October 8, 2015
By Joel Kreisberg, DC, ACC
Health and wellness coaching is “a patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach. The coach is a healthcare professional trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being.” – Wolever et al
Health coaching hasn’t been around long, but it has attracted researchers interested in seeing just what is happening and whether coaches are having an impact. Because it’s an emerging profession, it’s important to take stock of what we do know from objective research approaches. A review of the literature is a nice way of showing fellow health professionals what we do know. Luckily Ruth Wolever, PhD and her team produced a fabulous review of the literature in the 2014 issue of Global Advances in Health and Medicine (2013: 2 (4) 38-57), in which 800 studies were identified. Do read the whole review; I’m going to highlight a few findings plus spotlight several specific studies.
*(Note that I use the terms patient and client interchangeably below.)
According to Wolever, health and wellness coaching was considered fully or partially patient-centered in 86% of the full article reviews, and self-discovery and active learning processes (rather than the more passive ‘receiving advice’) were found in 63% of the articles. In 91% of the research articles, education coaches provided information as to health coaching processes, 86% of the research articles stated that coaching encouraged accountability of behaviors and 91% found that coaching occurs in consistent, ongoing relationships with a human coach who is trained specifically in behavior change, communications and motivational skills.
In the research articles that articulated whether patients determine their own goals for the coaching program, a full 45% described coaching goals as fully determined by the client and another 26% reported that the patients partially determined the coaching goals, while 30% of the literature found coaching to be completely set externally without input from the patients. 60% of the studies reporting had participants working with the same coach over time, and 21% offered coaching without a consistent coach.
In terms of how the coaching is delivered, 95% of the coaching happened between two people, and 5% used technology-based c
oaching. Of the human coaches 93% were professional coaches and 7% were lay individuals. Of these professional coaches, 53% were medically trained and 51% were allied health professionals (one can be in both categories)—42% were nurses, 21% mental health professionals, dieticians 11%, health educators 8%. In terms of training, there is a wide range of training from 2 hours to 2 years. The median is between 6 hours and 40 hours.
The emerging evidence-based consensus regarding the components of health and wellness coaching is that behavior change and learning occur most reliably when there is a helping relationship that (1) acknowledges the individual, (2) is collaborative, and (3) encourages active learning.
Interestingly, in terms of empirical outcome research, several studies stand out. Starting with Frates, Moore, Lopez and McMahon, in the American Journal of Physical Medicine and Rehabilitation 2011 90: No 12: 1074-1082 that found that health coaching led to improved outcomes in cardiovascular disease , diabetes, cancer pain and asthma. Vale, et al found a drop in cholesterol 3 times higher with coaching versus the control group. The Whittemore study with coaching and diabetes found “better diet self-management, less diabetes related distress and higher satisfaction with care.” Wolever’s et al study with 56 patients with type 2 diabetes found significant education in hemoglobin A1C among those with baseline over 7. Fischer et al completed a study of 191 children with asthma, finding a decreased re-hospitalization rate compared with controls, and the Oliver study with 67 cancer pain patients found improved pain severity compared with control groups.
More recently Kivela, Elo, Kynga and Kaarianinen’s systematic review of studies with health coaching by health care professionals published in October 2014 included 13 studies with outcome measures. Results were that 11 of the 13
showed statistically significant improvement such as improved physiological measures (body weight loss, lower hemoglobin A1C), improved behavioral outcomes (increased physical activity) improved psychological outcomes (self-efficacy and mental health) and improved social outcomes (social support) The conclusion of this study states that “(h)ealth Coaching improved the management of chronic diseases. (It) is an effective patient education method that can be used to motivate and take advantage of a patient’s willingness to change their lifestyle and to support the patient’s home based self-care.”
Finally, it should be noted that Frates et al, presented a very clear distinction between a physician and a health coach. The physician treats patients; the coach helps patients help themselves. The physician educates; the coach motivates and builds confidence. The physician relies on skills and expert knowledge; the coach relies on patient self-awareness and insights. The physician strives to have all the answers; the coach strives to help patient’s discover their own answers. The physician focuses on the problem; the coach focuses on what is working well. And finally. the physician advises and the coach collaborates.
Fisher, EB PhD; Strunk, RC; Highstein, GR; Kelley-Sykes, R; Tarr, KL MD, Trinkaus, K; Musick, J A Randomized Controlled Evaluation of the Effect of Community Health Workers on Hospitalization for Asthma, Arch Pediatr Adolesc Med. 2009;163(3):225-232. doi:10.1001/archpediatrics.2008.577
Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Couns. 2014 Nov;97(2):147-57. doi:10.1016/j.pec.2014.07.026.
Vale MJ1, Jelinek MV, Best JD, Dart AM, Grigg LE, Hare DL, Ho BP, Newman RW, McNeil JJ; COACH Study Group. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Intern Med. 2003 Dec 8-22;163(22):2775-83.
Wolever RQ, Dreusicke M, Fikkan J, Hawkins TV, Yeung S, Wakefield J, Duda L, Flowers P, Cook C, Skinner E. Integrative health coaching for patients with type 2 diabetes: a randomized clinical trial. Diabetes Educ. 2010 Jul-Aug;36(4):629-39. doi: 10.1177/0145721710371523.
Wolever, LA, ; Sforzo, GA, ; Dill, D, Kaye, M ; Bechard, EM, Southard, ME, Kennedy, M: Vosloo, J, Yang, N. A Systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioral intervention in Healthcare Global Adv Health Med. 2013;2(4)38-57. DOI: 10.7453/gahmj.2013.042