Motivational Interviewing: the skill that transformed my UX Research practice
Learn more about this important clinical technique in this 4 part series! Part I: Exploring open-endedness.
Years ago, in what feels like a previous life, I was a qualitative and community health researcher at a nationally recognized cancer center. Before I started here at Marketade, the majority of my career was dedicated to the medical and nonprofit industry. I loved the idea of working at the intersection of behavior and medicine. At the time, it seemed like one of the most underrated aspects of healthcare. It still does in some way, but over the course of the years, I’ve noticed it gaining traction among insurance and healthcare providers.
A major benefit working at a cancer center is access to pioneers in the field, and their knowledge of technical skills that they are willing to share. One of the most important things I’ve learned in my career is the Motivational Interviewing technique. This technique was developed by William Miller and Stephen Rollnick for use in therapeutic settings. Over the years, it has been refined and repurposed to help countless people manage addiction, eating disorders and a host of conditions that require patients to make dramatic behavioral changes and stick to them over time. While we rarely get the opportunity to foster those kinds of changes as UX researchers, the crux of motivational interviewing stands to help us work with participants, especially in the generative phases of research.
In this series, I want to talk about the Motivational Interviewing technique itself, and how some of the core principles have helped me practice the kind of UX I care about — one in which we capture the full range of the user experience and use that to create more equitable products and services. The first article will be an introduction to Motivational Interviewing and its core tenets. The following articles will break down each component of motivational interviewing, with a focus on how I have applied them in my UX practice.
What is Motivational Interviewing?
Motivational Interviewing is a technique that taps into individuals' core intrinsic motivations through continually reflecting and affirming what they already know about themselves.
For example, imagine you are friends with someone and they are a heavy smoker. You understand the health risks associated with smoking, so as a good friend, you want to persuade them to quit. Naturally, you begin to share all the information about smoking risks and even some cessation ideas. Your friend is smart, understands the risks and acknowledges your concern. Inevitably, what happens?
Your friend continues to smoke.
You think to yourself, why in the world would someone continue to smoke after all this information about how damaging it is? Because, as it turns out, education does not always yield behavior change. Neither does telling someone they need to change. They may agree with you, but that doesn’t necessarily mean that they feel compelled to act.
This is where Motivational Interviewing is an important departure from more traditional methods. Instead of adopting a position in which you educate your friend, you simply talk with your friend about why they smoke. And after a while, they’ll likely start talking about their motivations to cope. Soon after, they’ll begin to talk about wanting to change their behavior — either smoking less, or quitting altogether. Instead of giving them information on how to change, you wait until they begin to talk about it themselves. Once they do, your role is to recognize and affirm their strategies. Over time, your friend arrives at a solution themselves and guess what? They stick to it.
More often than not, the more you push people to change, the more it tends to make them feel dis-empowered and sometimes shameful. If you’re familiar with Brene Brown, she’s conducted some of the most comprehensive research to date on how shame discourages growth and change. Suffice it to say that external pressure is rarely an effective behavioral solution in the long term. Intrinsic motivations endures because it is not subject to the whims of the external world. And that’s really what Motivational Interviewing is about — centering the participant as the authority of their own experience. You can read more of my thoughts on that, if you’re curious.
What does Motivational Interviewing have to do with UX?
Since motivational interviewing is designed to encourage people to arrive at solutions on their own, those benefits are transferable to UX Research. Our job is to elicit genuine feedback from users to understand how they interact with a product, service, and software systems. Using the core tenets that we will explore over the course of this series, we will examine the ways in which motivational interviewing helps us enter into an authentic interaction with our participants and enables users to arrive at their own conclusions.
What are the core tenets of Motivational Interviewing?
The core tenets of Motivational Interviewing can be seen in the graphic below. As you can see, OARS is a helpful way to remember all of these elements. In the first article, we will explore “open-ended questions.” We will define the construct and examine its usefulness during UX research.
Open-ended questions
An open-ended question is a question that invites more than a simple yes or no as an answer. For example, if I want to know how your day went, I can ask you with a closed ended question:
Did you have a good day?
Or, an open-ended question:
How was your day?
The former requires only a yes or no answer. More importantly,the former requires the person to think in an either/or dichotomy — a way of thinking that is the antithesis of our practice as UX researchers. People can have frustrating days. People can have days that start off well and end terribly. People can feel good and bad at the same time. In truth, there are rarely instances over the course of a day that fit neatly into opposing categories. Asking people a closed-ended question requires them to divide and compartmentalize their experience into a false dichotomy and in turn, only surfaces a one-dimensional glimpse of information.
Collapsing information in such a way only does us a disservice as UX practitioners. Learning to ask open ended questions is a valuable addition to a UX Research toolkit, and likely one with which we’re all familiar to some degree. However, I argue that this technique is really about keeping us in the right frame of mind as much as it is about best practices in UX research.
Transform your open ended questions into an open ended approach
Open ended questions help users think about their own behaviors and motivations in expansive and holistic ways. As I’ve practiced qualitative research over the years, I’ve noticed that open ended questions really embody something more — they are the direct result of having a beginner’s mind. When we are curious and unassuming, the natural consequence are questions that foster a mutual understanding. To ask open ended questions, it’s first important to understand what they are. In order to apply the technique, it’s important to be “open ended” ourselves.
If I may be so bold, I think that we can transform the notion of open ended questions into an open ended approach. By that I mean, we don’t particularly care if something is good, bad, terrible, useless — we care why it’s terrible and in what context it is useless. Terrible for one person may be amazing for the next. Or, if something is terrible, that doesn’t necessarily mean that removing it improves the product experience.
For instance, in one of our recent projects, my team and I are trying to understand how Black and Latinx individuals feel about clinical trial registration. Specifically, we are trying to understand what they experience when we ask for demographic data in the context of clinical trials registration.
If we opted for a closed-ended approach, we would show them a design and ask them if they like it. From there, users would likely come up with a laundry list of qualities that irritate them. The problem with this approach is that a laundry list of things users hate rarely gives you insight into how changing what they don’t like will affect their behavior and interaction with a specific feature. We’re only capturing a piece of experience — the parts they don’t like. Experience is much more than what users like and don’t like about your product or service.
Instead, we opt for an open-ended approach. We talk to users about how they feel about having certain elements included in our design. We talk to them about what asking for race and ethnicity means to them. We ask them how they approach and answer race/ethnicity in other forms outside of healthcare, and if their approach changes when answering medical forms.
Notice the difference. An open-ended approach yields a baseline on users’ current behaviors so that we understand their current way of thinking and behaving and meet them where they are. Instead of knowing whether or not users like or dislike us asking for race, using an open ended approach, we learn how asking for race/ethnicity information affects Black and Latinx individuals and why they answer or avoid answering these questions on medical forms. From there, we can come up with solutions that consider this context and ultimately improve the experience.
If we don’t understand the why behind the what, our practice is useless. And truly, this is the heart of open-ended questions. The technique comes naturally when we commit ourselves to adopting an open-ended approach.
Building on an open-ended approach
Exploring an open-ended approach is a way for UX researchers to hold space for our users to articulate all the motivators, emotions and feelings that comprise experience. The practice gives us considerable insight into the context behind their experience, and creates new opportunities to think about our products from the perspective of our users. Asking open-ended questions and adopting an open-ended approach paints a richer portrait of who our users are, why they behave in certain ways and the context in which they interact with a product or service. This holistic view equips us with better data to design products or services for users as they are right now — not where we think they are or should be.
Understanding open-ended questions, and an open-ended approach, lays the groundwork for the next construct in the series: affirmation. In the next article, we will explore what affirmation is (spoiler alert: it’s not false flattery!) and the ways in which affirmation can foster an equitable and safe environment for sharing information.
Thanks for reading! If you have used this technique, or are curious about it, I’d love to hear from you!
