The “Health Coaching” programme: a new patient-centred and visually supported approach for health behaviour change in primary care

Abstract

BackgroundHealth related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients.MethodsOur new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques—such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors’ communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the “Health Coaching” programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients’ self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues.ResultsIn total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8–22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the “Health Coaching” programme were consistently high.ConclusionsOur innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

Efficacy of a Communication Skill Training Fostering Health Promotion in Primary Care: A Mixed Method Analysis

“…The concept and efficacy of this approach is described in detail elsewhere [12]: GPs are encouraged to assist patients in their motivation and efforts to change unhealthy behavior. At the beginning of a "Health Coaching" session, the goal is set by the patient, in the spirit of patient-centeredness and thus fostering the intrinsic motivation of patients: Beyond traditional patterns like prescribing drugs or treatments the GP is supporting patients' decision-making, planning and implementation activities, in the role of a coach.…”

Coaching aus der Perspektive der Allgemeinmedizin

“…Besonders bei chronischen Erkrankungen war der Prozess der Befähigung und Motivation der Patienten zur Lebensstiländerung eine große Herausforderung für die Angehörigen der Gesundheitsberufe, weshalb Coaching als sinnvolle Erweiterung in der Primärversor-gung angesehen wurde [26].…”

“…Gesundheitscoaching beschreibt ein Weg der Gesundheitserziehung und Gesundheitsförderung, der das Wohlbefinden des Individuums und das Erreichen seiner gesundheitsassoziierten Ziele bestärkt [1]. Die Ergebnisse der Literatursuche ergaben, dass durch diese Einbeziehung des Patienten in den Entscheidungsprozess positive Effekte auf die Übernahme von Verantwortung und Entscheidungen und letztendlich auch auf Motivation, Zufriedenheit und Gesundheitszustand verzeichnet werden können [26].…”

Kannattaako asiakkaan toimijuuden ja itseohjautuvuuden vahvistaminen?

“…Asiakkaan itseohjautuvuuden tukemista on kuvattu myös omahoitovalmennuksena (11) ja terveysvalmennuksena (12). Molemmissa lähtö kohtana on yksilön autonomia, riittävät tiedot ja taidot oman terveyden hoidosta sekä yksilön motivaation, voimavarojen ja pystyvyyden tun teen vahvistaminen.…”

“…Keskeistä on asiakkaan ohjaaminen oman toiminnan seurantaan ja hänen tukemisensa toi minnallisten, konkreettisten tavoitteiden sekä arkeen ja elämäntilanteeseen sopivien tekojen to teuttamisessa (13). Terveysvalmennuksesta asia kastyön menetelmänä on saatu positiivisia tu loksia ja valmennuksen on nähty sopivan am mattilaisen työmenetelmäksi (12,14). Sotealan ammattilaiset ovat kuitenkin pitäneet osaamis taan riittämättömänä asiakkaan ohjauksessa ja kokevat tarvetta asiantuntijuuden kehittämiseen hyvinvoinnin tukemisessa (15,16).…”