Problematizing health coaching for chronic illness self‐management

Abstract

To address the growing costs associated with chronic illness care, many countries, both developed and developing, identify increased patient self-management or self-care as a focus of healthcare reform. Health coaching, an implementation strategy to support the shift to self-management, encourages patients to make lifestyle changes to improve the management of chronic illness. This practice differs from traditional models of health education because of the interactional dynamics between nurse and patient, and an orientation to care that ostensibly centres and empowers patients. The theoretical underpinnings of coaching reflect these differences, however in its application, the practices arranged around health coaching for chronic illness self-management reveal the social regulation and professional management of everyday life. This becomes especially problematic in contexts defined by economic constraint and government withdrawal from activities related to the 'care' of citizens. In this paper, we trace the development of health coaching as part of nursing practice and consider the implications of this practice as an emerging element of chronic illness self-management. Our purpose is to highlight health coaching as an approach intended to support patients with chronic illness and at the same time, problematize the tensions contained in (and by) this practice.

Multidisciplinary perspectives: Application of the Consolidated Framework for Implementation Research to evaluate a health coaching initiative

“…In relation to individual responsibility, it is argued that it is often the things that people do in relation to modifiable risk factors (such as increasing physical activity and optimising medicines use) that make the most difference to their quality of life and health outcomes (World Health Organization, ). Moreover, there has been a fundamental shift in the relationship between the state and its citizens, with governments requiring citizens to be self‐responsible, self‐governing subjects (Howard & Ceci, ). In the UK, Government policy emphasises individual responsibility in the management of long‐term conditions.…”

What makes it so difficult for nurses to coach patients in shared decision making? A process evaluation

“…The literature also shows that health coaching is thought to require different (communication) skills and is experienced as much more complex than applying a fixed protocol (Poskiparta et al, 2001;Stacey et al, 2008). Professionals experience health coaching and shared decision making as broad and abstract concepts and therefore struggle to implement them in practice (Elwyn et al, 2000;Howard and Ceci, 2013). It is experienced as complex, because it requires them to act flexibly and to constantly reflect on the way each individual patient can be supported (Zoffmann et al, 2008).…”

The use of coaching in occupational therapy: An integrative review

“…Similarities between coaching and self‐management interventions have been identified including health coaching being described as a tool to support self‐management (Howard & Ceci, ). Although beyond the scope of this review, examination of the similarities and differences between health coaching and self‐management could add to understandings of the key components shared by these approaches for enabling occupation.…”