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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.


Overview

Health coaching for clinicians and practitioners is based on evidence-based clinical interventions such as
motivational interviewing 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 e ...
to facilitate behavior change, the
transtheoretical model 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 ...
of change,
goal setting A goal is an idea of the future or desired result that a person or a group of people envision, plan and commit to achieve. People endeavour to reach goals within a finite time by setting deadlines. A goal is roughly similar to a purpose or ai ...
,
active listening Active listening is the practice of preparing to listen, observing what verbal and non-verbal messages are being sent, and then providing appropriate feedback for the sake of showing attentiveness to the message being presented. This form of liste ...
, aggregation and trending of health outcome metrics, and prevention. The
Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
define wellness as "the degree to which one feels positive and enthusiastic about life". 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. Wellness coaching draws on the principles from
positive psychology Positive psychology is the scientific study of what makes life most worth living, focusing on both individual and societal well-being. It studies "positive subjective experience, positive individual traits, and positive institutions...it aims t ...
and
appreciative inquiry Appreciative inquiry (AI) is a model that seeks to engage stakeholders in self-determined change. According to Gervase Bushe, professor of leadership and organization development at the Beedie School of Business and a researcher on the topic, "AI ...
, and the practices of
motivational interviewing 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 e ...
and
goal setting A goal is an idea of the future or desired result that a person or a group of people envision, plan and commit to achieve. People endeavour to reach goals within a finite time by setting deadlines. A goal is roughly similar to a purpose or ai ...
. Health coaches are not licensed to prescribe diets.  In the US
Dietitian 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 ca ...
s 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. In 13 US states, it is illegal to perform individualized nutrition counseling unless licensed or exempt. Effectively only Registered Dietitians are eligible for licensure. 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.


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 (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 e ...
. Motivational interviewing is a process used in
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome pro ...
,
social work Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
,
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...
,
addiction Addiction is a neuropsychological disorder characterized by a persistent and intense urge to engage in certain behaviors, one of which is the usage of a drug, despite substantial harm and other negative consequences. Repetitive drug use o ...
and other fields. It aims to raise clients' awareness of problems and possibilities while reducing their
ambivalence Ambivalence is a state of having simultaneous conflicting reactions, beliefs, or feelings towards some object. Stated another way, ambivalence is the experience of having an attitude towards someone or something that contains both positively and neg ...
about change. 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.


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. 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.


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. 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.


Intersection with related disciplines

There is no evidence that
health maintenance organization In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded healt ...
s (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. In fact, the
American Medical Association The American Medical Association (AMA) is a professional association and lobbying group of physicians and medical students. Founded in 1847, it is headquartered in Chicago, Illinois. Membership was approximately 240,000 in 2016. The AMA's state ...
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.


Social work

Social workers are skilled in the field of helping individuals overcome obstacles that inhibit their growth potential. Both coaching and
social work Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...
fall under the mental health field. Coaching 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. 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. Many formal health coaching programs are now being offered through institutions of higher learning such as Duke Integrative Medicine,
Georgetown University Georgetown University is a private university, private research university in the Georgetown (Washington, D.C.), Georgetown neighborhood of Washington, D.C. Founded by Bishop John Carroll (archbishop of Baltimore), John Carroll in 1789 as Georg ...
and the Institute for Integrative Nutrition.


Efficacy

Several studies have shown health coaching to be effective in improving various aspects of health. One study on
type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, ...
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 Glycated hemoglobin, also known as HbA1c, glycohemoglobin, hemoglobin A1c, A1C, is a form of hemoglobin (Hb) that is chemically linked to a sugar. Most monosaccharides, including glucose, galactose and fructose, spontaneously (i.e. non-enzymat ...
over 7% showed significant improvement in A1C. A study on
coronary heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...
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 Low-density lipoprotein (LDL) is one of the five major groups of lipoprotein that transport all fat molecules around the body in extracellular water. These groups, from least dense to most dense, are chylomicrons (aka ULDL by the overall densit ...
. Those involved in the coaching program showed improvements in secondary outcomes such as
weight loss Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
, increased exercise, improved quality of life, less
anxiety Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat wh ...
, and improvement in overall health and mood. Another study shows that telephonic coaching is an effective program for assisting individuals with
self-efficacy In psychology, self-efficacy is an individual's belief in their capacity to act in the ways necessary to reach specific goals. The concept was originally proposed by the psychologist Albert Bandura. Self-efficacy affects every area of human endea ...
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 Body mass index (BMI) is a value derived from the mass (weight) and height of a person. The BMI is defined as the body mass divided by the square of the body height, and is expressed in units of kg/m2, resulting from mass in kilograms and he ...
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). A study on
tobacco cessation Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes ...
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.


See also

* Goal attainment scaling * *
Self-help Self-help or self-improvement is a self-guided improvement''APA Dictionary of Physicology'', 1st ed., Gary R. VandenBos, ed., Washington: American Psychological Association, 2007.—economically, intellectually, or emotionally—often with a subst ...
*


References

{{DEFAULTSORT:Health Coaching Health care occupations