Using Motivational Interviewing (MI) to Address Social Determinants of Health in New Mexico

What Are Social Determinants of Health (SDOH)?

SDOH: Different Outcomes for Different People

Social determinants of health (SDOH) are lived realities that shape the conditions under which people grow, work, connect, learn, love, play, and age. They influence everything from the likelihood of accessing quality care to the emotional safety of one’s community. Factors like income, education, housing stability, transportation, and social inclusion all coalesce to determine the trajectory of one’s health far more powerfully than the clinical interventions we often treat as paramount. In fact, research has consistently shown that around 80% of all health outcomes are related to factors that occur outside the medical setting—namely, SDOH.

When we talk about health disparities such as these, we are talking about the cumulative impact of systems that have long been designed without the full participation of those they affect. SDOH are unfortunately embedded in the architecture of everyday life and are supported by stigma, implicit bias, and microaggressions.

On Language: Social Drivers vs Social Determinants of Health

There’s an emerging shift in terminology from social determinants to social drivers of health, and the distinction is not merely semantic. “Determinants” suggest a kind of inevitability, as if these forces are immovable and predestined. “Drivers,” by contrast, imply motion and influence, something that can be redirected or resisted. This reframing places emphasis on agency and the possibility of transformation.

For those working at the intersection of public health and equity, especially in regions where colonial legacies and historical displacement and root shock continue to shape outcomes, it is critical to be intentional with language. The word “driver” allows us to examine the systems in motion, the people steering them, and those being carried—often involuntarily—by their momentum. In the context of New Mexico, a state with deep cultural histories and stark inequities, this shift carries weight.

Social Determinants Shaping Health Outcomes in New Mexico

New Mexico’s landscape tells a story of both beauty and exclusion. The wide expanse of rural communities is not just a geographic feature but a structural barrier to accessing timely and culturally safe care. Rurality here is often compounded by under-resourced infrastructure, limited healthcare providers, and logistical hurdles such as lack of transportation. For many, especially within Pueblo communities, access to care is yet even further shaped by justified historical mistrust rooted in centuries of violent forced assimilation, broken treaties, culturally disconnected service delivery, and other forms of erasure and genocide.

We also must add to this the challenges of behavioral health support, especially in areas where stigma intersects with scarcity. Mental health care often exists at a distance, both geographically and emotionally, when providers are not trained to hold space for cultural nuance, trauma histories, or the protective factors within collective traditions.

SDOH in New Mexico

In a place where cultural identity is inseparable from community health, history becomes a living determinant. The legacy of oppression—whether through displacement, systemic underfunding, or invisible narratives—continues to manifest in health outcomes that disproportionately affect Native populations, immigrants, and low-income families. While rurality is one factor shaping access to care in New Mexico, a less invoked but equally important part of the conversation is about dignity, choice, cultural resonance, and, above all, healing.

Unfortunately, as a State that is highly dependent on federal funding to address many of these systemic barriers and legacies, we are poised to have a challenging few years ahead of us, with further cuts to essential services. We believe that by working together and forming an equitable network of New Mexico's peoples, businesses, and organizations, we can help fill the gap.

The Power of Motivational Interviewing in SDOH Work

Motivational Interviewing (MI), when applied with fidelity and cultural responsiveness, offers a way of being with people that honors autonomy, evokes insight, and fosters partnership. In the terrain of social determinants of health, where individuals are often navigating systems that feel predetermined and impersonal, MI reintroduces agency and relational depth.

At its core, MI is about drawing out intrinsic motivation for change, especially in contexts where ambivalence is present. But ambivalence in SDOH-related work is not merely internal; it’s systemic. Individuals may be “ambivalent” about seeking care not because they are unmotivated, but because they have repeatedly encountered barriers that communicate: "this system was not designed for you."

MI practitioners are trained to listen reflectively, validate concerns, and elicit values. In the context of mitigating SDOH, this means creating space for individuals and communities to explore their relationship to systems of power, their priorities in the face of resource limitations, and their hopes that often exist beneath layers of valid skepticism. MI techniques like complex reflections allow facilitators to name both surface-level concerns and underlying structural dynamics without pushing an agenda.

Working Alongside Each Other for Local Solutions

Consider the use of a confidence ruler in a rural community health setting: when a CHW asks someone how confident they feel about navigating their insurance enrollment, the answer may not only reflect personal capacity but also speak to institutional mistrust, language access issues, and past disenfranchisement. MI helps make the invisible visible, not through extraction, but instead through partnership. It allows providers to say: your experience matters here, and we will move at your pace.

Skills like affirmations in MI are genuine validations that promote self-worth and autonomy. They are about recognizing strength amid adversity. For individuals whose choices have been constrained by systemic barriers, hearing a genuine affirmation rooted in personal narrative and cultural awareness can be transformative, and can help reshape the narratives and legacies that created SDOH in the first place.

Who Can Apply MI in Public Health Work?

Motivational Interviewing is not reserved for licensed counselors or physicians—it is deeply effective across a range of public health roles, especially for those who work at the community level. Community Health Workers (CHWs) and Community Health Representatives (CHRs), who are embedded in the very communities they serve, carry the cultural insight and relational proximity needed for MI to flourish. When trained in MI, these professionals are facilitators of change, navigating conversations with nuance and humility.

Promotoras, patient navigators, peer support specialists, case managers, and outreach staff in public agencies can benefit from incorporating MI into their work. In fact, the success of MI in SDOH contexts depends on widening the circle of who gets access to this skillset. When MI becomes a common language across interdisciplinary teams, it fosters coherence. It allows for unified approaches that recognize people not as cases or statistics, but as complex humans whose decisions are shaped by context. Person-centeredness and cultural responsiveness are built into effective MI practice.

Motivational Interviewing as a Culturally Responsive Approach

When practitioners embrace MI through the lens of cultural humility, they step back from the role of expert and into the space of learner. The person they are speaking with is not a client in need of fixing; they are a narrator, a navigator, and a teacher of their own experience. In contexts where institutional mistrust is deeply earned, particularly among communities who have been historically surveilled, medicalized, or silenced, MI offers a subtle but powerful contrast: it does not rush, it does not override, and it does not impose.

This is especially critical in spaces where the line between personal decision-making and systemic constraint is blurry. MI lets that complexity surface without judgment. A provider trained in reflective listening may hear hesitation about accessing care, and rather than labeling it as resistance, they may recognize echoes of historical disinvestment, cultural misalignment, or fear that the services offered will come at a cost to one’s dignity. MI allows space for those echoes to be heard, providing a critical step down the path towards collective healing.

Closing Reflection

Access and Equity for All

Using MI to mitigate social determinants of health in New Mexico is not about sweeping systemic failures under the rug. It’s about acknowledging them while building bridges of trust and agency. It’s about sitting beside someone rather than above them, about listening not to reply but to understand. In a state like New Mexico where history and culture run deep, and inequities are not accidental but inherited, this approach matters.

MI holds the potential to transform not only conversations, but outcomes. When wielded thoughtfully by those closest to the work—CHWs, CHRs, promotoras, peer support specialists, and more—it becomes a tool for collective movement. Not in the sense of rushing toward solutions, but in walking alongside people as they find their own.

How Ocotillo Training and Consulting Can Help Address SDOH in New Mexico

Are you ready to work together to address the systemic historical and cultural barriers that prevent New Mexico's people from becoming their healthiest and most empowered selves? The Spirit of MI, along with its four processes and OARS practices, are not difficult to understand—but they do take structured and guided practice to master and implement effectively.

At Ocotillo Training and Consulting, we specialize in designing training experiences that integrate Motivational Interviewing with person-centered public health professional development, right here in New Mexico. Our approach is grounded in cultural responsiveness, emotional intelligence, and practical application, ensuring that CHRs, CHWs, PSWs, and other public health professionals make a lasting impact in the lives of the communities they serve.

Through our Custom Training Solutions, we will tailor our Motivational Interviewing (MI) instruction to match your environment. And if you'd rather try a smaller sample of what we offer first, our Preplanned Trainings always remain available to you. Either way, we believe you will see positive return on your investment if you partner with us.

That's because we offer professional development that goes deeper than what you're used to. Our trainings in Motivational Interviewing, leadership, education, public health, and DEI are designed to help you embody person-centeredness while deepening your cultural responsiveness.

Whether you're a clinician, educator, supervisor, or community leader, we’ll work with you to create learning experiences that are engaging, inclusive, and tailored to your context. Our goal is to help you build trust, evoke change, and foster transformation that lasts.

Visit www.ocotillotraining.com to learn more or reach out to explore how we can support your team’s growth. We’re honored to walk alongside you.