Health coaching

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Health coaching is the use of evidence-based skillful conversation, clinical interventions and strategies to actively and safely engage client/patients in health behavior change. Health coaches are certified or credentialed to safely guide clients and patients who may have chronic conditions or those at moderate to high risk for chronic conditions. [1]

Contents

Overview

Health coaching for clinicians and practitioners is based on evidence-based clinical interventions such as motivational interviewing to facilitate behavior change, the transtheoretical model of change, goal setting, active listening, aggregation and trending of health outcome metrics, and prevention. [1]

The Centers for Disease Control and Prevention define wellness as "the degree to which one feels positive and enthusiastic about life". [2] Wellness coaching is a process that facilitates healthy, sustainable behavior change by challenging a client to develop their inner wisdom, identify their values, and transform their goals into action. [3] Wellness coaching draws on the principles from positive psychology and appreciative inquiry, and the practices of motivational interviewing and goal setting. [4] [5] [ page needed ]

Health coaches are not licensed to prescribe diets.  In the US Dietitians are the only nutrition professionals regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. Minimum requirement is a BSc in Dietetics or a related science degree with a postgraduate diploma or higher degree in Dietetics. [6]

In 13 US states, it is illegal to perform individualized nutrition counseling unless licensed or exempt. Effectively only Registered Dietitians are eligible for licensure. [7] However, around the world legislation varies depending upon the country.

Process

The health coaching model follows a process:

Establish relationship

The process begins with engagement. Engagement and building trust with the client is established by building rapport. Many factors are included in this process. Essential traits to building rapport include genuineness, eye contact, good energy, warmth, good quality of voice, a feeling of connectedness, being comfortable and relaxed in the exchange, mindful listening, being supportive and positive body language, and physical gestures. Rapport is fundamental not only in the initial coaching session but also in each coaching session thereafter. The background of the health coach can also be an asset to their bonding with patients. Allowing health coaches to connect with their patients by building a strong relationship plays a vital role in improving the health outcomes of patients. Especially when working with underrepresented populations, pairing patients with a health coach of similar race/ethnicity, socio-cultural or linguistic background makes the health coach more relatable, and this too impacts the health outcomes of patients. Health coaches may speak a variety of languages in addition to English, which helps to increase the audience of patients that health coaches can support. Speaking more than one language as a health coach is also an asset to the health coach-patient relationship. Having a health coach that is relatable and easy to talk to yields positive outcomes due to the positive relationship between the coach and the patient. Although rapport is important, a coach may want to avoid becoming too close with the client. Becoming too close to a client can create a barrier for successful coaching relationships by being too emotionally attached, having a personal agenda and falling into assumptions based on personal relationships or experience. [8] [ page needed ]

Motivational interviewing

Once a coach has established rapport, building strong communication strategies is essential. An effective tool used in health and wellness coaching and other clinical work is motivational interviewing. Motivational interviewing is a process used in psychotherapy, social work, medicine, addiction and other fields. It aims to raise clients' awareness of problems and possibilities while reducing their ambivalence about change. [9] [10]

Motivational interviewing is also characterized by a focus on the present rather than the past. The emphasis is on the communication that is conducted with clients, concentrating on internal motivating factors and an exploration into individual core values and goals. This allows the client to express their desire to change their lifestyle and identify it themselves rather than having it come from the health coach. [11]

Wellness vision

A wellness vision is a creative statement by the client that reveals his/her highest potential and can include physical, emotional, social, spiritual and financial realms of their life. [12] A new life vision empowers one to see new possibilities along with a specific and clear direction. It allows a client to activate their imagination and then think, feel, speak and ultimately see the manifestation of their highest potential. A wellness vision is a tool a health coach uses to help the client move to new levels of well-being by connecting the client to their own truth and wisdom that is held within. The wellness vision can also be a creative statement that reveals the client's highest potential and can include physical, emotional, social, spiritual and financial realms of life. [8] [ page needed ]

Guiding the agenda and goal setting

Guiding the agenda and goal setting are collaborative behavior change techniques used between the coach and the client. During the motivational interviewing process, after strengths, values and desires are determined and the client's vision is set in place, specific goals are safely set so the client is able to move in the direction of his/her newly formed desires. [13]

Goals promote behavior change through a collaborative process, which includes the coach making a plan to track and evaluate progress. The coach can help the client focus on success even if a goal is not yet achieved. Evaluating strengths and what is successful helps the client move forward. Positive feedback helps the client progress and move through negative self-talk, ambivalence, resistance, and other hurdles. Although self-regulation is a powerful behavior change tool, the client may lapse. When the coach promotes the principles of positive psychology and goal setting through the motivational interviewing process, the coach helps the client continue to improve self-efficacy, which supports behavior change. [11] [14]

There is no evidence that health maintenance organizations (HMOs) are using health coaches for their health care services. However, there is a growing awareness by healthcare practitioners of the role that the health coach plays in establishing sustainable lifestyle changes through behavior modifications, which is essential for chronic diseases management and prevention. [15] In fact, the American Medical Association has launched a STEPS Forward collection of practice improvement strategies, including a health coaching module, which educates physicians on recruiting, training and mentoring health coaches. [16]

Social work

Social workers are skilled in the field of helping individuals overcome obstacles that inhibit their growth potential. [17] Both coaching and social work fall under the mental health field. Coaching [18] and social work have similar elements. Both practices rely on motivational interviewing. Both are focused on the client being the expert, and both work with the client without judgment, allowing the client to be in control. The essential difference between social work and coaching is that social work is more oriented to the client's relationship to community life and social ethics, whereas coaching is focused on an individual's personal dreams, desires and goals. [9] [19] Aside from patients receiving social work support from various trained social workers, patients may also be connected by their health coach to useful social service programs that may benefit them or that they qualify for.

Patient education

The traditional approach to patient teaching and education is one that directs information "at" the patient. In essence, the goal is to have the patient do the things prescribed for them. Healthcare professionals have the knowledge about disease processes, exercise guidelines, special diets, and medications that must be imparted to the patient and caregivers in many forms: booklets, pamphlets, audio CDs, and the like. [20]

Many formal health coaching programs are now being offered through institutions of higher learning such as Duke Integrative Medicine, [21] Georgetown University [22] and the Institute for Integrative Nutrition. [23]

Efficacy

Several studies have shown health coaching to be effective in improving various aspects of health. One study on type 2 diabetes concludes that after six months, individuals who were coached showed improvement in medication adherence. Coaching had a positive effect on patients' knowledge, skill, self-efficacy and behavior change while a non-coached control group did not show any improvement. Additionally, coached participants with a hemoglobin A1C over 7% showed significant improvement in A1C. [24]

A study on coronary heart disease indicated that patients in a coaching program achieved a significantly greater change in total cholesterol of 14 mg/dl than the non-coached patients, with a considerable reduction in LDL-C. Those involved in the coaching program showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life, less anxiety, and improvement in overall health and mood. [25]

Another study shows that telephonic coaching is an effective program for assisting individuals with self-efficacy and weight loss. Confidence to lose weight increased from a baseline of 60% to 71% at three months, 76% at 6 months and 79% at 12 months. The average body mass index significantly decreased during this interactive coaching study. Average baseline was 32.1, and then documented at 3 months (31.4), 6 months (31.0), and 12 months (30.6). [26]

A study on tobacco cessation concluded that after 12 months, the coached participants had a 32% quit rate compared to 18% for non-participants. Those that participated in the program, who acknowledged that they were ready for change, had the highest rate of quitting at 44%. Additionally, 11% of participants who did not quit reported a reduction in tobacco use. This is considered a positive outcome because other studies have shown that when individuals reduced their tobacco usage, they find increased motivation to quit entirely in the future. [27]

See also

Related Research Articles

<span class="mw-page-title-main">Occupational therapy</span> Healthcare profession

Occupational therapy (OT) is a healthcare profession that involves the use of assessment and intervention to develop, recover, or maintain the meaningful activities, or occupations, of individuals, groups, or communities. The field of OT consists of health care practitioners trained and educated to improve mental and physical performance. Occupational therapists specialize in teaching, educating, and supporting participation in any activity that occupies an individual's time. It is an independent health profession sometimes categorized as an allied health profession and consists of occupational therapists (OTs) and occupational therapy assistants (OTAs). While OTs and OTAs have different roles, they both work with people who want to improve their mental and or physical health, disabilities, injuries, or impairments.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of cancer cachexia. Many dietitians work in hospitals and usually see specific patients where a nutritional assessment and intervention has been requested by a doctor or nurse, for example if a patient has lost their ability to swallow or requires artificial nutrition due to intestinal failure. Dietitians are regulated healthcare professionals licensed to assess, diagnose, and treat such problems. In the United Kingdom, dietitian is a 'protected title', meaning identifying yourself as a dietitian without appropriate education and registration is prohibited by law.

<span class="mw-page-title-main">Anger management</span> Therapy for anger prevention and control

Anger management is a psycho-therapeutic program for anger prevention and control. It has been described as deploying anger successfully. Anger is frequently a result of frustration, or of feeling blocked or thwarted from something the subject feels is important. Anger can also be a defensive response to underlying fear or feelings of vulnerability or powerlessness. Anger management programs consider anger to be a motivation caused by an identifiable reason which can be logically analyzed and addressed.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members.

Behavior change, in context of public health, refers to efforts put in place to change people's personal habits and attitudes, to prevent disease. Behavior change in public health can take place at several levels and is known as social and behavior change (SBC). More and more, efforts focus on prevention of disease to save healthcare care costs. This is particularly important in low and middle income countries, where supply side health interventions have come under increased scrutiny because of the cost.

<span class="mw-page-title-main">Theory of planned behavior</span> Theory that links behavior

The Theory of Planned Behavior (TPB) is a psychological theory that links beliefs to behavior. The theory maintains that three core components, namely, attitude, subjective norms, and perceived behavioral control, together shape an individual's behavioral intentions. In turn, a tenet of TPB is that behavioral intention is the most proximal determinant of human social behavior.

<span class="mw-page-title-main">Transtheoretical model</span> Integrative theory of therapy

The transtheoretical model of behavior change is an integrative theory of therapy that assesses an individual's readiness to act on a new healthier behavior, and provides strategies, or processes of change to guide the individual. The model is composed of constructs such as: stages of change, processes of change, levels of change, self-efficacy, and decisional balance.

Motivational interviewing (MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. It is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. Compared with non-directive counseling, it is more focused and goal-directed, and departs from traditional Rogerian client-centered therapy through this use of direction, in which therapists attempt to influence clients to consider making changes, rather than engaging in non-directive therapeutic exploration. The examination and resolution of ambivalence is a central purpose, and the counselor is intentionally directive in pursuing this goal. MI is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship.

<span class="mw-page-title-main">Self-care</span> Taking care of ones own health

Self-care has been defined as the process of establishing behaviors to ensure holistic well-being of oneself, to promote health, and actively manage illness when it occurs. Individuals engage in some form of self-care daily with food choices, exercise, sleep, reading and dental care. Self-care is not only a solo activity as the community—a group that supports the person performing self-care—overall plays a large role in access to, implementation of, and success of self-care activities.

Positive deviance (PD) is an approach to behavioral and social change. It is based on the idea that, within a community, some individuals engage in unusual behaviors allowing them to solve problems better than others who face similar challenges, despite not having additional resources or knowledge. These individuals are referred to as positive deviants.

Psychological resistance, also known as psychological resistance to change, is the phenomenon often encountered in clinical practice in which patients either directly or indirectly exhibit paradoxical opposing behaviors in presumably a clinically initiated push and pull of a change process. In other words, the concept of psychological resistance is that patients are likely to resist physician suggestions to change behavior or accept certain treatments regardless of whether that change will improve their condition. It impedes the development of authentic, reciprocally nurturing experiences in a clinical setting. Psychological resistance can manifest in various ways, such as denying the existence or severity of a problem, rationalizing or minimizing one's responsibility for it, rejecting or distrusting the therapist's or consultant's suggestions, withholding or distorting information, or sabotaging the treatment process. It is established that the common source of resistances and defenses is shame. This and similar negative attitudes may be the result of social stigmatization of a particular condition, such as psychological resistance towards insulin treatment of diabetes.

<span class="mw-page-title-main">Lifestyle medicine</span> Branch of medicine

Lifestyle medicine (LM) is a branch of medicine focused on preventive healthcare and self-care dealing with prevention, research, education, and treatment of disorders caused by lifestyle factors and preventable causes of death such as nutrition, physical inactivity, chronic stress, and self-destructive behaviors including the consumption of tobacco products and drug or alcohol abuse. The goal of LM is to improve individuals' health and wellbeing by applying the 6 pillars of lifestyle medicine (nutrition, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection) to prevent chronic conditions such as cardiovascular diseases, diabetes, metabolic syndrome and obesity. By focusing on these 6 areas to improve health, LM can prevent 80% of chronic illnesses and non-communicable diseases (NCD).

Sport psychology was defined by the European Federation of Sport Psychology (FEPSAC) in 1996, as the study of the psychological basis, processes, and effects of sport. Otherwise, sport is considered as any physical activity where the individuals engage for competition and health. Sport psychology is recognized as an interdisciplinary science that draws on knowledge from many related fields including biomechanics, physiology, kinesiology and psychology. It involves the study of how psychological factors affect performance and how participation in sport and exercise affect psychological and physical factors. Sport psychologists teach cognitive and behavioral strategies to athletes in order to improve their experience and performance in sports.

Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in health care. Clinical in this sense refers to the management of patients, including not only outpatients at clinics and in private practice, but also inpatients in hospitals. It incorporates primarily the scientific fields of nutrition and dietetics. Furthermore, clinical nutrition aims to maintain a healthy energy balance, while also providing sufficient amounts of nutrients such as protein, vitamins, and minerals to patients.

Multisystemic therapy (MST) is an intense, family-focused and community-based treatment program for juveniles with serious criminal offenses who are possibly abusing substances. It is also a therapy strategy to teach their families how to foster their success in recovery.

Symptom targeted intervention (STI) is a clinical program being used in medical settings to help patients who struggle with symptoms of depression or anxiety or adherence to treatment plans but who are not interested in receiving outpatient mental health treatment. STI is an individualized therapeutic model and clinical program that teaches patients brief, effective ways to cope with difficult thoughts, feelings, and behaviors using evidence-based interventions. Its individualized engagement process employs techniques from solution-focused therapy, using a Rogerian, patient-centered philosophy. This engagement process ensures that even challenging, at-risk, and non-adherent patients are able to participate.

Community reinforcement approach and family training (CRAFT) is a behavior therapy approach in psychotherapy for treating addiction developed by Robert J. Meyers in the late 1970s. Meyers worked with Nathan Azrin in the early 1970s whilst he was developing his own community reinforcement approach (CRA) which uses operant conditioning techniques to help people learn to reduce the power of their addictions and enjoy healthy living. Meyers adapted CRA to create CRAFT, which he described as CRA that "works through family members." CRAFT combines CRA with family training to equip concerned significant others (CSOs) of addicts with supportive techniques to encourage their loved ones to begin and continue treatment and provides them with defences against addiction's damaging effects on themselves.

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US (n = 85) had a dropout rate of 37.9% (range: 33.0% to 43.0%).

References

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  12. ↑ Wellness Vision and Plan for 2020 Worksheet (PDF). State University of New York Upstate Medical. Retrieved 29 October 2022.
  13. ↑ Bodenheimer, T; Handley, MA (August 2009). "Goal-setting for behavior change in primary care: an exploration and status report". Patient Education and Counseling. 76 (2): 174–80. doi:10.1016/j.pec.2009.06.001. PMID   19560895.
  14. ↑ Prochaska, James O.; Norcross, John C.; DiClemente, Carlo C. (1994). Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits (1st ed.). New York: Morrow. ISBN   978-0688112639. OCLC   29429279.
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  18. ↑ Maria Sitaara. "Transformational coaching: what is transformational coaching".
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  22. ↑ "School of Continuing Studies".
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  27. ↑ Terry, Paul E.; Seaverson, Erin L. D.; Staufacker, Michael J.; Tanaka, Akiko (June 2011). "The effectiveness of a telephone-based tobacco cessation program offered as part of a worksite health promotion program". Population Health Management. 14 (3): 117–125. doi:10.1089/pop.2010.0026. PMID   21323463.

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