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Kennedy MA, Wood KC, Campbell A, Potiaumpai M, Wilson CM, Schwartz AL, Gorzelitz J, Caru M, Schmitz KH. Identification of core competencies for exercise oncology professionals: A Delphi study of United States and Australian participants. Cancer Med 2024; 13:e70004. [PMID: 39046221 PMCID: PMC11267632 DOI: 10.1002/cam4.70004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/13/2024] [Accepted: 06/30/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION Integration of exercise into standard oncology care requires a highly skilled workforce of exercise professionals; however, competency requirements have not kept pace with advancements in the field. Therefore, the aim of this study was to obtain consensus on core competencies required for an exercise professional to be qualified to work with adults undergoing active cancer treatment. MATERIALS AND METHODS A three-round modified electronic Delphi process was used. In Round 1, an international group of 64 exercise oncology stakeholders (i.e., exercise oncology professionals (n = 29), clinical referrers (n = 21), and people with lived experience (n = 14)) responded to open-ended prompts eliciting perspectives regarding competencies needed for an exercise oncology professional to work with adults receiving active cancer treatment. Subsequently, only exercise oncology professionals participated, ranking the importance of competencies. In Round 2, professionals received summary feedback, ranked new competencies generated from open-ended responses, and reranked competencies not reaching consensus. In the final round, professionals finalized consensus ranking and rated frequency and mastery level for each. RESULTS Consensus was reached on 103 core competencies required for exercise professionals to be qualified to deliver care to adults undergoing active cancer treatment. The core competencies represent 10 content areas and reflect the needs of clinical referrers and people with lived experience of receiving cancer treatment. CONCLUSIONS The core competencies identified reflect significant advancements in the field of exercise oncology. Results will underpin the development of education, certification, and employment requirements for exercise oncology professionals, providing a critical step toward achieving routine integration of exercise into standard oncology care.
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Affiliation(s)
- Mary A. Kennedy
- Nutrition and Health Innovation Research Institute, School of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
| | | | - Anna Campbell
- School of Applied SciencesEdinburgh Napier UniversityEdinburghUK
| | - Melanie Potiaumpai
- Division of Hematology and OncologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Christopher M. Wilson
- Physical Therapy Program, School of Health SciencesOakland UniversityRochesterMichiganUSA
- Founding Residency Program DirectorBeaumont Health Oncology ResidencyTroyMichiganUSA
| | - Anna L. Schwartz
- College of Nursing, University of Nebraska Medical CenterOmahaNebraskaUSA
| | - Jessica Gorzelitz
- Department of Health and Human PhysiologyUniversity of IowaIowa CityIowaUSA
| | - Maxime Caru
- Department of Pediatrics, Division of Hematology and OncologyPennsylvania State Health Children's HospitalHersheyPennsylvaniaUSA
| | - Kathryn H. Schmitz
- Division of Hematology and OncologyUniversity of PittsburghPittsburghPennsylvaniaUSA
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Wolever RQ, Cline TR, Weiss JM, Carmack S, Schultz C, Arloski M, Lawson K. Group Health & Wellness Coaching: development and validation of the required competencies. BMC Health Serv Res 2024; 24:392. [PMID: 38549090 PMCID: PMC10976677 DOI: 10.1186/s12913-024-10704-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 02/09/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND As the popularity and demonstrated effectiveness of Health and Wellness Coaching (HWC) continue to grow to address chronic disease prevalence worldwide, delivery of this approach in a group format is gaining traction, particularly in healthcare. Nonetheless, very little empirical work exists on group coaching and there are currently no published competencies for Group Health and Wellness Coaching (GHWC). METHODS We used a well-established two-phase (Development and Judgment) process to create and validate GHWC competencies with strong content validity. RESULTS Seven highly qualified Subject Matter Experts systematically identified and proposed the GHWC competencies, which were then validated by 78 National Board Certified Health and Wellness Coaches (NBC-HWCs) currently practicing GHWC who rated the importance and use frequency of each one. The validation study led to 72 competencies which are organized into the structure and process of GHWC. CONCLUSIONS GHWC requires not only coaching skills, but significant group facilitation skills to guide the group process to best support members in maximizing health and well-being through self-directed behavioral change. As the presence of HWC continues to grow, it is imperative that GHWC skill standards be accepted and implemented for the safety of the public, the effectiveness of the intervention, and the value analysis of the field. Such standards will guide curriculum development, allow for a more robust research agenda, and give practical guidance for health and wellness coaches to responsibly run groups. High quality standards for GHWC are particularly needed in health care, where a Level III Current Procedural Terminology (CPT®) code for GHWC has been approved in the United States since 2019 and reimbursement of such has been approved by the Centers for Medicare and Medicaid for 2024.
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Affiliation(s)
- Ruth Q Wolever
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Schools of Medicine and Nursing, Nashville, TN, USA.
| | | | | | - Suzie Carmack
- Maryland University of Integrative Health, Laurel, MD, USA
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D’Adamo CR, Kaplan MB, Campbell PS, McLaughlin K, Swartz JS, Wattles KR, Lukaczer D, Scheinbaum S. Functional medicine health coaching improved elimination diet compliance and patient-reported health outcomes: Results from a randomized controlled trial. Medicine (Baltimore) 2024; 103:e37148. [PMID: 38394515 PMCID: PMC11309605 DOI: 10.1097/md.0000000000037148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The objective of this study was to determine whether an elimination diet with virtually provided functional medicine health coaching support would be more effective than a typical self-guided elimination diet with respect to dietary compliance and patient-reported health and quality of life. METHODS A parallel arm, randomized controlled trial was conducted among a sample of healthcare professionals. Participants were randomized to either an elimination diet with 5 sessions of functional medicine health coaching support (intervention arm) or a self-guided elimination diet (control arm). Outcomes assessed at baseline and at the conclusion of the 10-week study included PROMIS Global Health (GH) and medical symptoms questionnaire (MSQ). Compliance with the elimination diet was assessed at the conclusion of the study. Baseline and end of study outcomes were compared within study arms via paired t tests and between study arms with unpaired t tests. Subgroup analysis of symptomatology at baseline was performed. RESULTS 125 randomized participants (n = 64 intervention, n = 61 control) provided baseline outcomes data. There were statistically and clinically significant within-group improvements in patient-reported outcomes in both the intervention arm (PROMIS GH-physical = 4.68, PROMIS GH-mental = 3.53, MSQ = 28.9) and control arm (PROMIS GH-physical = 48.4, PROMIS GH-mental = 3.18, MSQ = 24.1). There were no between-group differences in the primary analysis (P > .1). However, participants with more symptoms at baseline had statistically and clinically significant between-group differences in PROMIS GH-mental health (3.90, P = .0038) and MSQ (12.3, P = .047) scores that favored the functional medicine health coaching arm. CONCLUSIONS An elimination diet, whether self-guided or with functional medicine health coaching support, may improve patient-reported health outcomes among relatively healthy healthcare professionals. While studies in more diverse samples are needed, functional medicine health coaching support appears to be superior to a self-guided approach with regard to both dietary compliance and improving health outcomes among those with greater symptomatology.
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Affiliation(s)
- Christopher R. D’Adamo
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Dan Lukaczer
- The Institute for Functional Medicine, Federal Way, WA
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Harenberg S, Sforzo GA, Edman J. A Rubric to Assess the Design and Intervention Quality of Randomized Controlled Trials in Health and Wellness Coaching. Am J Lifestyle Med 2024; 18:82-94. [PMID: 39184269 PMCID: PMC11339769 DOI: 10.1177/15598276221117089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Objective To collect health and wellness coaching (HWC) literature related to treatment of obesity and Type 2 Diabetes (T2D) for systematic assessment using a novel rubric. Data Source Pubmed, CINAHL, and PsychInfo. Study Inclusion and Exclusion Given 282 articles retrieved, only randomized and controlled trials meeting a HWC criteria-based definition were included; studies with intervention <4 months or <4 sessions were excluded. Data Extraction Rubric assessment required details of two theoretical frameworks (i.e., study design and HWC intervention design) be extracted from each included paper. Data Synthesis Data were derived from a 28-item rubric querying items such as sampling characteristics, statistical methods, coach characteristics, HWC strategy, and intervention fidelity. Results 29 articles were reviewed. Inter-rater rubric scoring yielded high intraclass correlation (r = .85). Rubric assessment of HWC literature resulted in moderate scores (56.7%), with study design scoring higher than intervention design; within intervention design, T2D studies scored higher than obesity. Conclusions A novel research design rubric is presented and successfully applied to assess HWC research related to treatment of obesity and T2D. Most studies reported beneficial clinical findings; however, rubric results revealed moderate scores for study and intervention design. Implications for future HWC research are discussed.
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Affiliation(s)
- Sebastian Harenberg
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
| | - Gary A. Sforzo
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
| | - Joel Edman
- Department of Human Kinetics, St Francis Xavier
University, Antigonish, NS, Canada (SH); Exercise & Sport Sciences, Ithaca College, Ithaca, NY, USA (GAS); and Edman Wellness Services, Media, PA, USA (JE)
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Moore M. Ground Zero in Lifestyle Medicine: Changing Mindsets to Change Behavior. Am J Lifestyle Med 2023; 17:632-638. [PMID: 37711351 PMCID: PMC10498987 DOI: 10.1177/15598276231166320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/13/2023] [Indexed: 09/16/2023] Open
Abstract
The aspiration of lifestyle medicine practitioners is a healthy population engaged daily in lifestyle behaviors that generate the vitality needed to live a good life. That said, we are aware that there is a high population prevalence of low readiness to change behavior. This article proposes that we can improve readiness to change by shifting our expert mindsets to coaching mindsets. We focus first on helping others mobilize resources that improve readiness to change, including motivation and confidence-rather than beginning with expert education and training on new skills and behaviors. We call this coaching activity tilling the (patient's) ground, which then germinates an interest in a mindset shift from an unresolved state (e.g., I don't have time to exercise) to a new state (e.g., I might feel better and be more productive, if I exercise). In a generative conversation, moving from unresolved to resolved improves confidence in behavior change. This mindset shift is called integration-connecting and integrating an unresolved state to new thoughts, ideas, or perspectives (the ah-hah experience). We use the ground zero metaphor in multiple ways, and invite readers to till their own ground, generate potential, and enable integration as role models.
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Affiliation(s)
- Margaret Moore
- Wellcoaches Corporation, Wellesley, MA, USA; Institute of Coaching, McLean is Belmont, MA NBHWC is San Diego, CA; and National Board for Health and Wellness Coaching, San Diego, CA, USA
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Fullen MC, Smith JL, Clarke PB, Westcott JB, McCoy R, Tomlin CC. Holistic Wellness Coaching for Older Adults: Preliminary Evidence for a Novel Wellness Intervention in Senior Living Communities. J Appl Gerontol 2023; 42:427-437. [PMID: 36307916 DOI: 10.1177/07334648221135582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Philip B Clarke
- Department of Counseling, 8676Wake Forest University, Winston-Salem, NC, USA
| | | | - Regina McCoy
- 14616University of North Carolina at Greensboro, Greensboro, NC, USA
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Jordan MA. The Role of the Health Coach in a Global Pandemic. Glob Adv Health Med 2021; 10:21649561211039456. [PMID: 34395059 PMCID: PMC8361512 DOI: 10.1177/21649561211039456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While medical teams were perplexed about the novel SARS-CoV-2 infection, transmission and impairment of organ systems and immune function, viral infections spread worldwide. Complex intersectional issues of co-morbidities coupled with marginalized, diverse ethnic/racial populations emerged as significant risks to contracting severe COVID-19. OBJECTIVE Since a healthy lifestyle is fundamental for lowering risk to chronic diseases, public health initiatives to manage this and future pandemics should include strategies that assist individuals to improve health status through targeted behavior changes. This conceptual paper builds a case for certified professional health coaches as primary actors in future preventive strategies, with expanded skills in addressing social determinants of health and "next generational" cultural competencies. METHODS This concept paper primarily synthesizes fast-tracked research in 2020 regarding the demographic impact of COVID-19, specifically those groups suffering the highest morbidity and mortality rates. Exploring these intersectional issues through a conceptual lens provides strategies for certified health coaches to contribute their expertise in behavioral change within the larger contextual settings of racial/ethnic disparities and social inequities. RESULTS As the co-morbidities and other chronic conditions related to COVID-19 among individuals and families in low-income communities are worsened by dual forces (lifestyle/behavioral choices and ingrained structural inequities), adding the support of certified health coaches to build trust, provide more convenient access to address vaccine hesitancy, and dispell falsehoods, is an effective means for advancing health and wellbeing. Group coaching and one-on-one coaching can work in tandem with public health initiatives for reducing chronic disease burden and addressing social determinants of health (SDoH). Skills are identified in coaching SDoH with expanded cultural competencies for health coaches. CONCLUSION Certified professional health coaches can make a positive impact on general risk reduction of chronic diseases within ethnic/racial minorities, thereby supporting population health in facing future contagions with greater health resilience.
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Affiliation(s)
- Meg A Jordan
- School of Professional Psychology and Health, California Institute of Integral Studies, San Francisco, California
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Piedade KC, Spencer H, Persani L, Nelson LM. Optimizing Fertility in Primary Ovarian Insufficiency: Case Report and Literature Review. Front Genet 2021; 12:676262. [PMID: 34249096 PMCID: PMC8261244 DOI: 10.3389/fgene.2021.676262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 12/31/2022] Open
Abstract
Primary ovarian insufficiency (POI) is a clinical spectrum of ovarian dysfunction. Overt POI presents with oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. Overt POI involves chronic health problems to include increased morbidity and mortality related to estradiol deficiency and the associated osteoporosis and cardiovascular disease as well as psychological and psychiatric disorders related to the loss of reproductive hormones and infertility. Presently, with standard clinical testing, a mechanism for Overt POI can only be identified in about 10% of cases. Now discovery of new mechanisms permits an etiology to be identified in a research setting in 25-30% of overt cases. The most common genetic cause of Overt POI is premutation in FMR1. The associated infertility is life altering. Oocyte donation is effective, although many women prefer to conceive with their own ova. Surprisingly, the majority who have Overt POI still have detectable ovarian follicles (70%). The major mechanism of follicle dysfunction in Overt POI has been histologically defined by a prospective NIH study: inappropriate follicle luteinization due to the tonically elevated serum LH levels. A trial of physiologic hormone replacement therapy, clinically proven to suppress the elevated LH levels in these women, may improve follicle function and increase the chance of ovulation. Here, we report the case of a woman with Overt POI diagnosed at age 35 years. To attempt pregnancy, she elected a trial of intrauterine insemination (IUI) in conjunction with follicle monitoring and physiologic hormone replacement therapy. She conceived on the eighth cycle of treatment and delivered a healthy baby. Our report calls for a concerted effort to define the best methods by which to optimize fertility for women who have POI.
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Affiliation(s)
| | - Hillary Spencer
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
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Barr JA, Tsai LP. Health coaching provided by registered nurses described: a systematic review and narrative synthesis. BMC Nurs 2021; 20:74. [PMID: 33966641 PMCID: PMC8108347 DOI: 10.1186/s12912-021-00594-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Aims The aim of this systematic review and narrative synthesis was to identify how and why health coaching is delivered by Registered Nurses. Design Systematic review and narrative synthesis. Data sources Articles were identified through a search of CINAHL, Medline, Scopus, and PsychINFO databases. Articles published in English between 2010 and 2021 were included. Review Methods Quality appraisal of relevant literature was independently undertaken by two authors to assess for risk of bias. The Critical Appraisal Skills Program (CASP) was used to appraise quality of potential papers. Results A main purpose of coaching by Registered Nurses is to optimise patient self-care. How coaching was conducted varied across studies, with the most common coaching approaches via telephone or online. Majority of studies highlight some effectiveness of coaching by nurses; however, some results were inconclusive. Health coaching generally reduced mental distress. Other benefits reported by patients included reduced pain and fatigue. Outcomes for changing lifestyle behaviours were mixed. However, for health coaching to be efficient greater evidence is needed to determine length of time to use coaching, number of habits to focus on to produce change, and to determine best training for coaches. Conclusions Registered Nurses are most suitable for implementing health coaching for self-care, including preventing and managing chronic illness and recovering from situations like post-surgical needs. Nurses already promote health, and therefore, are skilled in educating people in self-care. Coaching is an additional strategy for motivating, targeting and assessing progress of self-care. Extending the scope of nursing practice to routinely coach in self-care would be ideal.
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Affiliation(s)
- Jennieffer A Barr
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia
| | - Lily P Tsai
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Casuarina, Northern Territory, Australia.
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Davies F, Wood F, Bullock A, Wallace C, Edwards A. Training in health coaching skills for health professionals who work with people with progressive neurological conditions: A realist evaluation. Health Expect 2020; 23:919-933. [PMID: 32468639 PMCID: PMC7495084 DOI: 10.1111/hex.13071] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background Supporting people to self‐manage their long‐term conditions is a UK policy priority. Health coaching is one approach health professionals can use to provide such support. There has been little research done on how to train clinicians in health coaching or how to target training to settings where it may be most effective. Objective To develop theories to describe how training health professionals in health coaching works, for whom and in what circumstances, with a focus on those working with people with progressive neurological conditions. Design Realist evaluation using mixed methods (participant observation, pre‐ and post‐training questionnaires, and telephone interviews with participants and trainers). Realist data analysis used to develop and refine theories. Intervention Two 1‐day face‐to‐face training sessions in health coaching with 11 weeks between first and second days. Setting and participants Twenty health‐care professionals who work with people with neurological conditions in the UK, two training facilitators. Results Four theories were developed using context‐mechanism‐outcome configurations to describe how training triggers critical reflection; builds knowledge, skills and confidence; how participants evaluate the relevance of the training; and their experiences of implementing the training. Some participants reported a major shift in practice, and others implemented the training in more limited ways. Discussion Fully embracing the role of coach is difficult for health professionals working in positions and settings where their clinical expertise appears most highly valued. Conclusions Training should address the practicality of using coaching approaches within existing roles, while organizations should consider their role in facilitating implementation.
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Affiliation(s)
- Freya Davies
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Wood
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Alison Bullock
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Carolyn Wallace
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
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Effect of coaching on glycemic control among type 2 diabetes mellitus patients: A literature review. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.07.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rethorn ZD, Pettitt CD. What Is the Effect of Health Coaching Delivered by Physical Therapists? A Systematic Review of Randomized Controlled Trials. Phys Ther 2019; 99:1354-1370. [PMID: 31309976 DOI: 10.1093/ptj/pzz098] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/04/2019] [Accepted: 02/24/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Health coaching has emerged as an intervention for improving health behaviors. Given the recent increased integration of health coaching into physical therapist practice, there has been a subsequent rise in research examining the effects of health coaching provided by physical therapists. However, there is a lack of literature summarizing the effectiveness of health coaching delivered by physical therapists in changing patient health behaviors. PURPOSE The purpose of this study was to systematically review the effects of health coaching delivered by physical therapists on promoting participant health behaviors. DATA SOURCES Cochrane, CINAHL, MEDLINE, PEDro, PsycINFO, and Web of Science databases were searched from inception to May 26, 2018, to identify randomized controlled trials examining the effects of health coaching delivered by physical therapists. STUDY SELECTION Two reviewers independently screened titles, abstracts, and full texts according to inclusion and exclusion criteria to determine study eligibility. DATA EXTRACTION Methodological quality was assessed using Physiotherapy Evidence Database (PEDro) scores. Risk of bias was assessed using the Cochrane Collaboration risk-of-bias assessment tool. Data were extracted using a standardized data extraction form describing study methods, design, and outcomes. DATA SYNTHESIS Eleven trials met the inclusion criteria for this study. Health coaching produced positive effects on physical activity (6 studies) as well as physiological and psychological secondary outcomes. LIMITATIONS The inclusion of only 11 randomized controlled trials in this review could limit the generalizability of the findings. The heterogeneity of the findings precluded the performance of a meta-analysis. CONCLUSIONS Research on the effectiveness of health coaching delivered by physical therapists on health behavior outcomes is mixed. Data indicate statistically significant changes in some health behavior, physiological, and psychological outcomes.
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Affiliation(s)
- Zachary D Rethorn
- Rocky Mountain University of Health Professions and Doctor of Physical Therapy Division, Duke University, 2200 W Main St, Durham, NC 27703 (USA)
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Dejonghe LAL, Biallas B, McKee L, Rudolf K, Froböse I, Schaller A. Expectations Regarding Workplace Health Coaching: A Qualitative Study With Stakeholders. Workplace Health Saf 2019; 67:317-325. [PMID: 30931841 DOI: 10.1177/2165079919836682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The integration of health coaching in workplace interventions has increased over the past several years. However, the tasks and the qualifications of the coaches have not been clearly defined. The objective of this qualitative study was to assess workplace stakeholders' expectations regarding a health coach. Systematic field notes of 11 meetings and 14 semi-structured interviews with stakeholders of a workplace intervention, including employees, company doctors, and representatives of health insurances, were analyzed according to the structured content analysis. Stakeholders reported that the main aspect of a health coach's work should be the motivation of clients (workers) to achieve their internally developed goals. Regarding the coach's competencies, personal, methodological, and social skills were desired. They also expected that the health coach use a range of different approaches to develop contacts and, in terms of content, focus on physical activity. These findings provide a step toward establishing criteria for professional health coaching and an evidence-based curriculum for coach training.
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Affiliation(s)
| | | | | | | | | | - Andrea Schaller
- 1 German Sport University Cologne.,3 IST University of Applied Science
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Stark Taylor S, Blair Kennedy A. Health and Wellness Coaching: Providers and Practice-A Commentary on Sforzo and Colleagues (2018). Am J Lifestyle Med 2019; 12:451-455. [PMID: 30783396 DOI: 10.1177/1559827618790531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The field of health and wellness coaching holds great promise for making health behavior change interventions available to more individuals. We assert that the health and wellness literature should recognize the potential of lay persons to provide health coaching and lay person health coach studies should be included in the compendium compiled by Sforzo and colleagues. Limiting the field to current health professionals decreases the number of potential coaches unnecessarily. The compendium will be an excellent resource for researchers to compile the existing data to determine the effectiveness of coaching, what aspects of coaching are effective, for what conditions coaching is effective, and what outcomes coaching improves. We provide commentary that researchers exploring health coaching should recognize the importance of physical activity in improving outcomes for a number of different populations and should health behaviors as outcomes in health coaching intervention studies.
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Affiliation(s)
- Shannon Stark Taylor
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina (SST, ABK).,Greenville Health System, Greenville, South Carolina (SST)
| | - Ann Blair Kennedy
- University of South Carolina School of Medicine Greenville, Greenville, South Carolina (SST, ABK).,Greenville Health System, Greenville, South Carolina (SST)
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Boehmer KR, Guerton NM, Soyring J, Hargraves I, Dick S, Montori VM. Capacity Coaching: A New Strategy for Coaching Patients Living With Multimorbidity and Organizing Their Care. Mayo Clin Proc 2019; 94:278-286. [PMID: 30711126 PMCID: PMC6388414 DOI: 10.1016/j.mayocp.2018.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/16/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
Abstract
The prevalence of chronic conditions is growing; to date, 1 in 4 Americans lives with at least one chronic condition. In the population aged 65 years and older, most live with multiple chronic conditions, or multimorbidity. Coaching interventions have been widely touted as a potential way to prevent chronic illness and as a way to help patients better self-manage their chronic illnesses. Health and Wellness Coaching (HWC) is now a respected discipline that offers certification, and HWC for patients with chronic conditions has demonstrated the potential to positively change behaviors and health outcomes. Yet, despite the enthusiasm and advancement of the discipline, the role of HWC has not been examined in light of the latest conceptual and theoretical work in the treatment of multimorbidity. In this article, we briefly describe HWC activities and the way in which they can be modified in alignment with the progress in the field of multimorbidity to form a new type of coaching, Capacity Coaching.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
| | | | - Jason Soyring
- Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Sara Dick
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
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16
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Cornis-Pop M, Reddy KP. Integrative Medicine and Health Coaching in Polytrauma Rehabilitation. Phys Med Rehabil Clin N Am 2018; 30:261-274. [PMID: 30470424 DOI: 10.1016/j.pmr.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Veterans Health Administration (VHA) has embarked on a journey of cultural transformation focused on creating a personalized and patient-driven experience with health care service. In addition to training thousands of providers in the principles of whole health and expanding availability of complementary medicine, VHA also pursues developing the evidence for such care. The Polytrauma Integrative Medicine Pilot explored the feasibility of implementing health coaching in polytrauma care. The qualitative and quantitative data collected on 547 participants in the pilot shows high satisfaction with the health coaching services received and statistically significant positive changes in domains of life satisfaction and well-being.
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Affiliation(s)
- Micaela Cornis-Pop
- Rehabilitation and Prosthetic Services, McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA; Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kavitha P Reddy
- Primary Care, VA St. Louis Health Care System, 3641 Olive Street, St Louis, MO 63108, USA; Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
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17
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Tkacova R. Erickson health coaching: An innovative approach for weight management in obese patients with obstructive sleep apnoea? Med Hypotheses 2018; 120:43-47. [PMID: 30220338 DOI: 10.1016/j.mehy.2018.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/06/2018] [Accepted: 08/16/2018] [Indexed: 12/17/2022]
Abstract
Obstructive sleep apnoea (OSA) is a highly prevalent medical condition and amajor cardiovascular risk factor. Obesity is present in ∼70% of patients with OSA, nevertheless, continuous positive airway pressure (CPAP) ventilation - the gold standard therapy for moderate and severe OSA - has no appreciable long-term beneficial effects on obesity, body composition, energy metabolism, physical activities or the incidence of major cardiovascular events. Therefore, effective weight loss strategies in conjunction with CPAP therapy in OSA are critically needed. Since lifestyle interventions may positively impact body weight, there is a strong rationale to testing the hypothesis that Erikson coaching intervention as a form of lifestyle intervention to obese patients with OSA may increase their adherence to healthy lifestyle behaviour and thus result in weight reduction, improved body composition (reduction in %body fat) and improvements in glucose and lipid metabolism. There are three lines of evidence to justify testing this hypothesis: First, health coaching significantly facilitates uptake of healthy behaviours across a broad variety of chronic conditions; second, several randomized clinical trials suggested positive impact of health coaching on weight management and on cardiometabolic risk factors in overweight/obese otherwise healthy persons; third, Erickson coaching approach empowers the three key elements of health coaching (patient-centeredness, patient-determined goals, use of a self-discovery process) further, namely by introducing two other specific core elements into the coaching process: a) solution-focus and outcome frame, b) orientation at the patient-formulated positive outcomes (i.e., positive values resulting from behavioural change). Importantly, results of our recent pilot observational cohort study suggested that Erickson coaching is a powerful tool to address behavioural modification in obesity. In conclusion, testing our hypothesis may have significant clinical implications: if clinical randomized trials indicate that Erickson health coaching is an efficient approach to behavioural change and weight management in OSA then combining Erickson coaching with CPAP therapy may result in reductions in cardiovascular morbidity and mortality in these high-risk patients.
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Affiliation(s)
- Ruzena Tkacova
- Department of Respiratory Medicine and Tuberculosis, Faculty of Medicine, P.J. Safarik University, Kosice, Slovakia.
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18
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Tkacova R, Paranicova I, Timkova E, Vonkova D, Joppa P. Erickson solution-focused coaching for weight management in obese patients with obstructive sleep apnoea: ECOHEALTH pilot study. J Health Psychol 2018; 25:2141-2150. [PMID: 30010423 DOI: 10.1177/1359105318788695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Coaching as a lifestyle modification approach to weight management is insufficiently explored in obstructive sleep apnoea. We investigated anthropometry and body composition after 20 weeks of Erickson coaching in 26 obstructive sleep apnoea patients (19 males; 47.6 ± 2.4 years). Body weight, neck circumference, waist-to-hip ratio and %body fat significantly decreased after 20 weeks. The mean weight loss was 5.2 per cent ± 1.0 per cent; 20 (77%) participants achieved target reduction of >3 per cent. Coaching session attendance (p = 0.006) and reaching personal goal related to physical performance (p = 0.044) were independently associated with weight loss (multiple regression model R2 = 0.608, p < 0.001). Erickson solution-focused coaching supports adherence to healthy lifestyle and weight reduction in obstructive sleep apnoea.
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Affiliation(s)
| | | | - Eva Timkova
- Pavol Jozef Šafárik University in Košice, Slovakia
| | | | - Pavol Joppa
- Pavol Jozef Šafárik University in Košice, Slovakia
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19
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Johnson C, Saba G, Wolf J, Gardner H, Thom DH. What do health coaches do? Direct observation of health coach activities during medical and patient-health coach visits at 3 federally qualified health centers. PATIENT EDUCATION AND COUNSELING 2018; 101:900-907. [PMID: 29195719 DOI: 10.1016/j.pec.2017.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/15/2017] [Accepted: 11/24/2017] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine activities of health coaches during patient medical visits and when meeting one-on-one with patients at 3 urban federally qualified health centers. METHODS Encounters were videotaped and transcribed. Data was analyzed using a matrix analysis approach that allowed a priori identification of expected categories of activity, based on the health coach training model and previously developed conceptual framework, which were modified based on activities observed. RESULTS A total of 10 medical visits (patient, clinician and health coach), and 8 patient-coach visits were recorded. We identified 9 categories common to both medical and patient-coach visits and 2 categories unique to the medical visit. While observed activities were generally consistent with expected categories, some activities were observed infrequently or not at all. We also observed additional activity categories, including information gathering and personal conversation. The average amount of time spent on some categories of coaching activities differed substantially between medical visits and patient-coach visits. CONCLUSIONS Health coaching activities observed differed in several respects to those expected, and differed between medical visits and coaching only visits. PRACTICE IMPLICATIONS These results provide insights into health coaching behaviors that can be used to inform training and improve utilization of health coaches in practice.
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Affiliation(s)
- Christopher Johnson
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States.
| | - George Saba
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States
| | - Jessica Wolf
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States
| | - Heather Gardner
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States
| | - David H Thom
- Department of Family and Community Medicine, University of California, San Francisco School of Medicine, United States
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20
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Wolever RQ, Caldwell KL, McKernan LC, Hillinger MG. Integrative Medicine Strategies for Changing Health Behaviors: Support for Primary Care. Prim Care 2018; 44:229-245. [PMID: 28501227 DOI: 10.1016/j.pop.2017.02.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Until system reforms allow adequate time and reimbursement for primary care providers to focus on lifestyle change to prevent and mitigate chronic disease, primary care providers need a manageable, defined role to support lifestyle change. The authors suggest this role is to serve as a catalyst, priming the patient for change; educating and pointing the patient to appropriate, evidence-based resources for additional guidance and hands-on support; and providing ongoing encouragement throughout the long journey of change while patients work more intensely with health coaches or allied health providers.
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Affiliation(s)
- Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, Vanderbilt University School of Nursing, 3401 West End Avenue, Suite 380, Nashville, TN 37203, USA; Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Karen L Caldwell
- Department of Human Development and Psychological Counseling, Appalachian State University, 151 College Street, Boone, NC 28608, USA
| | - Lindsey C McKernan
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, 3401 West End Avenue, Suite 380, Nashville, TN 37203, USA
| | - Marni G Hillinger
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine at Vanderbilt, Vanderbilt University Medical Center, 3401 West End Avenue, Suite 380, Nashville, TN 37203, USA
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21
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Niebuhr F, Wilfling D, Hahn K, Steinhäuser J. Coaching aus der Perspektive der Allgemeinmedizin. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2018. [DOI: 10.1007/s11553-017-0636-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Sforzo GA, Kaye MP, Todorova I, Harenberg S, Costello K, Cobus-Kuo L, Faber A, Frates E, Moore M. Compendium of the Health and Wellness Coaching Literature. Am J Lifestyle Med 2017; 12:436-447. [PMID: 30542254 PMCID: PMC6236633 DOI: 10.1177/1559827617708562] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022] Open
Abstract
Health and wellness coaching (HWC) for lifestyle behavior change is emerging as a
practice, role, and profession, in diverse health care, employee wellness, and
community settings. Health care professionals apply HWC as a behavior change
methodology for the prevention and treatment of diabetes, hypertension,
hyperlipidemia, heart disease, cancer, and other chronic disorders. The purpose
of this systematic review was to provide a comprehensive and organized
compendium of HWC literature. To date, extant HWC literature remains scattered
with no meaningful summary accessible. Lack of comprehensive summary stems from
lack of consensus on HWC definition and standards. We applied a recently
proposed, standardized definition of HWC to determine compendium inclusion
criteria for peer-reviewed, data-based literature from relevant search engines
(ie, PubMed, PsychInfo, and CINAHL). A systematic review process was executed
and ultimately yielded 219 articles meeting HWC inclusion criteria. Of these,
150 were data-based and the remainder were expert opinion or review-style
articles. A summary of results generally reveals HWC as a promising intervention
for chronic diseases though further research is needed in most categories. The
resulting HWC compendium organizes and describes the quantity and quality of
available literature for the use and benefit of HWC practitioners and
researchers.
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Affiliation(s)
- Gary A Sforzo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Miranda P Kaye
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Irina Todorova
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Sebastian Harenberg
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Kyle Costello
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Laura Cobus-Kuo
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Aubrey Faber
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Elizabeth Frates
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
| | - Margaret Moore
- Department of Exercise & Sport Sciences, Ithaca College, Ithaca, New York (GAS, SH, KC, LC).,Clearinghouse for Military Family Readiness at Penn State University, University Park, Pennsylvania (MPK, AF).,Institute of Coaching, McLean Hospital, Belmont, Massachusetts (IT, MM).,Harvard Medical School, Boston, Massachusetts (IT, EF, MM).,Stroke Institute for Research and Recovery, Spaulding Rehabilitation Hospital, Boston, Massachusetts (EF).,Wellcoaches Corporation, Wellesley, Massachusetts (MM)
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Hackshaw KV, Plans-Pujolras M, Rodriguez-Saona LE, Moore MA, Jackson EK, Sforzo GA, Buffington CAT. A pilot study of health and wellness coaching for fibromyalgia. BMC Musculoskelet Disord 2016; 17:457. [PMID: 27821160 PMCID: PMC5100173 DOI: 10.1186/s12891-016-1316-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to test the hypothesis that a health and wellness coaching (HWC)-based intervention for fibromyalgia (FM) would result in sustained improvements in health and quality of life, and reductions in health care utilization. METHODS Nine female subjects meeting American College of Rheumatology criteria for a diagnosis of primary FM were studied. The HWC protocol had two components, which were delivered telephonically over a twelve-month period. First, each patient met individually with a coach during the 12 month study at the patient's preference of schedule and frequency (Range:22-32 × 45-min sessions). Coaches were health professionals trained in health and wellness coaching tasks, knowledge, and skills. Second, each patient participated in bimonthly (first six months) and monthly (second six months) group classes on self-coaching strategies during the 12 month study. Prior to the intervention, and after 6 months and 12 months of coaching, the Revised Fibromyalgia Impact Questionnaire (FIQR) was used to measure health and quality of life, and the Brief Pain Inventory-Short Form (BPI) was used to measure pain intensity and interference with function. Total and rheumatology-related health encounters were documented using electronic medical records. Data were analyzed using repeated measures ANOVA. RESULTS All nine patients finished the HWC protocol. FIQR scores improved by 35 % (P = 0.001). BPI scores decreased by 32 % overall (P = 0.006), 31 % for severity (P = 0.02), and 44 % for interference (P = 0.006). Health care utilization declined by 86 % (P = 0.006) for total and 78 % (P < 0.0001) for rheumatology-related encounters. CONCLUSION The HWC program added to standard FM therapy produced clinically significant improvements in quality of life measures (FIQR), pain (BPI), and marked reductions in health care utilization. Such improvements do not typically occur spontaneously in FM patients, suggesting that HWC deserves further consideration as an intervention for FM.
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Affiliation(s)
- Kevin V Hackshaw
- Internal Medicine and Molecular Biochemistry, The Ohio State University, Columbus, USA. .,Division of Immunology/Rheumatology, William Davis Medical Research Center, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH, 43210-1228, USA.
| | | | - Luis E Rodriguez-Saona
- Food Science and Technology, College of Food Agriculture and Environmental Science, The Ohio State University, 110 Parker Food Science and Technology Building, 2015 Fyffe Road, Columbus, OH, 43210, USA
| | - Margaret A Moore
- Wellcoaches Corporation, Wellesley, USA.,Institute of Coaching, McLean Hospital, a Harvard Medical School affiliate, Belmont, USA.,National Consortium for Credentialing Health & Wellness Coaches, San Diego, USA
| | | | - Gary A Sforzo
- Exercise & Sport Sciences, 323 Center for Health Sciences, Ithaca College, Ithaca, NY, 14850, USA
| | - C A Tony Buffington
- Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, USA
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Frates EP, Bonnet J. Collaboration and Negotiation: The Key to Therapeutic Lifestyle Change. Am J Lifestyle Med 2016; 10:302-312. [PMID: 30202286 PMCID: PMC6125074 DOI: 10.1177/1559827616638013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Counseling patients on behavior change is an important skill that traditional medical training does not emphasize. Most practitioners are trained in the expert approach to handle problems, which is useful in the acute care setting. However, in the case of chronic disease, a coach approach is more effective. This approach allows the patient to reflect on his or her own motivators for change as well as obstacles hindering the change. Changing from the expert approach to the coach approach is contingent on the lifestyle medicine practitioner sharing information when the patient is ready to receive it, listening mindfully, asking open-ended questions, treating problems as opportunities to learn and grow, and encouraging patients to take responsibility for their actions. By collaborating with the patient, the practitioner can guide patients to find solutions to the problems they are facing and foster an environment that leads patients to self-discovery, accepting responsibility for their behaviors, and ultimately, achieving goals that result in healthier daily habits. As a framework and a guide, lifestyle medicine practitioners can use a 5-step cycle of collaboration and a ladder of behavior change when working with patients on behavior change.
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Affiliation(s)
- Elizabeth Pegg Frates
- Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (EPF)
- University of Florida, Gainesville, Florida (JB)
| | - Jonathan Bonnet
- Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (EPF)
- University of Florida, Gainesville, Florida (JB)
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Advancing a new evidence-based professional in health care: job task analysis for health and wellness coaches. BMC Health Serv Res 2016; 16:205. [PMID: 27349746 PMCID: PMC4924333 DOI: 10.1186/s12913-016-1465-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The pressing need to manage burgeoning chronic disease has led to the emergence of job roles such as health and wellness coaches (HWCs). As use of this title has increased dramatically, so has the need to ensure consistency, quality and safety for health and wellness coaching (HWC) provided in both practice and research. Clear and uniform role definitions and competencies are required to ensure appropriate scope of practice, to allow best practices to emerge, and to support the implementation of well-designed, large scale studies to accumulate a rigorous evidence base. Since the nascent field is replete with heterogeneity in terms of role delineations and competencies, a collaborative volunteer non-profit organization, the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC), has been built over the past six years to support professionalization of the field. METHODS In 2014, a professionally led Job Task Analysis (JTA) was conducted with 15 carefully selected subject matter experts (SMEs) with diverse education and professional backgrounds who were practicing HWC in a wide variety of settings. After establishing a thorough list of specific tasks employed during HWC, the expert panel discussed the knowledge and skills necessary to competently perform the tasks. Subsequently, a large validation survey assessed the relative importance and frequency of each identified job task in conducting HWC. RESULTS The JTA identified 21 job tasks as essential to HWC. In the subsequent validation survey, 4026 practicing health and wellness coaches were invited to rate each of the 21 job tasks in terms of their importance and frequency. A response rate of 25.6 % provided a diverse sample (n = 1031) in terms of background, and represented a wide variety of training programs from academia, industry, the private sector and associations. Per best practices, the subset of practicing HWCs (n = 885) provided importance and frequency ratings to be used to calculate task and domain weights that can serve as a foundation for a NCCHWC national certification examination. CONCLUSIONS This JTA provides a significant step forward in the building of a clear and consistent definition of HWC that will allow for uniform practice standards and enable more stringent methodology to evaluate this promising approach within evidence-based medicine.
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26
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Wolever RQ, Dreusicke MH. Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. BMJ Open Diabetes Res Care 2016; 4:e000201. [PMID: 27239318 PMCID: PMC4873948 DOI: 10.1136/bmjdrc-2016-000201] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Medication adherence requires underlying behavior skills and a supporting mindset that may not be addressed with education or reminders. Founded in the study of internal motivation and health psychology, integrative health coaching (IHC) helps patients gain insight into their behaviors and make long-term, sustainable lifestyle changes. The purpose of the study is to determine whether IHC improves oral medication adherence, glycated hemoglobin (HbA1c), and psychosocial measures, and to assess whether adherence changes are sustained after the intervention. METHODS Using a prospective observational design, participants (n=56) received 14 coaching calls by telephone over 6 months. Medication possession ratio (MPR) was calculated for time intervals before, during, and after the intervention. HbA1c and patient-reported psychosocial outcomes were obtained to test interactions with MPR. RESULTS Medication adherence (MPR) increased from 0.74±0.197 to 0.85±0.155 during coaching, and was sustained at 0.82±0.175 during a 6-month period after the study. Better adherence correlated with a greater decrease in HbA1c. HbA1c decreased from 8.0±1.92% to 7.7±1.70% over the 6-month intervention. All psychosocial measures showed significant improvement. In addition to discussing medication adherence strategies with their coach, patients discussed nutrition and exercise (86.9% of calls), stress management (39.8%), and social support and relationships (15.4%). CONCLUSIONS IHC targets internal motivation and supports behavior change by facilitating patients' insight into their own behaviors, and it uses this insight to foster self-efficacy. This approach may yield sustainable results for medication adherence and warrants further exploration for health-related behavior change.
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Affiliation(s)
- Ruth Q Wolever
- Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt Schools of Medicine & Nursing, Nashville, Tennessee, USA
- Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark H Dreusicke
- Duke Integrative Medicine, Duke University School of Medicine, Durham, North Carolina, USA
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