Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Surg Obes Relat Dis. 2012 Sep-Oct;8(5):514-21. doi: 10.1016/j.soard.2012.05.002. Epub 2012 May 4.
Limited adherence to healthy habits in adults at risk of lifestyle diseases, some of whom become candidates for bariatric surgery, has been paralleled by high rates of nonadherence to postbariatric surgery behavioral recommendations. This is a specific case of the more general problem of nonadherence to medical treatment of chronic conditions. An adequate understanding of the problem of nonadherence requires an understanding of the motivational factors that influence whether persons implement healthy behavior. Motivational interviewing is an empirically supported counseling style for strengthening a person's own motivation and commitment to change. It offers a model for understanding and intervening with nonadherence to behavioral recommendations that emphasizes the role of clinician communication in both increasing and inadvertently decreasing patient motivation. A conceptual account of patient motivation for healthy change, highlighting the centrality of resolution of patient ambivalence through targeted conversation, is illustrated by thought exercises for the reader and supplemented by references to empirical data. Recommendations for changes in clinical practice to improve patient adherence to behavioral recommendations are also offered.
在有生活方式疾病风险的成年人中，健康习惯的坚持程度有限，其中一些人成为减重手术的候选人，而手术后行为建议的坚持程度也很高。这是更普遍的慢性疾病治疗不依从问题的一个具体案例。要充分理解不依从问题，就需要了解影响个人实施健康行为的动机因素。动机性访谈是一种经过实证支持的咨询方式，可增强个人改变的内在动力和承诺。它为理解和干预行为建议的不依从提供了一个模型，该模型强调临床医生沟通在增加和无意中降低患者动力方面的作用。通过为读者提供思维练习，并参考实证数据，本文以阐明患者健康改变动机的概念性说明为例，重点介绍了通过有针对性的对话解决患者矛盾心理的核心作用。本文还为改善患者对行为建议的依从性提出了临床实践的改变建议。
