Wellness Coaching to Improve Lifestyle Behaviors Among Adults With Prediabetes: Patients' Experience and Perceptions to Participation

Feasibility and acceptability of a tailored health coaching intervention to improve type 2 diabetes self-management in Saudi Arabia: a mixed-methods randomised feasibility trial

BACKGROUND

Around one-third of the population of Saudi Arabia have been diagnosed with type 2 diabetes, a condition often requiring lifestyle changes. Personalised health coaching, a strategy developed to assist individuals in overcoming challenges to adopt healthy behaviours, has not yet been widely applied in the country.

AIMS

We aim to explore the feasibility and acceptability of tailored health coaching in Saudi Arabia, in order to help those with type 2 diabetes to more effectively manage their condition.

METHODS

Using a mixed-methods approach, this research involved a randomised controlled trial with 30 Saudi adults who have type 2 diabetes. They were randomly allocated into either the intervention or control arm for 12 weeks. The Capability, Opportunity, Motivation and Behaviour framework was used to guide the intervention implementation along with the Behaviour Change Techniques Taxonomy V.1. The primary goal was to assess the suitability and duration of the intervention, recruitment, retention and completion rates. The secondary outcome focused on the preliminary efficacy of the health coaching measured by the glycaemic index, blood pressure, body mass index (BMI), waist circumference, weight, patient self-efficacy and diabetes self-management.

RESULTS

The results showed high rates of eligibility, recruitment and retention (a screening rate of 90%, a recruiting rate of 79% and a retention rate of 97%). Notable improvements were observed in the health coaching group across five outcomes: haemoglobin A1c, BMI, waist circumference, patient self-efficacy and diabetes self-care. Qualitative findings highlighted the participants' perceived benefits from the intervention, including enhanced motivation, better understanding of diabetes management and a supportive coaching relationship. Participants expressed high satisfaction with the intervention and advocated for its expansion.

CONCLUSION

The findings demonstrated positive outcomes, supporting the need for a larger randomised controlled trial to evaluate the efficacy of health coaching in improving diabetes self-management among individuals with type 2 diabetes in Saudi Arabia.

Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study

BACKGROUND

An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension.

OBJECTIVE

This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.

METHODS

We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority).

CONCLUSIONS

The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process.

Patient Engagement in Health Coaching and Self-Management Abilities in Chronic Obstructive Pulmonary Disease

Objective: Health coaching has the potential to improve self-management abilities (SM) in patients with Chronic Obstructive Pulmonary Disease (COPD). Patient engagement with health care providers has a beneficial effect on patient outcomes. We examined the association of patient engagement with the health coach on SM abilities in patients with COPD. Methods: We analyzed the association between the degree of engagement measured by the Working Alliance Inventory (WAI-SR) and the SM measured by the Self-Management-Ability-Scale-30 (SMAS-30) at the end of a COPD health coaching intervention. Results: The cohort included 146 moderate to severe COPD patients. The WAI-SR total score was 85% of the maximum possible scores indicating a high degree of engagement between the health coach and the patients. The WAI-SR Task and Bond domains were positively associated with SM abilities after adjusting for lung function (FEV1 %) and depression symptoms (PHQ-2). Conclusion: The degree of engagement between a health coach and patients is associated with the perception of SM abilities in patients with COPD. Our results may inform self-management intervention and clinical practice.

Adults' perceived health promotion needs in the prediabetes stage: a meta-synthesis study

Introduction

One of the methods to promote pre-diabetic patients' adherence to preventive behaviors and improving their lifestyle is to pay attention to their needs in the designed educational programs. Therefore, this study was conducted with the aim of identifying the needs of individuals with prediabetes.

Methodology

Three databases, including ISI/Web of Sciences, PubMed, Scopus were searched without time limitation until August 2022. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines and to achieve the research goal, Sandelowski and Barroso's seven-step meta-synthesis method (2007) was used. Thematic synthesis was used to analyses the data.

Results

Out of the 1934 studies obtained, 34 studies were finally examined and 805 codes were recorded based on the extracted data. Through synthesizing and analyzing the primary studies, 8 main themes were extracted regarding individuals' needs in the prediabetes stage: Information needs, Cultural needs, psychological needs, Social support needs, Education needs, Financial needs, Service needs and Skill needs.

Discussion and Conclusions

The perceived needs and their types in each of the dimensions in detail can be a proper guide for designing educational programs and various interventions to control the prediabetes condition, leading to a reduction in the prevalence of type 2 diabetes in the society.

A Pilot Evaluation of a University Health and Wellness Coaching Program for College Students

Poor mental well-being has been associated with negative student success outcomes among college students. Health and wellness coaching programs have been implemented in college campuses to address gaps in well-being support services. This pilot study evaluated a health and wellness coaching program at a large, urban university. A total of 499 students expressed interest in the program with 120 responding to a retrospective survey about their experience. Findings revealed that most students attended coaching for issues related to time and stress management or factors that commonly influence stress. Overall, students who participated in coaching were successful at improving their self-efficacy toward behavior change, changing their behavior, and achieving their goals. Students reported attending an average of four sessions with number of sessions attended being associated with increased confidence and motivation. In addition, autonomy, competence, and relatedness felt within the relationship with the coach were correlated with increased motivation, confidence, and readiness for behavior change. There was some relapse in terms of goal attainment observed with 17.4% of students who met their goals being unable to maintain progress. The program participants appeared to have enjoyed the process with 96% of students saying they would recommend the program to a friend. Health and wellness coaching programs may alleviate the burden of stress and other subclinical mental health concerns as well as decrease the number of students requiring services from more intensive mental health resources on campus.

The Untapped Power of Health and Wellness Coaching

The Department of Veterans Affairs (VA) has launched an organization-wide transformation to a Whole Health System of Care, which relies heavily on Health and Wellness Coaching. A brief history and overview of Health and Wellness Coaching, in general, is provided, along with specific developments within VA, selected evaluation results, and coordination to date with the Department of Defense. As VA's Whole Health transformation reaches maturity, there is an opportunity to adopt VA's Health and Wellness Coaching approach into the Department of Defense's Total Force Fitness efforts with integration at the unit level.

Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities

Although resident wellness is increasingly a priority in senior living communities, there are few programs that promote holistic wellness in later life. A total of 79 residents (ages 71 to 97; M = 84.27, SD = 6.46) from eight senior living communities completed a pilot study of a novel, staff-led wellness coaching program consisting of resident-driven goals and individual and group coaching sessions. Participants completed surveys at three time points (pre-program, post-program, and 1-month follow-up). Repeated measures ANOVAs revealed positive changes in resident health satisfaction, physical quality of life (QOL), psychological QOL, loneliness, relatedness, competence, and sense of purpose. Some of these results (i.e., psychological QOL, loneliness) persisted at follow-up. Residents reported high satisfaction with the program. These findings have implications for the application of holistic wellness frameworks in later life, as well as the development and implementation of wellness coaching programs with older adults.

Behavioral Theory-Based Framework for Prediabetes Self-Care System-Design Perspectives and Validation Results

Type 2 diabetes (T2D) is a chronic condition that can lead to many life-threatening diseases. Prediabetes is defined as a state in which blood glucose levels are elevated but not high enough to be diagnosed as diabetes. This stage can be reversible with appropriate lifestyle and dietary modifications. Existing solutions are mostly developed to deal with T2D instead of preventing it in the first place. In this study, we propose a framework to aid in the development of self-care systems to prevent T2D, which integrates behavioral change theories and techniques and offers features, such as goal setting, activity planning, and health monitoring. We then assessed the feasibility of a prediabetes self-care system designed based on the proposed framework. Quantitative and qualitative methods were adopted in evaluating i-PreventDiabetes, a prototype. Numerous aspects of the prototype were evaluated, including (1) its effectiveness in assisting individuals with prediabetes in improving their health management behaviors, (2) its effect on users’ attitudes toward diabetes prevention, (3) users’ motivation levels, (4) user acceptability of the system, and (5) user experience. Users viewed i-PreventDiabetes positively and experienced a positive change in their attitude toward their health. Diabetes prevention systems, such as i-PreventDiabetes, have the potential to increase self-care behaviors among individuals with prediabetes, enabling them to manage their lifestyle and nutrition more effectively to avert a variety of potentially fatal conditions.

Ethics in Telehealth: Comparison between Guidelines and Practice-based Experience -the Case for Learning Health Systems

OBJECTIVES

To understand ethical issues within the tele-health domain, specifically how well established macro level telehealth guidelines map with micro level practitioner perspectives.

METHODS

We developed four overarching issues to use as a starting point for developing an ethical framework for telehealth. We then reviewed telemedicine ethics guidelines elaborated by the American Medical Association (AMA), the World Medical Association (WMA), and the telehealth component of the Health Professions council of South Africa (HPCSA). We then compared these guidelines with practitioner perspectives to identify the similarities and differences between them. Finally, we generated suggestions to bridge the gap between ethics guidelines and the micro level use of telehealth.

RESULTS

Clear differences emerged between the ethics guidelines and the practitioner perspectives. The main reason for the differences were the different contexts where telehealth was used, for example, variability in international practice and variations in the complexity of patient-provider interactions. Overall, published guidelines largely focus on macro level issues related to technology and maintaining data security in patient-provider interactions while practitioner concern is focused on applying the guidelines to specific micro level contexts.

CONCLUSIONS

Ethics guidelines on telehealth have a macro level focus in contrast to the micro level needs of practitioners. Work is needed to close this gap. We recommend that both telehealth practitioners and ethics guideline developers better understand healthcare systems and adopt a learning health system approach that draws upon different contexts of clinical practice, innovative models of care delivery, emergent data and evidence-based outcomes. This would help develop a clearer set of priorities and guidelines for the ethical conduct of telehealth.