What is Health Coaching?
Lifestyle-related chronic disease lies at the heart of the current healthcare crisis in the United States and with it, a large gap between healthcare provider recommendations and sustainable patient action. An allied health professional skilled in the art of behavior change and charged with improving patient engagement and activation is urgently needed. As a model of educational and clinical innovation aimed at patient empowerment in lifestyle modification, integrative health coaching is aligned well with the tenants and goals of recently sanctioned federal healthcare reform, specifically the creation of the first national prevention and health promotion strategy.
Improvement in Clinical Effectiveness Through Lifestyle Health Coaching
Recent efforts to provide more integrated, patient-centered primary care have included patient activation, patient education and engagement (agency), shared decision making, and self-management support. Health coaches work in all of these areas, providing patients with health-related information, navigational support, connections to community resources, and personal support. Coaches focus on helping patients identify goals, create plans to make changes, and implement changes. Health coaching has been proposed as an inexpensive and effective means to improve control of chronic conditions and has been effective in improving management of diabetes and other risk factors for cardiovascular disease, asthma, and COPD. Coaches may be particularly valuable in resource-poor settings, where minority and low-income communities bear a disproportionate burden of chronic disease and its complications, and are less likely to engage in effective self-management of their conditions.
Shared Characteristics Between Health Coaches and Patients
Above all, we ultimately strive to be “passionate, educated healthy professionals offering health advice,” utilizing, and balancing, both expertise and personal experience. We stand for living and working in integrity and congruence of our core values, and in order to be in a position to ask for our patient’s trust, we must first value our own knowledge and lead from the front ourselves. We believe our health-related advice, on top of being science-based, is more valuable through the perspective that comes with real world personal experience, a shared experience of everyone on their wellness journey. We know the struggles, frustrations, overwhelm, and the sticking points - because we have personally overcome them.
Availability of Health Coaches to Patients
Availability, including frequency of visits, the longer duration of the relationship, and accessibility of the health coach, were all seen as important by patients in establishing a positive relationship needed for affective support. We have the luxury of extended appointment times (1-2 hour appointments), enabling us to take deep dives into important topics most providers can barely brush over.
Establishing a Trusting Relationship
Thanks to the extended appointment times, our providers get to meet our patients on a level of depth and specificity rarely seen in healthcare. A professional relationship is formed, and our patients feel comfortable asking important questions relevant to their case without feeling rushed. Equally important, our coaches have time to answer those important questions without feeling rushed. We know its not enough for the patient to memorize what the provider or coach said - what matters is that the patient understand not just the “what” but also the “why” behind their care plans. We believe the coach-patient relationships are optimal when the patient
Educational Role of the Health Coach
To make informed decisions, patients need to have a basic understanding of their condition, their options, and the consequences of each option. Health coaches provide education using patient centered techniques that included determining patient's goals in readiness for change and checking for patient's understanding. Our educational goals are to empower and equip the patient to not only solve their current complaints but navigate their health in the long-term and solve future problems and prevent diseases before they happen.
Providing Personal Support for the Patient
Health coaching was forged based on two primary observations: 1) people often struggle to make and sustain health related behavior changes, even when well-informed and seemingly motivated; and 2) a clinical professional specifically educated and trained to partner with patients to affect behavior change is absent from the present system. It is important to differentiate the coaches role from the role of a rescuer. Coaches support and assist by asking questions and offering professional tools, guiding patients toward goals using a forward focus. Coaches are trained to maintain forward momentum but work flexibly within the process, frequently referring back to a patient;s deeply held values and sense of purpose.
Providing Support for Decision Making
The theme of decision support included working with patients to identify options, create action plans, identify and overcome barriers, locate resources, and provide reminders. By providing a support, coaches enabled patients a wider range of choices. Although coaches identified options and made suggestions, it was essential that the choice was the patient's own. No one knows more about the patient and their specific circumstances and environment then the patient themself, and combined with the professional toolbox of the health coach a combined-expertise partnership is formed.
Bridging Between the Patient and Clinician
The last theme refers to coaches working in conjunction with the clinicians to support patient decisions. It included improving patient understanding and communication with the clinician, helping the patient identify and ask questions of the clinician, supporting the patient between visits, and reducing the patient's fear and anxiety around office visits.
Excepts taken from A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes. Thom, D.H. 2016. DOI:10.1370/afm.1988.
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