Abstract: The transformation of "medical advice" into "health behaviors" is a core challenge in primary care chronic disease management, as traditional one-way communication often fails to adequately address the difficulties patients face in maintaining behavioral changes in real life. Motivational Interviewing (MI) provides a significant framework for addressing this issue; however, existing MI practices are mostly implemented in research settings with relatively ample time, which creates a disconnect from the reality of Chinese primary care clinics characterized by short consultation times and heavy workloads. Based on this, this paper employs narrative literature review and theoretical integration analysis, combined with examples of primary care doctor-patient communication, to concretely explain the technical system of MI. This includes change talk and sustain talk, the four core foundational skills, the four stages of a session, the "relational-technical" dual-path mechanism model, and the four pillars of the MI spirit. Furthermore, based on an analysis of typical service scenarios and the longitudinal nature of primary care services, three adaptation strategies are proposed: capturing "MI moments" in daily outpatient clinics to embed "light-weight MI"; establishing "mini-MI" closed-loops during family doctor contract follow-ups; and promoting the shift of health education from "one-way preaching" to "group motivation stimulation," aiming to provide a reference for the practical implementation of MI in primary care chronic disease management. Future research should focus on advancing the construction of localized lightweight and mini-MI techniques, developing stratified and categorized MI training systems, and improving institutional supports and localized fidelity assessment tools to support the routine implementation of MI.

Key words: Motivational interviewing, Primary healthcare services, Chronic disease management, Healthcare provider-patient communication, Health behavior change

摘要： “医学建议”向“健康行为”转化是基层慢性病管理的核心难题，传统单向沟通难以充分回应患者在现实生活中的行为维持困境。动机式访谈（MI）为解决这一问题提供了重要思路，但现有MI多在时间相对充足的研究场景中实施，与中国基层门诊时间短、任务重的真实情境存在一定脱节。基于此，本文采用叙述性文献综述与理论整合分析方法，结合基层医患沟通示例，具象化阐释MI的技术体系，包括改变语句与持续语句、四项核心基础技能、会谈的四个阶段、“关系—技术”双路径的作用机制模型及MI四大精神。进而，基于服务典型场景分析，结合基层服务连续性特征，提出三类适配策略：在日常门诊中捕捉“MI时刻”，嵌入“轻量化MI”；在家庭医生签约随访中设置“微型MI”闭环；推动健康教育由“单向宣教型”向“团体动机激发型”转变，以期为MI在基层慢性病管理中的实践落地提供参考。未来研究可关注在推进本土化轻量及微型MI技术构建，开发分层分类的系统化培训体系，并完善支持MI常规实施的制度保障与本土化保真度评价工具。

关键词: 动机式访谈, 基层卫生服务, 慢性病管理, 医患沟通, 健康行为改变