Motivational Interviewing and Its Application in Health Promotion

The context in this paper analyzes the case study of Jan, a 40-year-old woman who lives in Queens land town. She is a single mother of two kids and experiences a hard time due to the separation from her husband and the loss of her job. Jan has a family history of cardiovascular disease, but she finds it hard to adapt to behaviors which could minimize her risks to the condition. She is stressed out with her situation, and she is advised to visit a local community health nurse to help her with how she will reduce the risk factors to the heart disease. In this review, the issues to be assessed include the impact of heart condition to the women of Australia, social and behavioral determinants that raise Jan’s risk of the disease, and the principles of motivational interviewing and how they are used in the context of health promotion.

Impact of Cardiovascular Disease in Australian Women

Heart disease is a significant danger to the wellbeing of women of Australia. However, there exists a lack of knowledge of its implications. Notably, the condition is the primary cause of mortality and impairment among women in Australia. Essentially, coronary heart disease is ranked the first amongst the causes of women deaths. According to the Australian Bureau of statistics, in 2007, 61% of Australians who succumbed to a stroke, 60% to heart failure and 47% to coronary heart disease were women (Australian Bureau of Statistics, 2009). A national study of 2004-2005 found that the incidence of this disease was higher in women than men. The population of women who had the disease was 55%. One among the five Australian women has cardiovascular disease as compared to one among six men (Australian Bureau of Statistics, 2006). The prevalence and cost of cardiovascular disease among women in Australia are likely to increase in the future. In 2006, the deaths of women due to cardiovascular disease were at 37%.

 Heart disease is less likely recognized in women than in men. Primarily, this is because women tend to develop the symptoms of the disease at a later stage of the illness. The signs are often not specific, diagnostic tests are less accurate, women do not seek help quickly, and in some instances, health professionals are less likely to check the symptoms in women than in men (NHFA, 2009). Fundamentally, the impact of this disease on women is the loss of life years due to premature deaths, poor health, and disability. The evidence available suggests that the heart disease behaves differently according to the gender. Notably, more women who suffer from the disorder are over 45 years. The cardiovascular disease is seen as a disease for men, and hence women do not think that the condition is relevant to them. Women should be made aware of the symptoms of the disease to avoid its impact when it is already late.

Social determinants that increase Jan’s risk of CVD

Social determinants of wellbeing are responsible for health imbalances between different groups of people. There has been an establishment of the effect of economic advancement and social management on individuals’ wellbeing over the past years. The existence of some risk factors associated with cardiovascular disease is rising globally, and hence it is necessary to focus on those social determinants to clear the existing gap in the occurrence of the disease (World Health Organization, 2010). Jan’s risk of heart disease is due to social determinants surrounding her. She lives in a rural area. Further, she is a single mother who recently separated from her husband. She is also currently unemployed and therefore her income flow is very tight.

Cardiovascular disease is bound to increase globally due to the increased population, increasing life expectancy, and the changes in the economic, social and cultural sectors which have resulted to increase in heart disease risk elements such as the use of tobacco, high blood pressure, diabetes, and obesity (Kreatsoulas & Anand, 2010). Essentially, when analyzing the risk factor prevalence rates of cardiovascular disease concerning income, people of lower socioeconomic status are more susceptible to the heart disease as compared to their counterparts from high socioeconomic status. People in low-income societies, the risk factor prevalence rates are high because the individuals are more exposed to factors such as tobacco use that show as diabetes, obesity, hypertension or dyslipidemia. Those people who are socioeconomically deprived are less likely to acquire quality health care services, advanced therapies and information on awareness on how to modify the risk factors. As a result, the mortality rates in these groups continue increasing. CVD risk factors are also expected to increase due to ethnicity. Majorly, this is due to the variations in geography, education and lifestyle position among different people. Age and gender are also significant social determinants that increase the heart disease risk factors.

            Behavioral determinants that increase Jan’s risk of CVD

     Different behaviors among populations determine their vulnerability to heart disease. According to a report by the inter heart study, some modifiable risk factors increase the risk of heart diseases. They include smoking, high blood pressure, abnormal lipids, diabetes, psychosocial factors, and obesity, regular consumption of alcohol, fruits, and vegetables (Gillison et al., 2012). Those modifiable risk factors and unhealthy lifestyle behaviors are the primary determinants of CVD mortality and morbidity. Jan has a family history of heart disease, she has irregular exercising routines, follows unhealthy eating behaviors and she has a lot of stress due to her situation. All these behaviors put her at risk for heart disease.

         According to various studies, people perceive stress as the primary factor triggering their risk factors for heart diseases. Stress affects a person's physical activity, diet, and compliance with medication (Andric & Vuletic, 2012). There are psychosocial sources of stress such as unemployment, divorce, less income and family issues which catalyze the risks to cardiovascular diseases. Knowledge, understanding, and attitudes influence peoples' behaviors (World Health Organization, 2011). Radically, people with a good understanding and positive attitude towards physical activity and a healthy diet are more motivated to continue with such behaviors. There are others who lack the knowledge of how the various risk factors influence the danger of heart disease. Such people are unlikely to adopt appropriate actions which will not put them at risk. Perceived susceptibility and severity of cardiovascular diseases among different individuals results in the adoption of healthy behaviors among them. Also, perceived benefits are believed to alter strongly behavioral changes especially in areas of physical activity, diet and stress management. Maintenance of self-efficacy is the essential predictor of behaviors such as physical activities and healthy dietary.  People should be confident in being able to hold onto challenging behaviors and look forward to putting up with the impending barriers surrounding them to eliminate risk factors for heart diseases.

Principles of Motivational Interviewing and Their Use in the Context of Health Promotion

        Motivational interviewing is an interpersonal orientation which is a client-centered counseling approach which is manifested through particular techniques and strategies. Primarily, the goal of motivational interviewing is to help people work through their ambivalence regarding the behavioral change. It is specifically efficient for individuals who are low concerning their readiness to change. Majorly, the spirit of motivational interviewing consists of a collaborative relationship between nurses and patients. Nurses are capable of exploring the understanding of patients, their motivation, confidence, and hindrances to change.

                The spirit of motivational interviewing is based on four key factors which are collaboration, empathy, acceptance, and compassion (Chen, Creedy, Lin & Wollin, 2012). Collaboration involves building a rapport and facilitating trust in the assistance relationship especially if it is a hierarchical one. Although the practitioner and the client may view things differently, the process is focused on a mutual understanding. Expressing empathy consists of using reflective listening to portray nonjudgmental and accepting attitude. Acceptance allows the clients to give in and believe that they need to change. Compassion enables the promotion of the welfare of the client and giving priority to their needs.  

 The core skills of motivational interviewing in health promotion include asking open-ended questions that result to further clarification and viewing, affirmations which promote positive feelings, reflections that show that the practitioner understood the client, and summaries which generate interest in developing changes (Miller & Rollnick, 2013). Also, motivational interviewing involves four critical processes in health promotion. Engaging put the client and the practitioner in a collaborative relation using the OARS. Focusing maintains a unique direction of the conversation towards the change of goals. Evocation involves the practitioner drawing out the client’s motivation and skills for their willingness to change without telling them what to do or what should be done. Finally, planning ensures that the desired change is met.

Conclusion

The report analyzes that Jan is at high risk of cardiovascular disease due to the risk factors surrounding her. Primarily, the impact of this disorder is fatal, especially to Australian women. They are not aware of this threat since it is highly considered to be a problem for men. Many women disregard the symptoms of this disease, and thus the highest rates of morbidity and mortality due to this disease. The social and behavioral determinants highlighted above influence the risk factors linked to heart diseases, and hence they should be modified to eliminate the disorder. For individuals like Jan who are at risk of a chronic illness like cardiovascular disease, motivational interviewing is necessary for helping them to work through their ambivalence concerning behavioral change. Adopting appropriate lifestyle and modifying the social determinants of risk factors associated with heart diseases, the prevalence and death rates will reduce.

References

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