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Health coaching is becoming recognized as a new way to help individuals "manage" their illnesses and conditions, especially those of a chronic nature. Health coaching is a method of guiding another to "discover" and address their own ambivalence to health behavior change. Health coaching gives health care providers a framework by which they can assist someone to identify issues, beliefs, and concerns that may hinder or support his/her lifestyle change or responsibility for health that lies ahead for the individual. Like traditional coaching, health coaches utilize goal setting, identification of obstacles, and use of personal support systems. The relationship between the coach and coachee is an accountability partnership focused on the overall health outcome goals as defined by healthcare practitioners and the patient/coachee. There are several definitions of health coaching that are offered in the literature.

Contents

Defining health coaching

Palmer, Tubbs, & Whybrow [1] describe health coaching 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.

Duke University Center for Integrative Medicine [2] explains that health coaching is a structured, supportive partnership between the participant and the coach that effectively motivates behavior change.

Rollnick, Mason, & Butler [3] describes health coaching as a directive, client-centered counseling style for eliciting behavior change by helping individuals explore and resolve ambivalence.

Dr. Michael Arloski [4] describes health or wellness coaching as the application of the principals and processes of professional life coaching applied to the goals of lifestyle improvement for higher levels of wellness.

Health coaching may also be referred to as motivational interviewing in a healthcare context.

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Evidenced-based of health coaching

Given the imperative for the application of evidence-based interventions in health care, there has been growing debate about the numerous health coaching trainings and certifications primary based on unvalidated "life coaching" models or popular psychology. As an alternative to life coaching-based approaches, health care stakeholders and associations worked to define and validate core competencies for health care professionals who deliver health coaching and self-care support to patients at risk of, or affected by, chronic conditions through accepted workforce competency modeling methodologies. [5] The effort was guided by the core workforce competency recommendations of the Institute of Medicine [6]and the World Health Organization [7]. It also included a review of peer-reviewed journals to define validated approaches and interventions for improving patient engagement, activation, health-related behavior change facilitation, disease self-care support,and treatment adherence. Based on this research, a professional certification program was subsequently developed and piloted in the State of Minnesota in 2004 (Chronic Care Professional Certification). This program has been widely adopted by nurses, case managers and other health care professionals serving in health plans, health systems and population health improvement settings and it currently required or recommended by health plans and health care provider organizations,[8]

Premise of health coaching

Miller and Rollnick[9] state that the reason for health behavior change comes from the patient, which increases the liklihood that ambivalence toward making a change will be replaced with readiness for change.

Health coaching replaces the traditional "do as I instruct you to do" model of health care and allows the coachee to discover why he/she has any existing ambivalence to health behavior change.

Health coaching provides motivation, encouragement, and health education in an atmosphere where full attention is given to the coachee and where the way to self discovery is paved. Health education is a part of the information that is shared with the coachee.

Origins

The roots of health coaching began with psychologists treating persons addicted to alcohol.[10] In the early 1990's, The National Institute on Alcohol Abuse and Alcoholism conducted a study that compared several methods of treatment for alcohol addiction. They included: cognitive behavioral therapy, a twelve-step program approach similar to Alcoholics Anonymous, and motivational interviewing.

The findings demonstrated that while all were equally effective, motivational interviewing was more cost effective and timelier in reaching the desired results.

Due to the success of this project and others, researchers have been keenly interested in using this approach and studying how its use may affect health behavior change in persons with chronic conditions. Studies are likely to continue in this arena as this is a relatively new approach for many healthcare providers.

How health coaching differs from traditional 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 to do. 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 CD's,and the like[11] These materials are provided with the expectation that the patient will ultimately "do these things."

Health coaching, by contrast, guides patients to talk about what is most troubling to them about their conditions, what they most want to change, what support they have to foster change, and what obstacles or difficulties must be removed or minimized to advance healthy behaviors. It is not the main role of the health coach to teach, advise or counsel the patient. Health coaching focuses on the special issues and concerns unique to the individual patient that fit into the context of the patient's life.[12]

Several Health Maintenance Organizations (HMO) are now using health coaches as a selling point for their health care services. Healthcare professionals that are entering the field of health coaching may include: Certified Health Education Specialists, nurses, respiratory therapists, physical therapists, pharmacists, nurse practitioners, physician's assistant, nursing case managers, and those practicing occupational therapy.

The National Society of Health Coaches(NSHC) was established in 2007 for the purpose of educating, training and certifying healthcare professionals in the area of health coaching. The Society's self-study program, Health Coaching Made Easy for Healthcare Providers, was developed especially for nurses, therapists, social workers, pharmacists, and physicians.

References

  1. ^ Palmer, S., Tubbs, I., and Whybrow, A. (2003) Healthcoaching to facilitate the promotion of healthy behaviors and achievement of health-related goals. International Journal of Health Promotion & Evlauation, 41(3), pp. 91-93
  2. ^ Duke University Center for Integrative Medicine. (2006) Health Coaching Retrieved April, 2006 from Duke Health
  3. ^ Rollnick, S., Mason, P., & Butler, C. (1999) Health Behavior Change: A guide for practioners. London: Churchill Livingsone.
  4. ^ Arloski, M.,(2007) Wellness Coaching For Lasting Lifestyle Change.  Duluth, MN: Whole Persons Associates. (2nd Ed. 2009)
  5. ^ Spencer LM & Spencer SM, Competence at Work: Models for Superior Performance; 1993 New York: John Wiley & Sons, Inc.
  6. ^ The Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press;2001.
  7. ^ The World Health Organization. Preparing a Health Care Workforce for the 21st Century: The Challenge of Chronic Conditions. World Health Organization;2005.
  8. ^ DMAA Population Health Improvement Professional Development Survey, 2007
  9. ^ Rollnick, S.R., and Miller, W.R., (2002) Motivational interviewing: Preparing people for change. 2nd Edition. NY: The Guilford Press
  10. ^ Ossman, S.S., (2004 May-June) Motivational Interviewing: A process to encourage behavioral change. Nephrology Nursing Journal. 31(3), p. 346
  11. ^ Huffman, M., (2007). Health Coaching: A new and exciting technique to enhance patient self-management and improve outcomes. Home Healthcare Nurse, 25(4), p 271-276.
  12. ^ Disease Management Advisor, 2005.

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