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Practice Applications Topics of Professional Interest| Volume 113, ISSUE 5, P626, May 2013

Interviewing Clients and Patients: Improving the Skill of Asking Open-Ended Questions

Published:February 09, 2013DOI:https://doi.org/10.1016/j.jand.2013.01.002
      Years of observations of nutrition counselors conducting open discussions with clients reveal that asking effective open-ended questions is a limiting factor during these exchanges.
      • Nestor B.
      • McKenzie J.
      • Hasan N.
      • et al.
      Client satisfaction with the nutrition education component of the California WIC program.
      • AbuSabha R.
      Client-Centered Nutrition Education Intervention Fit WIC Final USDA Report.
      Educators and counselors are aware of the nature of open-ended questions, which usually begin with who, what, when, where, why, and how. They avoid simple, limited “yes” or “no” responses and are often used to initiate conversation. By providing the opportunity to reflect and engage in conversation, such questions elicit opinions and rich descriptions of experiences. Open-ended questions are often used by psychotherapists to encourage patients to share relevant information.
      • Yalom I.D.
      • Leszcz M.
      The Theory and Practice of Group Psychotherapy.
      Use of effective open-ended questions is the cornerstone of motivational interviewing technique, which uses discussion to help guide clients to overcome ambivalence and move toward behavior change.
      • Rollnick S.
      • Miller W.R.
      • Butler C.C.
      Motivational Interviewing in Health Care: Helping Patients Change Behavior.
      Motivational interviewing and open discussion techniques are increasingly being used by nutrition educators and registered dietitians to effect behavior change in their clients.
      • Constance A.
      • Sauter C.
      Inspiring and Supporting Behavior Change: A Food and Nutrition Professional's Counseling Guide.
      • Mahan K.
      • Escott-Stump S.
      • Raymond J.L.
      Krause's Food & Nutrition Care Process.
      • Flattum C.
      • Friend S.
      • Story M.
      • Neumark-Sztainer D.
      Evaluation of an individualized counseling approach as part of a multicomponent school-based program to prevent weight-related problems among adolescent girls.
      • Spahn J.M.
      • Reeves R.S.
      • Keim K.S.
      • et al.
      State of the evidence regarding behavior change theories and strategies in nutrition counseling to facilitate health and food behavior change.
      In outpatient settings, facilitating support groups with open discussion to manage conditions, such as overweight and diabetes, is common,
      • Nonas C.A.
      • Foster G.D.
      Managing Obesity A Clinical Guide.
      • Livhits M.
      • Mercado C.
      • Yermilov I.
      • et al.
      Is social support associated with greater weight loss after bariatric surgery?.
      • Ramadas A.
      • Quek K.F.
      • Chan C.K.
      • Oldenburg B.
      Web-based interventions for the management of type 2 diabetes mellitus: A systematic review of recent evidence.
      whereas in inpatient and community settings, more targeted participant-centered interviewing techniques are often recommended.
      • Mahan K.
      • Escott-Stump S.
      • Raymond J.L.
      Krause's Food & Nutrition Care Process.
      • Sigman-Grant M.
      Facilitated Dialogue Basics: A Self-Study Guide for Nutrition Educators.
      • Smith R.C.
      • Dwamena F.C.
      • Grover M.
      • et al.
      Behaviorally defined patient-centered communication—A narrative review of the literature.
      The success of these approaches to counseling is largely dependent on using the correct type of open-ended questions.
      • Example of a poor question: “What foods that you normally eat are high in calcium?”
      • Example of a better question: “How do you make sure that you are getting enough calcium in your diet?”
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