Exploring the Intersection of Empathy and Behavior Change Techniques in Telehealth Coaching Messages: A Survey Study

Abstract

Background: The global rise in noncommunicable diseases (NCDs) demands innovative public health strategies. Key NCD risk factors are lifestyle-related, emphasizing the importance of behavior change (BC) interventions. Here, empathy plays a pivotal role by fostering rapport, enhancing patient-provider communication, and promoting an individual's motivation to change. However, the role of empathy in BC interventions and its potential intersection with BC techniques (BCTs) remains understudied, especially in telehealth. This study seeks to investigate this intersection in the context of asynchronous health coaching. Methods: We conducted a two-round survey with 11 health coaches (HCs) who responded to 10 participant messages from the Bump2Baby and Me trial. In total, we examined 88 HC messages for empathic responses and the presence of techniques from the taxonomies of BC techniques (BCTs), Motivational BCTs (MBCTs), and Self-Determination Theory techniques (SDTTs). Results: We identified 121 empathic responses that strongly overlapped with MBCTs (79%, n=213) in the form of Praise (47%, n=100) via unconditional positive regard and acknowledging patient perspectives and feelings, and Normalizing (23%, n=49) via neutral support and unconditional regard. While BCTs and SDTTs showed no substantial overlaps with empathic responses, 67% of BCTs elicited participants’ feelings and views about their coaching program. Conclusions: The role of MBCTs in empathy expressions boosts patient engagement and self-perception, fostering relatedness. BCTs supported a patient-centered approach by empowering patients to articulate and plan their goals, which promotes autonomy. The lack of alignment in other categories suggests that considering empathy and BC techniques in isolation provides an incomplete picture of BC interventions.