The LAST Word on Coaching as a Stroke Intervention?

Exploring facilitators and barriers to long-term behavior change following health-wellness coaching for stroke prevention: A qualitative study conducted in Auckland, New Zealand

INTRODUCTION

Health-wellness coaching (HWC) has grown in popularity as a means of empowering individuals to take responsibility for their health behavior and make lifestyle changes to reduce their risk of stroke. Understanding the facilitators and barriers to long-term behavior change is key if preventive strategies such as HWC are to be robust and effective. This study aimed to explore the experiences of people at risk of stroke after receiving HWC for stroke prevention, specifically the facilitators and barriers to long-term behavior change from the perspective of study participants.

METHODS

All participants received HWC as part of a randomized controlled trial 3 years earlier. Semi-structured telephone interviews were conducted with eight participants from the trial sample. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key concepts and themes.

RESULTS

Three overarching themes were identified: "Awakening of the mind" captured the importance of seeing the bigger picture, recognizing the impact of potential disease and using skills and tools to support decision-making. "It's not just about health behavior" conveyed the importance of being respectfully responsive to individual need and addressing emotional well-being alongside physical health. "Social connectedness" encapsulated the significance of community engagement, accountability, and paying it forward.

CONCLUSIONS

Enhancing awareness of personal risk and the impact of potential disease are facilitators of long-term behavior change and should be incorporated into coaching conversations. This supports the process of "waking up" to health needs and the possibility of change, which are important precursors to long-term change. Health coaching should be responsive to individual need, with emotional well-being, happiness, and life satisfaction being addressed alongside physical health. The opportunity to develop skills to support decision-making and self-management should be included in coaching initiatives, to enhance self-efficacy and help facilitate long-term behavior change.

Telehealth coaching to improve self-management for secondary prevention after stroke: A randomized controlled trial of Stroke Coach

BACKGROUND

Stroke Coach is a lifestyle coaching telehealth program to improve self-management of stroke risk factors.

AIMS

To examine the efficacy of Stroke Coach on lifestyle behavior and risk factor control among community-living stroke survivors within one-year post stroke.

METHODS

Participants were randomized to Stroke Coach or an attention control Memory Training group. Lifestyle behavior was measured using the Health Promoting Lifestyle Profile II. Secondary outcomes included specific behavioral and cardiometabolic risk factors, health-related quality of life (HRQoL), cognitive status, and depressive symptoms. Measurements were taken at baseline, post-intervention (6 months), and retention (12 month). Linear mixed-effects models were used to test the study hypotheses (p < 0.05). All analyses were intention-to-treat.

RESULTS

The mean age of the Stroke Coach (n = 64) and Memory Training (n = 62) groups was 67.2 and 69.1 years, respectively. The majority of participants (n = 100) had mild stroke (modified Rankin Scale = 1 or 2), were active, with controlled blood pressure (mean = 129/79 mmHg) at baseline. At post-intervention, there were no significant differences in lifestyle (b = -2.87; 95%CI - 8.03 to 2.29; p = 0.28). Glucose control, as measured by HbA1c (b = 0.17; 95%CI 0.17 to 0.32; p = 0.03), and HRQoL, measured using SF-36 Physical Component Summary (b = -3.05; 95%CI -5.88 to -0.21; p = 0.04), were significantly improved in Stroke Coach compared to Memory Training, and the improvements were maintained at retention.

CONCLUSION

Stroke Coach did not improve lifestyle behavior; however, there were improvements to HbA1c and HRQoL among community-living stroke survivors with mild stroke-related disability. (ClinicalTrials.gov identifier: NCT02207023).