><div class="bk_ref" id="article-160730.r24">Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB, Murphy PW, Crouch MA. Rapid estimate of adult literacy in medicine: a shortened screening instrument. <span><span class="ref-journal">Fam Med. </span>1993 Jun;<span class="ref-vol">25</span>(6):391-5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8349060" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8349060</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>25.</dt><dd><div class="bk_ref" id="article-160730.r25">Parker RM, Baker DW, Williams MV, Nurss JR. The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills. <span><span class="ref-journal">J Gen Intern Med. </span>1995 Oct;<span class="ref-vol">10</span>(10):537-41.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8576769" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8576769</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>26.</dt><dd><div class="bk_ref" id="article-160730.r26">Baker DW, Williams MV, Parker RM, Gazmararian JA, Nurss J. Development of a brief test to measure functional health literacy. <span><span class="ref-journal">Patient Educ Couns. </span>1999 Sep;<span class="ref-vol">38</span>(1):33-42.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/14528569" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14528569</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>27.</dt><dd><div class="bk_ref" id="article-160730.r27">Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. <span><span class="ref-journal">Ann Fam Med. </span>2005 Nov-Dec;<span class="ref-vol">3</span>(6):514-22.</span> [<a href="/pmc/articles/PMC1466931/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1466931</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16338915" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16338915</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>28.</dt><dd><div class="bk_ref" id="article-160730.r28">Morris NS, MacLean CD, Chew LD, Littenberg B. The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. <span><span class="ref-journal">BMC Fam Pract. </span>2006 Mar 24;<span class="ref-vol">7</span>:21.</span> [<a href="/pmc/articles/PMC1435902/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1435902</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16563164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16563164</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>29.</dt><dd><div class="bk_ref" id="article-160730.r29">Lee SY, Bender DE, Ruiz RE, Cho YI. Development of an easy-to-use Spanish Health Literacy test. <span><span class="ref-journal">Health Serv Res. </span>2006 Aug;<span class="ref-vol">41</span>(4 Pt 1):1392-412.</span> [<a href="/pmc/articles/PMC1797080/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1797080</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16899014" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16899014</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>30.</dt><dd><div class="bk_ref" id="article-160730.r30">Shoemaker SJ, Wolf MS, Brach C. Development of the Patient Education Materials Assessment Tool (PEMAT): a new measure of understandability and actionability for print and audiovisual patient information. <span><span class="ref-journal">Patient Educ Couns. </span>2014 Sep;<span class="ref-vol">96</span>(3):395-403.</span> [<a href="/pmc/articles/PMC5085258/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5085258</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24973195" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24973195</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>31.</dt><dd><div class="bk_ref" id="article-160730.r31">Kountz DS. Strategies for improving low health literacy. <span><span class="ref-journal">Postgrad Med. </span>2009 Sep;<span class="ref-vol">121</span>(5):171-7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/19820287" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19820287</span></a>]</div></dd></dl><dl class="bkr_refwrap"><dt>32.</dt><dd><div class="bk_ref" id="article-160730.r32">Sudore RL, Schillinger D. Interventions to Improve Care for Patients with Limited Health Literacy. <span><span class="ref-journal">J Clin Outcomes Manag. </span>2009 Jan 01;<span class="ref-vol">16</span>(1):20-29.</span> [<a href="/pmc/articles/PMC2799039/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2799039</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20046798" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20046798</span></a>]</div></dd></dl></dl></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Kimmy Nguyen declares no relevant financial relationships with ineligible companies.</p></div></dd></dl><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin">
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<b>Disclosure: </b>Letitia Warunek declares no relevant financial relationships with ineligible companies.</p></div></dd></dl></dl></div></div></div><div class="fm-sec"><h2 id="_NBK603742_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">Kimmy T. Nguyen</span><sup>1</sup>; <span itemprop="author">Letitia Warunek</span><sup>2</sup>.</p><h4>Affiliations</h4><div class="affiliation"><sup>1</sup> Wilkes University Nesbitt School of Pharmacy</div><div class="affiliation"><sup>2</sup> Wilkes University Nesbitt School of Pharmacy</div><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">April 15, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2025, StatPearls Publishing LLC.<p class="small">
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This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)
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(<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=uri">
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http://creativecommons.org/licenses/by-nc-nd/4.0/
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</a>), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.
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</p></div></div><h3>Publisher</h3><p><a href="https://www.statpearls.com/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">StatPearls Publishing</a>, Treasure Island (FL)</p><h3>NLM Citation</h3><p>Nguyen KT, Warunek L. Pharmacy Communication Strategies. [Updated 2024 Apr 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobarticle160730table0"><div id="article-160730.table0" class="table"><h3><span class="title">Table 1. Transtheoretical Model of Change</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table0/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table0_lrgtbl__"><table style="width: 700px;" cellspacing="1" cellpadding="10" class="no_top_margin"><tbody><tr style="height: 35px;"><td rowspan="1" colspan="1" style="width: 112px; height: 35px;height: 35px;vertical-align:top;">
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<p><b>Stages of Change</b></p>
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</td><td rowspan="1" colspan="1" style="width: 470px; height: 35px;height: 35px;vertical-align:top;">
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<b>Definitions</b>
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</td></tr><tr style="height: 40px;"><td rowspan="1" colspan="1" style="width: 112px; height: 40px;height: 40px;vertical-align:top;">
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<p>Precontemplation</p>
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</td><td rowspan="1" colspan="1" style="width: 470px; height: 40px;height: 40px;vertical-align:top;">Lack of awareness and acknowledgment of the problematic behavior (no intention to change)</td></tr><tr style="height: 49.4px;"><td rowspan="1" colspan="1" style="width: 112px; height: 49.4px;height: 49.4px;vertical-align:top;">
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<p>Contemplation</p>
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</td><td rowspan="1" colspan="1" style="width: 470px; height: 49.4px;height: 49.4px;vertical-align:top;">Awareness and acknowledgment of the problematic behavior (considering change but without commitment to action)</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 112px; height: 13px;height: 13px;vertical-align:top;">Preparation</td><td rowspan="1" colspan="1" style="width: 470px; height: 13px;height: 13px;vertical-align:top;">
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<p>Acknowledgment of the problematic behavior with a commitment to correcting it (intending to take action and planning approach)</p>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 112px; height: 13px;height: 13px;vertical-align:top;"> Action</td><td rowspan="1" colspan="1" style="width: 470px; height: 13px;height: 13px;vertical-align:top;">Modification of behaviors</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 112px; height: 13px;height: 13px;vertical-align:top;">Maintenance</td><td rowspan="1" colspan="1" style="width: 470px; height: 13px;height: 13px;vertical-align:top;">
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<p>Efforts to prevent relapse and maintain the taken action</p>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 112px; height: 13px;height: 13px;vertical-align:top;">Termination</td><td rowspan="1" colspan="1" style="width: 470px; height: 13px;height: 13px;vertical-align:top;">
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<p>Eradication of the problematic behavior</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobarticle160730table1"><div id="article-160730.table1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table1_lrgtbl__"><table style="width: 800px;" cellspacing="1" cellpadding="8"><tbody><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 155.675px; height: 13px;height: 13px;vertical-align:top;">
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<b>Skills</b>
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</td><td rowspan="1" colspan="1" style="width: 445.325px; height: 13px;height: 13px;vertical-align:top;">
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<b>Explanations</b>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 155.675px; height: 13px;height: 13px;vertical-align:top;">
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<p>Open-ended questions</p>
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</td><td rowspan="1" colspan="1" style="width: 445.325px; height: 13px;height: 13px;vertical-align:top;">
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<p>Encourage patients to share their experiences and perspectives</p>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 155.675px; height: 13px;height: 13px;vertical-align:top;">
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<p>Affirmation of strengths</p>
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</td><td rowspan="1" colspan="1" style="width: 445.325px; height: 13px;height: 13px;vertical-align:top;">Highlights patient strengths, accomplishments, and efforts made toward change</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 155.675px; height: 13px;height: 13px;vertical-align:top;">
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<p>Reflective listening</p>
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</td><td rowspan="1" colspan="1" style="width: 445.325px; height: 13px;height: 13px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Communicates respect for patients and encourages nonjudgmental, collaborative relationships</div></li><li class="half_rhythm"><div>Provides support without necessarily agreeing with specific statements</div></li><li class="half_rhythm"><div>Involves repeating or rephrasing the patient's words to demonstrate active listening</div></li></ul>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 155.675px; height: 13px;height: 13px;vertical-align:top;">Summarization</td><td rowspan="1" colspan="1" style="width: 445.325px; height: 13px;height: 13px;vertical-align:top;">
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<p>Similar to reflective listening. The skill captures the key points of several patient statements to demonstrate active listening, foster a shared understanding, convey comprehension, or seek clarification</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobarticle160730table2"><div id="article-160730.table2" class="table"><h3><span class="title">Table 3. Motivational Interviewing Principles</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table2_lrgtbl__"><table style="width: 800px;" cellspacing="1" cellpadding="8" class="no_top_margin"><tbody><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 151px; height: 13px;height: 13px;vertical-align:top;">
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<b>Principles</b>
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</td><td rowspan="1" colspan="1" style="width: 443.85px; height: 13px;height: 13px;vertical-align:top;">
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<b>Explanations</b>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 151px; height: 13px;height: 13px;vertical-align:top;">
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<p>Express empathy</p>
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</td><td rowspan="1" colspan="1" style="width: 443.85px; height: 13px;height: 13px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Establish a meaningful connection and build rapport</div></li><li class="half_rhythm"><div>Reflect on understanding issues from the patient's perspective</div></li></ul>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 151px; height: 13px;height: 13px;vertical-align:top;">Develop discrepancy</td><td rowspan="1" colspan="1" style="width: 443.85px; height: 13px;height: 13px;vertical-align:top;">Explore discrepancies between current behavior and values or goals</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 151px; height: 13px;height: 13px;vertical-align:top;">Roll with resistance</td><td rowspan="1" colspan="1" style="width: 443.85px; height: 13px;height: 13px;vertical-align:top;">
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<p>Accept the patient's fears and concerns regarding change</p>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 151px; height: 13px;height: 13px;vertical-align:top;">
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<p>Support self-efficacy</p>
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</td><td rowspan="1" colspan="1" style="width: 443.85px; height: 13px;height: 13px;vertical-align:top;">
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<p>Boost patient confidence in their ability to change and offer positive reinforcement</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobarticle160730table3"><div id="article-160730.table3" class="table"><h3><span class="title">Table 4. Common Pitfalls</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table3_lrgtbl__"><table style="width: 800px;" cellspacing="1" cellpadding="8" class="no_top_margin"><tbody><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<b>Pitfalls</b>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">
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<b>Explanations</b>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<p>Expert trap</p>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Avoid the "righting reflex" or the directive impulse,  which is the instinct to correct a patient's understanding or behavior immediately</div></li><li class="half_rhythm"><div>Avoid arguing with the patient</div></li></ul>
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</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<p>Labeling trap</p>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">Avoid labeling patients by their medical conditions, such as diabetic</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<p>Question-and-answer trap</p>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">Avoid having the assessment devolve into an interrogation rather than a conversation</td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<p>Premature focus trap</p>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">Avoid developing plans or actions for change before the patient is ready to commit to change </td></tr><tr style="height: 13px;"><td rowspan="1" colspan="1" style="width: 158px; height: 13px;height: 13px;vertical-align:top;">
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<p>Blaming trap</p>
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</td><td rowspan="1" colspan="1" style="width: 437.975px; height: 13px;height: 13px;vertical-align:top;">Avoid placing blame or judgment on the patient. Instead, prioritize reassuring patients that you are available to listen and support them</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobarticle160730table4"><div id="article-160730.table4" class="table"><h3><span class="title">Table 5. Health Literacy Screening Tools </span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table4_lrgtbl__"><table style="width: 800px;" cellspacing="1" cellpadding="8" class="no_top_margin"><tbody><tr style="height: 68px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 68px;height: 68px;vertical-align:top;">
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<p>Rapid Estimate of Adult Literacy in Medicine (REALM)</p>
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</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 68px;height: 68px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Utilizes 66 everyday terms related to anatomy or illnesses to detect inadequate literacy</div></li><li class="half_rhythm"><div>Typically requires 3 to 6 minutes</div></li><li class="half_rhythm"><div>Commonly used in research studies</div></li><li class="half_rhythm"><div>A shortened version, "REALM-SF," is also available</div></li><li class="half_rhythm"><div>Solely evaluates literacy levels</div></li></ul>
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</td></tr><tr style="height: 68px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 68px;height: 68px;vertical-align:top;">Test of Functional Health Literacy in Adults (TOFHLA)</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 68px;height: 68px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Comprises 50 reading and 17 numeracy items relating to common medical situations</div></li><li class="half_rhythm"><div>Typically requires up to 22 minutes</div></li><li class="half_rhythm"><div>Commonly used in research studies</div></li><li class="half_rhythm"><div>A shortened version, "sTOFHLA," is also  available</div></li><li class="half_rhythm"><div>Assesses both health literacy and numeracy</div></li></ul>
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</td></tr><tr style="height: 54px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 54px;height: 54px;vertical-align:top;">Newest Vital Sign (NVS)</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 54px;height: 54px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Consists of 6 questions focusing on interpreting a standard nutrition label</div></li><li class="half_rhythm"><div>Typically takes 3 minutes</div></li><li class="half_rhythm"><div>Has been tested in primary care settings</div></li><li class="half_rhythm"><div>Assesses health literacy and numeracy</div></li></ul>
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</td></tr><tr style="height: 54px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 54px;height: 54px;vertical-align:top;">Single Item Literacy Screener (SILS)</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 54px;height: 54px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Features a single item prompting patients to rate, on a scale of 1 (never) to 5 (all the time), how frequently they require aid with reading health-related materials</div></li><li class="half_rhythm"><div>Brief to administer</div></li><li class="half_rhythm"><div>Assesses literacy and health literacy</div></li></ul>
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</td></tr><tr style="height: 40px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 40px;height: 40px;vertical-align:top;">Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50)</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 40px;height: 40px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Comprises 50 reading items with reading comprehension elements</div></li><li class="half_rhythm"><div>Assesses health literacy</div></li></ul>
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</td></tr><tr style="height: 27px;"><td rowspan="1" colspan="1" style="width: 169.575px; height: 27px;height: 27px;vertical-align:top;">Patient Education Materials Assessment Tool (PEMAT)</td><td rowspan="1" colspan="1" style="width: 515.425px; height: 27px;height: 27px;vertical-align:top;">Offers a systematic method to evaluate and compare the comprehensibility and usability of printed and audiovisual patient education materials</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobarticle160730table5"><div id="article-160730.table5" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK603742/table/article-160730.table5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__article-160730.table5_lrgtbl__"><table style="width: 800px;" cellspacing="1" cellpadding="8"><tbody><tr style="height: 49px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 49px;height: 49px;vertical-align:top;">
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<p>Using plain, non-medical language</p>
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</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 49px;height: 49px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Avoiding using medical jargon</div></li><li class="half_rhythm"><div>Providing specific explanations</div></li><li class="half_rhythm"><div>Illustrating with examples</div></li></ul>
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</td></tr><tr style="height: 54px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 54px;height: 54px;vertical-align:top;">
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<p>Prioritizing key points</p>
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</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 54px;height: 54px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Limiting information and reinforcing key points to prevent information overload</div></li><li class="half_rhythm"><div>Writing down complex information or providing patient-friendly handouts</div></li></ul>
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</td></tr><tr style="height: 49px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 49px;height: 49px;vertical-align:top;">
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<p>Using visual aids</p>
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</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 49px;height: 49px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Drawing or showing pictures</div></li><li class="half_rhythm"><div>Using placebo devices</div></li><li class="half_rhythm"><div>Explaining and demonstrating skills</div></li></ul>
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</td></tr><tr style="height: 49px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 49px;height: 49px;vertical-align:top;">
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<p>Increasing patient participation</p>
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</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 49px;height: 49px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Encouraging questions</div></li><li class="half_rhythm"><div>Urging patients to bring family members or friends to appointments</div></li></ul>
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</td></tr><tr style="height: 62px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 62px;height: 62px;vertical-align:top;">
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<p>Assessing knowledge and skills</p>
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</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 62px;height: 62px;vertical-align:top;">
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<p>Using the "teach-back" method and correcting any inaccuracies</p>
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</td></tr><tr style="height: 40.2001px;"><td rowspan="1" colspan="1" style="width: 186.062px; height: 40.2001px;height: 40.2001px;vertical-align:top;">Chunking and checking</td><td rowspan="1" colspan="1" style="width: 499.938px; height: 40.2001px;height: 40.2001px;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Breaking down complex topics into manageable sections</div></li><li class="half_rhythm"><div>Assessing knowledge at the end of each section</div></li></ul>
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