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The Inside Story: Health Coaching nudges toward lasting lifestyle changes

October 12, 2018

What do your old high school gym teacher, your book club buddies, the worker at the home improvement store, your family, and (we hope) your boss, and even some colleagues all have in common? They all provide support and guidance—in this case, for getting active, expanding your mind, renovating your kitchen, and having successes at home and work. Essentially, they are all coaches. And to begin where the September 2018 edition of The Inside Story left off, health coaching is an example of smart spending because it nudges your plan members toward lasting lifestyle changes. Here’s how…

And, just checking… what exactly happened to all those New Year’s resolutions?

If your answer is “absolutely nothing,” you’re not alone. In fact, if you’re like most people, try as you might, your resolutions eventually fall by the wayside. However, also if you’re like most people, “absolutely nothing” is a bit harsh. With lifestyle changes, most people have really good intentions and try things like purging their cupboards of any evil sugary treats, going cold turkey with no cigarettes or alcohol, and throwing money at the situation by joining a gym or health program. But alas, most people struggle with behaviour change and sadly, often fail. Why is that?

Without a nudge, it’s hard to budge

Remember all those behaviour change theories introduced in the July/August 2014 edition of The Inside Story? What’s common to all of them is that behaviour change is hard. Unfortunately, there is no quick fix—and lasting change typically requires various strategies and many kicks at the can. That’s where nudging theory comes in (as elaborated on in the October 2014 edition of The Inside Story). In a nutshell, to positively influence behaviour change, little nudges guide your plan members toward a specific choice in a way that still leaves them in control. Accordingly, nudges create self-reliance. And nudges come in all shapes and forms; one is health coaching.

A health coach isn’t necessarily a doctor and increasingly not a doctor. As explained in the March 2016 edition of The Inside Story, pharmacists, dietitians, nurses, and exercise physiologists can all act as health coaches. This is typically considered a good thing given the time limitations most doctors face. In addition, a variety of types of health coaches means easier access.

Recognizing the many benefits of health coaching as a way to help address today’s cash-strapped and chronic-diseaseabundant environment, health coaching skill development is gaining traction in Canada. As a result, health coaching is a part of many health professionals’ work to various degrees. For example, as described in the March 2016 edition of The Inside Story, the University of Waterloo’s pharmacy program weaves elements of health coaching into its curriculum. Health coaching is also a growing part of dietitian training.

In addition, although there is no accreditation body for health coaches in Canada, a variety of certificate programs in health coaching are now available through Canadian colleges and universities, as well as private educational organizations. Most programs are continuing education with eligibility based on already having a diploma or degree from a college or university in, for example, nursing, social work, nutrition, or kinesiology. In-person classes, online modules, and work placements are typically part of the certificate program.

Regardless of the type of condition or setting, health coaching has a common purpose: to help move patients toward their health prevention or management goals by motivating and supporting them to take responsibility for their own health and progress. Taking responsibility is key; health coaching is successful to a large part because it represents a significant shift away from the patient simply taking direction as a passive recipient of care (as in, “my doctor knows best and tells me what to do”). By contrast, health coaching focuses on collaboration where the patient is actively involved in their health care (as in “my health coach works with me to problem solve to help me make better lifestyle choices”).9

It’s time to teach them to fish (OK, not literally…)

Due to an emphasis on self-management, health coaching is sometimes compared to the old adage: “Give the man (or plan member) a fish, and the plan member eats for a day. Teach a plan member to fish, and he eats for a lifetime.”10 By giving plan members a “fish”—drugs for conditions like high cholesterol and hypertension—we are helping, but to a limited degree. Whereas, what plan members need to successfully prevent and manage chronic conditions is not just fish/drugs, they need to learn
to fish.

Health coaching teaches your plan members how to fish—they learn the skills to self-manage their lifestyle behaviours. Research shows that selfmanagement is precisely the component that is essential for long-term, consistent behaviour change. For example, an analysis of 53 randomized controlled trials concluded that self-management support improves blood pressure and glucose control.11 Research also shows that the addition of support in the form of coaching to increase a patient’s skills and confidence in managing their condition and setting realistic goals can be significantly more effective than education alone.12

Overall, the evidence reveals that health coaching in many forms is leading to positive health outcomes.

In-person health coaching shows benefits…

A 2015 study published in the The Annals of Family Medicine investigated whether in-person health coaching by medical assistants improves the ability to control cardiovascular and metabolic risk factors like blood pressure and cholesterol levels, when compared with standard care. It involved a 12-month randomized controlled trial with 441 patients. Results include that the intervention group, which received health coaching, improved control of average blood glucose level and “bad” cholesterol (low-density lipoproteins that leads to a buildup of cholesterol arteries) compared with usual care.14

Telephone health coaching shows benefits…

A 2014 study published in the Journal of Occupational Health Psychology explored whether a six-session, telephone-based coaching intervention helps employees with chronic conditions manage the challenges they face when compared with employees with chronic conditions who did not receive health coaching. It involved a 12-week randomized controlled trial with 59 participants. Results include that the intervention group that received telephone coaching showed significantly improved perceptions of their ability to work, less burnout due to exhaustion, and better resilience. These positive effects were still present 12 weeks after coaching ended.15

Internet health coaching shows benefits…

A 2016 study published in Diabetes Technology & Therapeutics examined whether using an internet-based diabetes management program helps patients with type 2 diabetes, who are starting insulin, to achieve better glycemic control compared with patients who just receive standard clinical practice. It included a 14-week randomized controlled study with 40 patients. Standard practice included face-to-face care with phone follow-up as needed. The internet-based program included regular communications about glycemic control and insulin doses and was conducted via patient self-tracking tools, shared decision-making interfaces, secure text messages, and virtual visits (audio, video, and shared-screen control) instead of office visits. Results include that the intervention group receiving the internet-based diabetes management program had better glycemic control compared with the control group. The researchers also conclude that mobile health technology could be an effective tool in sharing data and enhancing communication, while enabling collaborative decision making in diabetes care.16

The facts have spoken: Relying on the best available evidence from the scientific research reveals that health coaching delivers health value in terms of behaviour change. In other words (or in GSC-speak), that means smart spending.

If it walks like a duck, and talks like a duck, it’s a duck…

First a fish, now a duck… applying the deductive reasoning “duck test,” health coaching represents smart spending. It can not only deliver positive health outcomes, its high level of flexibility—in terms of type of professional coach, health condition, and setting—means it also adds value in numerous ways. For example, with telephone and internet-based health coaching, in addition to leading to positive health outcomes, these virtual approaches overcome barriers, like cost, accessibility, and time commitment.

So why is it that health coaching delivers this bundle of benefits; what exactly is its magic bullet? Turns out there are many magic bullets as Peter Gove, GSC’s innovation leader, health management, explains:

“It seems that health coaching has a number of attributes built into it that help patients develop the self-management skills necessary to successfully change their behaviour. For example, health coaching
is highly customized to each person’s specific situation. So the coach’s advice isn’t generic, instead it’s tailored to specific needs and individual environments. Also, of course, coaching in essence is support so people don’t feel like they’re going it alone; they have support for better or for worse. This is important because behaviour change typically involves two steps forward, one step back. And inherent in health coaching is also a sense of accountability and commitment so the person feels a combination of determined and dedicated, plus they don’t want to let the coach down.

“Evaluation is also key; measurement needs to be built into health coaching models. For example, even with what could be considered mental health coaching—psychotherapy—which has been notoriously difficult to assess, research shows that measuring psychotherapy leads to better outcomes. For example, providing both therapists and clients with session-by-session progress measurements, like completing surveys, improves results because it catches when therapy isn’t working earlier. This can decrease the number of therapy drop outs. In fact, regularly measuring progress has been found to double the positive outcomes for clients who were not improving in therapy and to decrease by more than half the number of people who were getting worse.”18

Everyone needs a helping hand… ideally, in the form of a nudge from a health coach

With the high incidence of chronic conditions, helping plan members get healthier is understandably top of mind. In the 2018 Sanofi Healthcare Survey, 77% of plan sponsors indicate they are concerned about the impact of unmanaged chronic disease on the productivity of their workforce. And 79% of plan sponsors would like their health benefit plan to do more to support plan members with chronic diseases.19 We’re listening! GSC is exploring how to expand beyond our current health coaching programs that focus on cardiovascular health, smoking cessation, and nutrition.

Fitness health coaching for inactive plan members, as well as possibly diabetes prevention and asthma health coaching are all fuelling our innovation grey matter lately. Plus, since in addition to digging up research, we like doing our own (OK, we love it), we’re planning a depression prevention study that involves, you guessed it, telephone health coaching. We hope to give plan sponsors the helping hand they need to nudge plan members into getting help.

Click here for a PDF of the Inside Story

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