Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Abstract

BACKGROUND: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI − 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI − 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (− 4.6; 95% CI − 9.1, − 0.15; p = 0.04). CONCLUSIONS:We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.GOV IDENTIFIER: NCT01828567KEY WORDS: telephone coaching; health risk assessment; health literacy; health numeracy.

Primary Care Providers’ Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older

“…37 While additional research is needed on how best to support shared decision making for low literacy populations, some experts recommend that patients be offered skills training in shared decision making and others recommend decision coaching. 38,39 Studies examining the added effectiveness of decision coaching to patient decision aids alone are needed particularly in low literacy populations. 40…”

Alzheimer's Disease Prevention Health Coaching

“…Furthermore, there is evidence for health coaching efficacy in low-income and underserved populations ( 28 , 29 ). Health coaching is especially beneficial for lifestyle change in people with numeracy and literacy deficits because it facilities participant interpretation of health risk information ( 30 ). Previous findings have indicated that health coaches should personalize the coaching experience to balance competing and conflicting needs in limited-resource groups to maximize lifestyle change ( 31 ).…”

Effectiveness of a nurse‐led, face‐to‐face health coaching intervention in enhancing activation and secondary outcomes of primary care users with chronic conditions

“…Researchers studying HC among adults with chronic conditions have found that it can increase patient activation (Nouri et al, 2019), self-efficacy (Tuluce & Kutluturkan, 2018), and medication adherence (Wolever & Dreusicke, 2016), and also improve HRQoL (Benzo et al, 2016) and lifestyle behaviors (O'Hara et al, 2013). Benzo et al (2017) found that HC was a cost-effective strategy for reducing healthcare use, although Hale and Giese (2017) concluded that the findings are inconclusive, at least in the short term.…”