Health coaching is a way of helping people gain the knowledge, skills, tools and confidence they need take an active part in their own health care. It helps them reach the health goals they want to achieve.
Health coaching is useful if you are working with someone who has ongoing health issues or complex health needs.
Its goal is to improve their long-term outcomes.
It can include whānau members, so they can also support your client in achieving their health goals.
Health coaching is based on the saying that if you give a person a fish, they will eat for a day, but if you teach them to fish, they will eat for a lifetime.
It’s not about one person rescuing another; it’s about giving someone the resources to help themselves. Rescuing is appropriate for acute care when doctors need to take over and do something or tell someone what to do. But if someone has an ongoing health issue, rather than telling them what to do, a health coach works alongside them so they can manage their condition well and achieve the goals that they set.
What does a health coach do?
Just like sports coaches, the role of a health coach is to inspire confidence in you, share knowledge with you and find ways to motivate you to achieve your goals.
They might help someone manage their appointments or medication, answer questions about their condition, or explain more fully why the doctor recommended they take certain actions. They will help them work out what they want to achieve and will help them find the support to do that.
Health coaches have five roles, which are to:
provide support for their client to manage their condition themselves
bridge the gap between their client and their doctor
help their client find their way around the healthcare system
offer their client emotional support
be their client's ongoing first person to contact if they have a question.
(Image source: American Academy of Family Physicians, Fam Pract Mgt, 2010)
Credits: Health Navigator Editorial Team. Reviewed By: Dr. Janine Bycroft
Last reviewed: 28 Aug 2017
Who could become a health coach?
Non-health professionals are ideal for the role of health coach, as they can provide a bridge between an over-stretched clinician and a patient needing the input of time and information to help them best manage their condition. When practices maximize the use of lay people, it frees clinicians to focus on aspects of patient care that require their expertise.
Health coaches use evidence-based practice and improvement science methodology to support patients, unlike wellness coaching, which may not draw on best practice.
Health coaching is based on a collaborative approach rather than a directive one, so as well as requiring some technical skills that can be taught, a health coach needs certain personality traits. It would therefore suit someone who:
can match the cultural and language needs of the population being served
has excellent communication skills, including listening skills
has an encouraging, supportive and motivating attitude and approach
can connect with a wide range of people
is empathetic, caring and nurturing.
Candidates for health coach training could include those who have these personal qualities and who currently work as a:
whanau ora worker
community health worker
peer support worker
Stanford course leader.
Training options for health coaches
As the role of health coaches is relatively new in New Zealand, there is not any formal NZQA qualified course at this stage. In time this will hopefully be developed. Meanwhile, a brief two-day introductory workshop to complement existing skills was developed and piloted over September to December 2017.
Two models of health coaching have been trialled overseas.
The teamlet model
In this model, the 15-minute primary care visit is extended to include coaching before and after the physician appointment. Prior to seeing the health practitioner, the coach checks on medication and helps with agenda setting for the consultation, assists during the consultation and then immediately afterwards assesses whether the patient understands and agrees with the recommended care plan, while also motivating the patient to engage in behaviour change. This is supported by phone calls between visits.
The hospital-to-home model
One widely used programme in the United States reports a 20 to 50 per cent reduction in hospital re-admissions. Their programme focuses on the four pillars of:
having a reliable plan in place to take medications regularly
overcoming barriers to follow-up appointments
having an acute plan and ensuring patients know how to recognise and respond to worsening signs and symptoms
using a personal health record to record 30-day goals, health information and key questions to be shared with the doctor or nurse at the next appointment.
Efficacy of health coaching
Several studies have shown health coaching to be effective.
Researchers have found promising clinical benefits from health coaching in diabetes and asthma management, while phone coaching improved attendance at colonoscopy clinics and better adherence to lipid-lowering drugs than usual care.
Clinics in the USA have also reported productivity gains in delegating the work of health coaching away from primary care clinicians, with reports of physicians being able to see two to three more patients a day, and improvements in visit volumes and collections by 60%.
One study on type 2 diabetes found that after six months, people who were coached showed improvement in medication adherence, as well as a positive effect on their knowledge, skill, self-efficacy and behaviour change, while a non-coached control group did not show any improvement. Also, coached participants with a hemoglobin A1C over 7% showed significant improvement in A1C.
A study on coronary heart disease found that patients in a coaching programme achieved a significantly greater change in total cholesterol of 14 mg/dl than the non-coached patients, with a considerable reduction in LDL-C. They also showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life and less anxiety, as well as improvement in overall health and mood.
Another study found telephone coaching to be effective for assisting people with weight loss. The average body mass index of participants significantly decreased during the study, from an average baseline of 32.1%, to 31.4% at three months, 31% at six months and 30.6% at 12 months.
In a study on tobacco cessation over 12 months, the coached participants had a 32% quit rate compared to 18% for nonparticipants.
And a study in six Minnesota primary care clinics found that adult patients with hypertension, diabetes or heart failure who were allocated ‘care guides’ (health coaches) achieved more goals, had a greater reduction in their unmet needs and improved more than the usual care patients in meeting several individual goals, including not using tobacco.
The vision for SMILE is to normalise self-management support in ProCare-affiliated practices in the Manukau locality. As part of this project, in 2016, ProCare worked in collaboration with the Mt Wellington Family Health Centre to pilot the health coach model.
This pilot enabled the SMILE team to identify the skills and competencies for the health coaching role and develop a job description for use by other general practices. They also identified the issues that patients covered in their health conversation topics.
The most frequent topic was appointment booking, followed by goal setting, healthy lifestyle, nutrition and whakawhanaunga (nurturing the relationship). Other issues included blood glucose levels and medication.
“The Health Coach helps me to communicate better” ....
“I like the brainstorming and decision making techniques” .....
“I don’t like to waste peoples time, I like the fact that we can talk and listen to each other” ....
“I can be a stubborn so and so. The coach has helped me get back on track.”
East Tamaki Healthcare (ETH) PHO health coaching programme
Building on the success of their peer-led self-management education (SME) programme, Kia Kaha, ETH has initiated a health coaching programme. It has also expanded the original team to include options for self-management education, health psychology, peer support and care coordination.
To support the development of health coaches within their team, they have also been running two-day health coaching workshops as part of the Manaaki Hauora project. These workshops have been attended by primary and secondary care health workers, including diabetes specialists, pharmacists, nutritionists, psychologists, peer workers and volunteers.
Organiser and health psychologist Leona Didsbury says, “We’re very encouraged about the value of health coaching skills as an enhancement of practice for anyone working with patients as it is very patient-centred. We are especially excited about the possibilities of health coaching ‘teamlets’ working together in primary care. Our feedback to date indicates people find this training relevant and useful for their setting.”
Leona is a trained facilitator of the University of California's Centre for Excellence in Primary Care health coaching programme. She has run several training sessions as this is proving to be a popular course for both regulated and non-regulated health staff, both from ETH and other organisations in the Counties Manukau district.
All health coaches working in ETH have regular supervision as well as a weekly mentoring and support session. The health coaches reflect the cultural and linguistic makeup of the enrolled population.
Challenges have included getting the resources to do the training and quality control, the need to maintain and support the lay and volunteer workforce, and referral of patients to the programme.
To overcome these challenges, support from Counties Manukau Health and Ko Awatea as part of the Manaaki Hauora campaign has made a big difference, as well as the seed funding that enabled it to happen. A validated and structured health coaching model has enabled role definition boundaries.
Key lessons that may be useful for other teams who are interested in starting health coaching include to:
build on what works (lessons from the SME implementation informed the model)
apply the improvement science methodology rather than depend on evidence from RCTs
give time to explore ideas and to change and do things differently
use a structured health coaching programme because it makes the idea easier to sell to others in the organisation, particularly clinical staff
include information about the programme in in-house online publications
offer a menu of options.
The model below shows how health coaching fits into the overall SME approach.
(Source: East Tamaki Healthcare (ETH) PHO – Health Coaching Programme)
East Tamaki Healthcare (ETH) PHO – Health Coaching Programme.
Report from a health coach
In February, I was introduced to Bob. His wife had just had their first baby, and this had prompted him to look at weight loss and a healthy lifestyle.
It was a very different interaction from the norm. From then until now we have not actually met in person. The beauty of this programme is that we can think outside the box and communicate in the best way possible to accommodate the busy lives of patients.
The constant contact has been virtually based. For example, after liaising by phone and email, I sent Bob a link for the Big Boys Club introduction. His response was very positive – he couldn’t wait to get started, so we organised for him to meet up with a colleague, Edith, at the gym. The meeting went well and Bob was introduced to the team for the Big Boys Club. Bob started the programme and is thoroughly enjoying it.
After three months, Bob is still doing very well. He has lost 17kg and feels great. He will attend the GP for a check in a month and we're hoping for some significant improvements in his baseline results.