Table 3 Motivational interviewing protocol demonstrating how the MI principles were upheld in the health professional consultations

Autonomy

The participant was encouraged to set or revise their own dietary and physical activity strategies with the guidance of the health professional, including developing and revising six specific, measurable, achievable, realistic and timely (SMART) dietary and exercise goals, negotiating a change plan and setting the agenda.

Collaboration

The health professional avoided advice giving and only provided advice when requested by the participant or after consent to provide advice had been sought (E.g. “would you like me to give you a suggestion of what has worked for other people in a similar situation to you?”). The participant’s permission was also sought when discussing the importance of and options for monitoring weight, diet and physical activity, helping to facilitate a productive discussion.

Evocation

The health professional asked the participant to explain what they value in life and how these values may help to boost motivation “Think about all aspects of your life and tell me the characteristics that are most important to you?” (E.g. my family). “What is it about those aspects of your life that you value?” (E.g. I enjoy spending time with my grandchildren). “How might the values you mentioned help motivate you to make changes to diet and exercise behaviours?” (E.g. I need to improve my health to make sure I am here to see them grow-up). The participant was asked to report how important weight control is to them. “On a scale of 1 to 10, with 1 being the lowest and 10 being the highest, how important is weight control to you?”. “What made you choose a 7 and not a lower number?” (E.g. I chose 7 because I value my health and fitness levels and I know that weight control is important for these). “What would it take to bump you up a few notches to a number 9?” (E.g. If I had a health complication).

Roll with resistance by avoiding arguments and confrontation

Shifting the focus (“I can hear that your drinking is not something you would like to talk about now. Is there something else you would like to talk about with the time we have today?”).

Express empathy by accepting the clients perspective without judging or criticising

Through the use of reflections such as “that must have been very difficult for you”.

Develop discrepancy between current behaviour and desired goals and values

Participants were asked to identify their desired goals and values during the consultation and were then asked to describe their current behaviour. The participant was encouraged to identify the discrepancy between their current behaviour and their desired goals.

Supporting self-efficacy and fostering a belief that a change is possible may increase confidence levels and increase motivation

Participant confidence was enhanced by exploring and drawing on client strengths and past successes with weight control and other difficult times in their life and the strategies they used to overcome the adversity. Participants were also asked to report on their confidence to make a change using a 10-point Likert scale. Barriers to change and strategies to overcome these barriers were identified.