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"I was bad." Morality in Dietary Case-Taking: A Conversation Analytic Study
Heidi M Meyer1, Sjaan R Gomersall1,2, Denis Y Giguere3
1Health and Wellbeing Centre for Research Innovation, School of Human Movement and Nutrition Sciences, The University of Queensland.
Health Communication
|June 1, 2026
Summary
Dietitians can improve type 2 diabetes management by using motivational interviewing (MI) to explore client behaviors. This communication approach helps address moralistic disclosures and self-deprecation, fostering positive dietary changes.
Area of Science:
- Behavioral Science
- Clinical Nutrition
- Health Communication
Background:
- Diet is crucial for managing chronic diseases like type 2 diabetes.
- Motivational Interviewing (MI) is recommended for dietary behavior change but its real-world application is unclear.
- Understanding how dietitians use communication in practice is essential.
Purpose of the Study:
- To examine the use of motivational interviewing (MI) in dietitian-client consultations for type 2 diabetes.
- To analyze communication during dietary case-taking and its impact on behavior change discussions.
Main Methods:
- Video-recorded analysis of 20 dietitian-client consultations in an Australian community healthcare clinic.
- Conversation analysis was used to examine communication patterns during dietary history-taking.
Main Results:
- Clients often expressed moralistic views on food and self-deprecating behavior.
- Dietitians frequently responded with questions, admonishments, or reassurances, rather than exploring underlying reasons.
- One case demonstrated MI-consistent communication, leading to behavior exploration and action planning.
Conclusions:
- Dietitians have a significant opportunity to utilize motivational interviewing (MI) to guide dietary behavior change.
- MI can effectively address client moralizing and self-criticism, promoting better health outcomes.
- Enhanced communication skills can improve the effectiveness of dietary interventions for type 2 diabetes.
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