"I was bad." Morality in Dietary Case-Taking: A Conversation Analytic Study

Diet is a key modifiable health behavior for mitigating and managing chronic disease, including type 2 diabetes. Dietitians use a range of communication approaches, such as motivational interviewing (MI), to support dietary behavior change. Professional associations recommend MI in their guidelines; however, its application in real-world settings is unknown. Furthermore, little is known about how dietary behavior change talk (e.g. MI) is operationalized in clinical practice. This study examined how MI was used in the dietary case-taking phase of one-to-one dietary behavior change consultations between dietitians and clients at risk of, and living with, type 2 diabetes. Twenty dietitian-client consultations were conducted in a community healthcare clinic in Australia and were video-recorded and analyzed with conversation analysis. During dietary history-taking, clients often adopted a moralistic stance toward food and engaged in self-deprecation when describing their dietary behavior. In response, the dietitian offered several response types. Typically, the dietitian responded with interrogative question sequences, admonishment, reassurance, or assessments of clients' dietary behavior rather than exploring the underlying reasons for the behaviors, leading to confusion about whether dietary behavior change was required. In one case, the dietitian used communication practices that reflected MI, resulting in exploration of clients' behaviors and the development of an action plan. This study highlights the opportunity for dietitians to leverage MI to guide their clients toward positive dietary behavior change, especially in response to moralistic disclosures and self-deprecations.