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T.27 Motivational Interviewing

Motivational Interviewing (MI) is an approach to interpersonal communication between community members and hygiene promoters that identifies people’s strengths, aspirations and autonomy in order to motivate them to take action on hygiene. It emphasises listening and asking questions so that people can identify their own solutions for improving hygiene.

The four key principles used for MI are summarised in the acronym RULE: Resisting the urge to tell people what to do; Understanding that the individual must want to change for their own reasons rather than those of the facilitator; Listening and drawing out solutions to the problem rather than presenting ready-made solutions; Empowering the individual to take action if they are able. The role of the facilitator is to affirm and summarise what has been said and enable people to stand back and look at an issue more objectively. MI employs four key techniques: (1) Open-ended questions, (2) Affirmations, (3) Reflective listening and (4) Summaries. This approach can be useful for communicating hygiene issues such as handwashing or household water treatment with individuals or groups but can be adapted for any interaction where change is sought. MI tools can help develop interpersonal communication skills. It can also encourage hygiene promoters to be less didactic in their approach. Training and practice are necessary to develop the skills but the main principles and techniques can be learned and practised by all hygiene promoters.


This approach to communication can be used in all contexts and phases. The principles can be easily learned. Skills improve through practice and use in real-world situations. It can be scaled up rapidly.


  • Listen closely and ask people questions about what prevents or helps them to take action

  • Be empathetic and put yourself in the other person’s shoes

  • Periodically summarise and reflect what has been said and ask if they agree

  • Encourage people to define actions they can carry out and agree on what happens next


  • Do not tell people what to do, impose your solutions on others or offer un-asked for advice 

  • Do not argue or be confrontational 

  • Do not act as if you are an expert

Practical Example

There is limited documented use of MI in the WASH sector although it has been used in several research studies, e.g. in Zambia and elsewhere to promote handwashing. In one of the Zambian studies, health volunteers were trained in MI and made Household Visits T.18 to encourage the use of a household water treatment. Rates of purchase of the promoted disinfectant were much higher in the MI group than in the control group; the rates sustained over the eight months of sales monitoring. In another study, health volunteers visited households every four weeks; evaluation revealed a 16-fold increase in chlorine residuals in the MI group (65%) compared to the group exposed to health education alone (4%).

Key Decision Critria

Response Phase
Acute Response
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Protracted Crisis
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HP Component
Preconditions and Enabling Environment
Community Engagement and Participation
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Assessment, Analysis and Planning
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Social and Behaviour Change
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Monitoring, Evaluation, Accountability and Learning (MEAL)
Target Group
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Older People
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Persons with Disabilities
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Local Leaders
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Society as a whole
Application Level
Individual / Household
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Community / Municipality
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Guidance on MI theory and practice incl. details about how to use numerous tools to support MI

Fuller, C., Taylor, P (2008): A Toolkit of Motivational Skills. Encouraging and Supporting Change in Individuals, John Wiley and Sons. ISBN 978-0-470-51658-4

Research paper on use of MI in promoting household water treatment

Thevos, A., Olsen, S. et al. (2002): Social Marketing and Motivational Interviewing as Community Interventions for Safe Water Behaviors: Follow-up Surveys in Zambia, International Quarterly of Community Health Education. Vol. 21, Issue 1