Health coaching

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Health coaching, also referred to as wellness coaching, is a process that facilitates healthy, sustainable behavior change by challenging a client to listen to their inner wisdom, identify their values, and transform their goals into action. Health coaching draws on the principles of positive psychology and the practices of motivational interviewing and goal setting.[1][2] The terms “health coaching” and “wellness coaching” are used interchangeably.

Origins[edit]

Coaching involves a conversation where one person listens and then advises another person on any subject matter.[1] Over time this term has been used for coaches in education, athletics and music. Through his book The Inner Game of Tennis,[3] Tim Gallwey changed the perspective of coaching when he shifted the focus of coaching. Rather than teaching a skill or technique, his process encouraged individuals to explore their inner strength and wisdom, improving their confidence and making changes and improvements from within. Health coaching is embedded in psychology, social work, nursing, eastern philosophy, holistic health and wellness management fields.

The roots of health coaching began with psychologists treating persons addicted to alcohol.[4] In the early 1990s, 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.

There are many people seeking help for various situations and in 2009 the largest category of coaching was that of health, fitness and wellness, with a combined 83.7 millions listings. The importance of a health coach is widely needed as well as guidelines to properly counsel somebody in the area of health and fitness.

Process of health coaching[edit]

To fully appreciate and understand health coaching, one must be aware of the process.

Establish relationship[edit]

The process starts with engagement. Engagement and building trust with client is established by building rapport. Many factors are included in this process. Essential traits to building rapport includes 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 in the initial coaching session but must also be sustained in each coaching session. Although rapport is important, a coach may want to avoid becoming too close with client. Becoming too close to a client can create a barrier for a successful coaching process by being too emotionally attached, having a personal agenda and falling into assumptions based on personal relationship or experience.[1]

Motivational interviewing[edit]

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 is a process used in psychotherapy, social work, medicine, addiction, coaching and other fields. The basis for support of this method is that motivational interviewing provides motivation to shape the knowledge obtained which encourages behavior change. Research shows knowledge alone does not promote change; but when motivation is added to the equation, change is likely to occur.[5][6][7]

Motivational Interviewing is also characterized by a focus on the present rather than the past. There is an emphasis on communication that is conducted with clients concentrating on internal motivating factors and an exploration of individual core values an 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.[8]

Wellness vision[edit]

A wellness vision is a creative statement by client that reveals his/her highest potential and can include physical, emotional, social, spiritual and financial realms of one’s life. A new life vision empowers one to see new possibilities along with a specific and clear direction, which can be manifested through inner creativity, wisdom and power. It allows one to activate their imagination and then think, feel, speak and ultimately see the manifestation of their unified highest potential to manifest. A wellness vision is a tool coach uses to help client move to new levels of wellbeing by connecting client to the truth and wisdom within.[1]

Goal setting[edit]

The manifestation of a wellness vision is done through the process of goal setting. Goal setting is a collaborative behavior change technique used between the coach and the client. During the motivational interviewing process, after strengths, values and desires are determined and client’s vision is set in place, specific goals are set so client is able to move in the direction of his/her newly formed desires.[9]

Goals promote behavior change through a collaborative process, which includes the coach making a plan to follow up and evaluate progress. The coach can help the client focus on the success the client has had, even if 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 any negative self-talk, ambivalence, resistance and other hurdles. Although self-regulation is a powerful behavior change tool, client may lapse. When 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.[7][10]

Difference between coaching and psychotherapy[edit]

Coaching and psychotherapy both are rooted in person-centered psychology. Today many therapists are now coaching or have practices where they concurrently are practicing both disciplines. Both coaching and psychotherapy take place in individual and group sessions. Both are catalyst for change driven by the desire of the client for improved health. Both use similar methods of inquiry. A clear difference between psychotherapy and coaching is therapy focuses on a problem while coaching focuses on the solution, driven by client’s inner strength and wisdom.[1][11]

Difference between coaching and social work[edit]

Social workers are skilled in the field of helping individuals overcome obstacles that inhibit their growth potential.[12] Both coaching and 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 the driver seat. 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.[5][13]

Difference from traditional patient education[edit]

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.[14]

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 counselors, social workers, health education specialists, nutritionists, psychologists, nurses, respiratory therapists, physical therapists, pharmacists, nurse practitioners, physician assistants, nursing case managers, occupational therapists, and Oriental medicine practitioners.

Efficacy of Health Coaching[edit]

Several studies have shown health coaching to be effective in improving various aspects of health. One study on type 2 diabetes concludes that after 6 months, individuals who were coached showed improvement in medication adherence. Coaching had a positive effect on patient’s knowledge, skill, self-efficacy and behavior change while an non-coached control group did not show any improvement. Additionally, coached participants with a hemoglobin A1C over 7% showed significant improvement in A1C.[15]

A study on coronary heart disease 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. Those involved in the coaching program showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life, less anxiety, and improvement in overall health and mood.[16]

Another study shows that telephonic coaching is an effective program for assisting individuals with self-efficacy and weight loss. Confidence to lose weight increased from a baseline of 60% to 3 months 71%, 6 months 76% and 12 months 79%. The average BMI significantly decreased during this interactive coaching study. Average Baseline was 32.1%, and then documented at 3 months (31.4%), 6 months (31.0%), 12 months (30.6%).[17]

A study on tobacco cessation concluded that after 12 months, the coached participants had a 32% quit rate compared to 18% for nonparticipants. 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 reduction in tobacco use. This is considered a positive outcome because other studies have shown that when individuals reduce their tobacco use they find increase motivation to quit in the future.[18]

References[edit]

  1. ^ a b c d e Starr, Julie (2008). The coaching manual : the definitive guide to the process, principles, and skills of personal coaching (2nd ed. ed.). Harlow, England: Pearson Prentice Hall. ISBN 0273713523. 
  2. ^ Moore & Tschannen (2010). Coaching psychology manual. Philadelphia: Wolters Kluwer Health/Lippincott, Williams & Wilkins. ISBN 0781772621. 
  3. ^ Gallwey, W. Timothy (2008). The inner game of tennis : the classic guide to the mental side of peak performance (Random House trade pbk. ed. ed.). New York: Random House. ISBN 978-0679778318. 
  4. ^ Ossman, Sherry Smith (May—June 2004), "Clinical Consult: Motivational Interviewing: A process to encourage behavioral change", Nephrology Nursing Journal (American Nephrology Nurses' Association) 31 (3): 346—347, ISSN 2163-5390, OCLC 47847530, PMID 15303434 
    PDF available for a fee; no abstract.
  5. ^ a b Hohman, Melinda; Rollnick, Stephen (2011). Motivational interviewing in social work practice. New York: Guilford Press. ISBN 978-1609189693. 
  6. ^ Lundahl, B; Burke, BL (November 2009). "The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses.". Journal of clinical psychology 65 (11): 1232–45. PMID 19739205. 
  7. ^ a b Rollnick, William R. Miller, Stephen (2002). Motivational interviewing : preparing people for change (2nd ed. ed.). New York: Guilford Press. ISBN 1572305630. 
  8. ^ Engel, Reed. "AN EXAMINATION OF WELLNESS COACHES AND THEIR IMPACT ON CLIENT BEHAVIORAL OUTCOMES". Purdue University. Retrieved 5/1. 
  9. ^ Bodenheimer, T; Handley, MA (August 2009). "Goal-setting for behavior change in primary care: an exploration and status report.". Patient education and counseling 76 (2): 174–80. PMID 19560895. 
  10. ^ DiClemente, James O. Prochaska, John C. Norcross, Carlo C. (2006). Changing for good (1st Collins pbk. ed. ed.). New York: HarperCollins. ISBN 978-0380725724. 
  11. ^ Hart, Vicki; Blattner, John; Leipsic, Staci (1 January 2001). "Coaching versus therapy: A perspective.". Consulting Psychology Journal: Practice and Research 53 (4): 229–237. doi:10.1037/1061-4087.53.4.229. 
  12. ^ Caspi, J (October 2005). "Coaching and social work: challenges and concerns.". Social work 50 (4): 359–62. PMID 17892246. 
  13. ^ Shafer, Kathryn C.; Kiebzak, Lisa; Dwoskin, Jacquelyn; Zelvin, Elizabeth (1 March 2003). "Coaching: New Role for Addictions Social Workers?". Journal of Social Work Practice in the Addictions 3 (2): 105–112. doi:10.1300/J160v03n02_07. 
  14. ^ Huffman, Melinda (April 2007), "Health Coaching: A new and exciting technique to enhance patient self-management and improve outcomes", Home Healthcare Nurse (Bridgewater, New Jersey: Home Healthcare Nurses Association) 25 (4): 271–276, doi:10.1097/01.NHH.0000267287.84952.8f, ISSN 0884-741X, OCLC 729640500, PMID 17426499 
  15. ^ Wolever, R. Q.; Dreusicke, M.; Fikkan, J.; Hawkins, T. V.; Yeung, S.; Wakefield, J.; Duda, L.; Flowers, P.; Cook, C.; Skinner, E. (9 June 2010). "Integrative Health Coaching for Patients With Type 2 Diabetes: A Randomized Clinical Trial". The Diabetes Educator 36 (4): 629–639. doi:10.1177/0145721710371523. 
  16. ^ Vale, Margarite J. (8 December 2003). "Coaching patients On Achieving Cardiovascular Health (COACH)<subtitle>A Multicenter Randomized Trial in Patients With Coronary Heart Disease</subtitle>". Archives of Internal Medicine 163 (22): 2775. doi:10.1001/archinte.163.22.2775. 
  17. ^ Merrill, RM; Aldana, SG; Bowden, DE (2010 Mar-Jun). "Employee weight management through health coaching.". Eating and weight disorders : EWD 15 (1-2): e52–9. PMID 20571321. 
  18. ^ Terry, Paul E.; Seaverson, Erin LD; Staufacker, Michael J.; Tanaka, Akiko (1 June 2011). "The Effectiveness of a Telephone-Based Tobacco Cessation Program Offered as Part of a Worksite Health Promotion Program". Population Health Management 14 (3): 117–125. doi:10.1089/pop.2010.0026. 

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