Application of Motivational Interviewing in Healthcare Provider-Patient Communication for Chronic Disease Management in Primary Care: from Principles to Practice

doi:10.12114/j.issn.1007-9572.2026.0117

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (31): 4536-4542.DOI: 10.12114/j.issn.1007-9572.2026.0117

Special Issue: 社区卫生服务最新研究合辑

• Methodology Series in Chinese General Practice Medicine (Ⅱ) • Previous Articles Next Articles

Application of Motivational Interviewing in Healthcare Provider-Patient Communication for Chronic Disease Management in Primary Care: from Principles to Practice

1. School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2. Bao'an Central Hospital of Shenzhen, Shenzhen 518000, China
3. Department of Women Healthcare, Guangdong Women and Children Hospital, Guangzhou 511442, China

Received:2026-07-01 Revised:2026-08-05 Published:2026-11-05 Online:2026-10-10
Contact: KUANG Li
About author:
^★Member of the Motivational Interviewing Network of Trainers (MINT)

动机式访谈在基层慢性病管理医患沟通中的应用：从原理到实践

1．510080　广东省广州市，中山大学公共卫生学院
2．518000　广东省深圳市宝安区中心医院
3．511442　广东省广州市，广东省妇幼保健院妇女保健部

通讯作者: 匡莉
作者简介:
^★动机式访谈培训师国际网络（MINT）会员
作者贡献：
匡莉负责研究统筹和论文撰写，对文章整体负责；丁欣欣负责部分文献检索和部分文献阅读，参与动机式访谈技术体系和基层服务典型场景分析的内容讨论；马远珠负责部分文献阅读，参与动机式访谈技术体系部分的内容讨论。
基金资助:
国家自然科学基金资助项目(71673311)

Abstract

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

CLC Number:

R 197　R 395

KUANG Li,DING Xinxin,MA Yuanzhu. Application of Motivational Interviewing in Healthcare Provider-Patient Communication for Chronic Disease Management in Primary Care: from Principles to Practice[J]. Chinese General Practice, 2026, 29(31): 4536-4542. DOI: 10.12114/j.issn.1007-9572.2026.0117.
匡莉,丁欣欣,马远珠. 动机式访谈在基层慢性病管理医患沟通中的应用：从原理到实践[J]. 中国全科医学, 2026, 29(31): 4536-4542. DOI: 10.12114/j.issn.1007-9572.2026.0117.

Figures/Tables 1

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沟通回合	传统"宣教—建议—劝说"沟通风格	动机式访谈沟通风格
开场	医：你的血糖还是控制得不行，今天空腹又是9.8，太高了患：最近有点乱吃，控制不住嘴……	医：今天空腹血糖是9.8，你是怎么看待这个结果的？（开放式提问）患：最近有点乱吃，控制不住嘴……（持续语句）
回应困难	医：你这样下去肯定会出问题的，糖尿病不是说说而已，会伤眼睛、伤肾、还可能截肢患：嗯……我知道……	医：听起来你也注意到饮食上有些难度。你以前有没有试过什么方法，让自己更好控制血糖？（反映性倾听+开放式提问）患：有段时间我把晚饭的米饭换成杂粮，血糖就降了点。就是后来又懒了……（改变语句+持续语句）
回应矛盾	医：你就是太不重视了！我上次就提醒过你饮食要控制、要运动、要按时吃药患：我有在吃药，就是有时候忘了	医：你调整主食时血糖有改善，说明你是有办法的。你说"懒了"，可能也和工作累、没力气有关（肯定+深层反映）患：对，下班回到家就懒得动，不太想管吃的（持续语句）
确立焦点	医：吃药不能忘，血糖不稳就是这么来的！你有没有每天坚持走路？运动也不做，药也吃不稳，那怎么控制血糖？患：有时候下班太晚，就没动……	医：你平时挺辛苦的，晚上还想着健康，已经很不容易了。你觉得饮食、运动、吃药里，现在最想从哪一块开始调整？（肯定+聚焦）患：吃药应该不难，我只是有时候忘记吃……（能力型改变语句）
唤出动机	医：借口不能当饭吃。你不动起来，血糖怎么降？下次再来还这样，我只能考虑把你的药加上去患：唉……	医：你接受吃药这件事了，只是需要点提醒（反映性倾听+重构）患：对，我在想能不能设个手机提醒（启动型CT）
形成计划	医：你现在开始就要严格地动起来。第一，每天快走30分钟；第二，少吃米饭、面条，多吃青菜；第三，药必须按时吃。这几点你记住了吗患：……好，我尽量吧	医：好主意，很实用，能帮你更稳地管理血糖。你已经想好了第一步。如果以后想聊饮食或运动，随时可以说，你自己决定节奏就好（摘要+尊重自主性）患：可以先从吃药开始，运动等我状态调整一下再说（启动型改变语句+愿望型改变语句）医：很好，从自己最有把握的地方开始，这种安排很成熟（肯定）

沟通回合	传统"宣教—建议—劝说"沟通风格	动机式访谈沟通风格
开场	医：你的血糖还是控制得不行，今天空腹又是9.8，太高了患：最近有点乱吃，控制不住嘴……	医：今天空腹血糖是9.8，你是怎么看待这个结果的？（开放式提问）患：最近有点乱吃，控制不住嘴……（持续语句）
回应困难	医：你这样下去肯定会出问题的，糖尿病不是说说而已，会伤眼睛、伤肾、还可能截肢患：嗯……我知道……	医：听起来你也注意到饮食上有些难度。你以前有没有试过什么方法，让自己更好控制血糖？（反映性倾听+开放式提问）患：有段时间我把晚饭的米饭换成杂粮，血糖就降了点。就是后来又懒了……（改变语句+持续语句）
回应矛盾	医：你就是太不重视了！我上次就提醒过你饮食要控制、要运动、要按时吃药患：我有在吃药，就是有时候忘了	医：你调整主食时血糖有改善，说明你是有办法的。你说"懒了"，可能也和工作累、没力气有关（肯定+深层反映）患：对，下班回到家就懒得动，不太想管吃的（持续语句）
确立焦点	医：吃药不能忘，血糖不稳就是这么来的！你有没有每天坚持走路？运动也不做，药也吃不稳，那怎么控制血糖？患：有时候下班太晚，就没动……	医：你平时挺辛苦的，晚上还想着健康，已经很不容易了。你觉得饮食、运动、吃药里，现在最想从哪一块开始调整？（肯定+聚焦）患：吃药应该不难，我只是有时候忘记吃……（能力型改变语句）
唤出动机	医：借口不能当饭吃。你不动起来，血糖怎么降？下次再来还这样，我只能考虑把你的药加上去患：唉……	医：你接受吃药这件事了，只是需要点提醒（反映性倾听+重构）患：对，我在想能不能设个手机提醒（启动型CT）
形成计划	医：你现在开始就要严格地动起来。第一，每天快走30分钟；第二，少吃米饭、面条，多吃青菜；第三，药必须按时吃。这几点你记住了吗患：……好，我尽量吧	医：好主意，很实用，能帮你更稳地管理血糖。你已经想好了第一步。如果以后想聊饮食或运动，随时可以说，你自己决定节奏就好（摘要+尊重自主性）患：可以先从吃药开始，运动等我状态调整一下再说（启动型改变语句+愿望型改变语句）医：很好，从自己最有把握的地方开始，这种安排很成熟（肯定）

Application of Motivational Interviewing in Healthcare Provider-Patient Communication for Chronic Disease Management in Primary Care: from Principles to Practice

动机式访谈在基层慢性病管理医患沟通中的应用：从原理到实践

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