No one would deny that, during the past 100 years, vast amounts of knowledge about disease, health and human nature have been achieved through research and experimentation. Health professionals now know more about what causes illness and how to prevent and treat it than ever before in human history. Everyday a new breakthrough in disease management is announced. Being a health care provider in 2011 should be an awe-inspiring thing; we should be watching the wonder of optimal health unfold before our eyes as all of this knowledge is put into play.
Unfortunately, this has not been the case. In North America, we have seen the levels of disease spiral out of control as obesity, addiction and other health risk behaviours soar. (Linden, 2010) Diabetes, hypertension, kidney disease and cancer rates continue to grow right alongside the impressive body of medical knowledge. Many aspects of these diseases are directly linked to the lifestyle choices of the patient; early prevention through cognitive and behaviour changes is key to ending this downward spiral.
The medical community has come to the realisation that knowledge itself is simply not enough; giving patients information and telling them what to do is not effective in bringing about meaningful lifestyle change. (Gale, 2009) In many different settings, health coaching is being used as an adjunct to traditional forms of medical care to bring about long lasting health improvement. This paper looks to explore the idea of health coaching and the degree to which it is being used successfully in patients with different chronic health conditions such as diabetes, obesity and hypertension.
While coaching has become a more mainstream practice in both business and personal development, it is only recently that the benefits have been recognized for work in health settings. This is evident from a comprehensive literature review using the University of Toronto’s extensive online databases – the majority of articles available on coaching relate to life and business coaching with a relative handful assigned to health coaching.
Health coaching is defined as
the practice of health education and health promotion within a coaching context to enhance the well-being of individuals and to facilitate the achievement of their health related goals. (Palmer et al, 2003)
It is the point where health psychology and coaching psychology meet to tackle lifestyle behaviour change for both the prevention and management of chronic health conditions. (Gale, 2011)
Many health coaching models make use of both Motivational Interviewing (Rollnick et al, 2008) and Solution Focused Coaching (Greene et al, 2003). While both methodologies are client centered in their approach, Motivation Interviewing stresses the need for a relationship building approach that allows the client to gain clarity around their desire, ability, reasons and need for change (Rollnick et al, 2008) and thus may be best suited in early stages when clients may be highly resistant to change. Solution Focused Coaching looks specifically to the small changes that will be required for a client to fix their problem. (Hicks, 2010) In both approaches, there is room and need for more direction and teaching from the Health Coach than from a traditionally prepared Life Coach. While you
don’t have to have a detailed understanding of the problem to find a solution, (Hicks, 2010)
once the client identifies a readiness to make a change, some direction from the Health Coach is necessary as specific, medically approved changes may be preferred over the client’s idea of what needs to be done. (Linden, 2010)
The Wheel of Health
Many coaches (a google search of life+wheel+coaching yielded >6.8M results) utilize a version of the “Wheel of Life” as a tool to help their clients understand sources of imbalance in their lives. This tool has been adapted by some health practitioners to better model the connections among such things as nutrition; exercise and physical activity; taking medications properly; personal development; communications and relationship; and stress reduction in achieving optimal health. (Wolever et al, 2010) While each of these areas is considered important in achieving overall, sustainable lifestyle and health changes, most studies focus on one aspect of the wheel. An overview of results in three of these specific areas follows.
Taking Medications as Prescribed
Taking medication to help manage the symptoms of an illness or to halt or delay its progression is a central practice in illness care. When a physician prescribes a medication, she assumes that it has been taken properly when she next examines the patient and makes further decisions about the patient’s plan of care. In one study, up to 66% of patients do not take their medications as prescribed, which is problematic for their achievement of optimal health. (DeLory, 2011)
In one study of patients with diabetes, treatment non-adherence rates were cited as frequently exceeding 50% and occasionally reaching 93%. In measuring Medication Adherence (taking medications as prescribed), the study reported that those participants who received regular health coaching over a 6-month period demonstrated a significant reduction in the number of perceived barriers to taking their drugs properly and missed fewer doses. Ultimately, this lead to improved lifestyle behaviours and lab results. (Wolever et al, 2010)
Working with a large group of over 4000 patients with hypertension, another study looked at the effectiveness of using a health coaching model to promote self management behaviours and demonstrated that patients who achieved a high level of self-activation through regular telephone coaching self reported better adherence to medications. (Linden et al, 2010)
Dr. Wong-Rieger explored the rate of unfilled prescriptions; it is impossible to take medications as prescribed if the patient does not fill the prescription. Her data showed improvement in the rate of prescription filling when patients received health coaching to manage their ambivalence. (DeLory, 2011)
Exercise and Physical Activity
Many chronic conditions such as diabetes can be better managed with regular physical activity and exercise. Although not without risk (Riddell, 2006), aerobic exercise can help restore normal blood glucose metabolism by decreasing body fat, increasing muscle tone and improving glucose uptake by the muscle cells thereby improving or reducing the dangerous levels of circulating glucose. (www.diabetescare.com) In some cases, regular exercise can be the difference between medical management and lifestyle management of the disease.
In patients with hypertension, regular exercise can improve the strength and contractility of the heart meaning that it works better with less effort. If a heart can work less hard to pump more blood, the force on the patient’s arteries will decrease resulting in lower blood pressure. (www.mayoclinic.com)
Because exercise and activity are central to illness prevention and optimal wellness, many studies have looked at ways to improve patient motivation to add exercise habits to their lives and have included health coaching as one method to do so.
One study demonstrated that the use of a Health Coach to engage with at risk seniors over the course of a year resulted in higher participation in both stretching and aerobic activity while reporting decreased symptoms of depression. (Holland et al, 2010) Another looked at a program at the Methodist Hospital System in Houston, Texas. There, an Employee Wellness program uses monthly coaching based sessions with diabetic employees to encourage behaviour changes such as exercise to improve their overall health. This program, which is available to the employee for the duration of his tenure at the hospital, has shown significant improvement in participant health. (Crow et al, 2010)
The relationship between health and diet has been long established. Essentially, a healthy, well balanced diet is necessary for a healthy physical body. It is no coincidence that the rapidly increasing incidence of disease and illness in North America has occurred alongside the rapidly expanding waistlines of its citizens. Several studies have been designed to specifically examine the impact of health coaching methods on weight loss.
A study of 1298 overweight or obese participants recruited from a wide variety of workplace settings was conducted to test the efficacy of a telephone based coaching program. While 48% of the participants lost weight, those who received 5 session of individualized coaching averaged 2.6 times more weight loss in the same period. (Terry et al, 2011) Furthermore, the members of the higher weight loss group reported improvements in activity levels, eating habits and overall health status.
Across the Atlantic, a study conducted in England employed a similar research methodology to explore the wearing down of resistance to weight loss through a telephone-based coaching program. In this study, over 6000 people enrolled in telephonic health coaching over a 6-year period. Those who stayed with the program for at least 12 months experienced a reduction in Body Mass Index; a reported increase in confidence to lose weight and an overall improvement in health. On deeper analysis, the results improved the greatest in those participants who needed the success the most. (Merrill et al, 2010) In both this and the previously cited study, conclusions were made that suggested the health coaching model can have a positive impact on the health of overweight or obese worksite participants.
Health coaching is a relatively new player on the already crowded field of health care professionals. While some early research is suggesting that benefit to improved health outcomes can be achieved through comprehensive health coaching, the jury is still out.
Any new profession needs to prove itself to the established team members before gaining widespread acceptance. Health Coaches can do this by continuing to engage in robust and credible research projects such as the ones cited in this paper.
Several studies discussed the attributes of the Health Coach(es) who participated in the research and referred to their high level of skill and expertise in using a wide variety of coaching approaches. This suggests that establishing clear expectations for Health Coach training, certification and accreditation will strengthen the trust other credentialed health professionals will hold for those in the role. Seeking high standards and demanding it of others is likely to fortify the profession’s existence in the coming years.
Much additional qualitative and quantitative research in the field of health coaching needs to be undertaken to demonstrate its efficacy to both peers and potential clients. The early results are impressive; improved medication adherence; superior management of diabetes and hypertension; an increase in healthy physical activity and significant reductions in weight are just the start of health coaching’s potential impact on the health wheel of individuals and on health care in North America.
DeLory, A. (2011). Self-management requires support of "health coach". Medical Post, 47(2), 77.
Diabetes Mellitus and Exercise. (n.d.). Diabetes Care . Retrieved Mar 6, 2011, from http://care.diabetesjournals.org/content/25/suppl_1/s64.full
Exercise: A drug-free approach to lowering high blood pressure - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved Apr 4, 2011, from http://www.mayoclinic.com/health/high-blood-pressure/HI00024
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