Positive Health Online

Today there exists a missing link in modern health care. Many patients/clients find it difficult to make and sustain health behaviour change because the way that health care, whether conventional allopathic or complementary and alternative (CAM), is delivered does not help them address the complex factors that dictate their lifestyle and health choices. Consequently, the results that patients attain are often unsatisfactory and, if they are initially successful, are rarely sustained and long lasting.



The Problem
Whether a person visits their GP or a nutritionist the experience they have with them, and once they leave, are likely to be much the same. In both cases patients are likely to be given a diagnosis and provided with a prescription, whether that is medication, herbs and supplements, or some lifestyle changes. The appointment will centre on advice and education. I call this the 'Diagnose and Prescribe' approach. This traditional method to care is one that directs information 'at' the patient.

In essence, the goal is to have the patient do the things prescribed for them. In this type of relationship there is very little collaboration, and the process itself is usually quite impersonal with the unique issues, concerns and circumstances of the patient rarely being taken into account. The patient will leave with a lot of information which they will then be expected to implement and integrate into their life. This is where the problem lies. Leaving patients on their own to make what are often complicated lifestyle and health behaviour changes is inefficient. Compliance is often a significant problem with patients often ambivalent and resistant to change. The trouble is that information alone is rarely a sufficient incentive for change. What is needed is a far more personal approach with someone in the health care system who has the required knowledge, skills and the time necessary to provide motivation and support for patients to help them reach their health goals. The missing link is someone whose job is to partner with patients for success, so they can make the lasting and sustained changes they need and wish to make. The missing link is the health coach.

The Solution: The Health Coach
A health coach is an individual who possesses a unique combination of skills and knowledge that they use to guide their clients/patients to make gradual, sustained and lasting changes and improvements in their health. On the one hand, they possess knowledge and expertise in health and lifestyle practices that they use to educate, inform and train their clients with. This would usually entail a combination of nutrition, mindfulness and stress management, yoga and meditation, and physical exercise. On the other hand, health coaches also possess behavioural and coaching expertise to provide a safe, supportive and collaborative environment in which their clients can most effectively address their health issues. This ensures that their clients set appropriate and achievable goals, feel emotionally and psychologically supported, and remain fully accountable and responsible for their health outcomes. To facilitate these processes, a health coach will draw from a variety of fields, the most notable being positive psychology, behavioural and motivational psychology, emotional and social intelligence and coaching psychology. Taken together they enable the coach to address and overcome the often confronted issues of patient compliance, motivation and adherence and ensure that the patient fully integrates and habituates their new found health and lifestyle behaviours. Thus an effective and successful health coach will fulfil a variety of roles simultaneously. He will be both a motivator, a supporter, a collaborator, an educator, and a facilitator.

Whilst the above definition does a good job in articulating and defining what a health coach does and where their skills and competencies lie it says nothing about one facet of their mentality and outlook that contributes so much to the coach's level of skill and expertise and the results they achieve: Their philosophy of health. To a successful and effective health coach the notion of health is much more than the mere absence of disease. It is something that cannot be simply reduced down to a fragmented set of measurements like blood pressure and cholesterol levels. No, to a modern health coach the concept of health is something holistic and integrative. It is something that embodies the mind, body, and the spirit and encompasses all aspects of a person's life. The health coach understands that every aspect of our life affects and impacts every other part. Unhealthy relationships lead to unhealthy mental states which lead to, ultimately, unhealthy physical states and vice versa. It is adherence to this philosophy that explains the range and depth of a health coach's extensive training and the successful results they so often achieve with their clients.

It explains why a health coach might guide an individual to look at the impact that their career is having on their health and why a simple assessment of that individual's strengths and values, and whether or not they are living in accordance with them, might yield such positive results for their health. It also explains why a health coach might not write a client off as lacking willpower because they fail to change a particular eating or drinking habit. Instead the integrative health coach might look to determine what impact untreated addictions, and perhaps behind those the role that unresolved trauma, might be having on an individual's state of mind and wellbeing. It does not say that the health coach is at all qualified to treat or assist in the resolution or management of these conditions - they are not - just merely that their holistic and integrative philosophy imbues them with an understanding and insight that these issues might play in preventing an individual from reaching their health goals. It affords them the ability to identify the problem and then make the necessary referrals so that their clients can get the help and treatment they need.

The Coaching Process
Taken together, the health coach's rare combination of skills, expertise and philosophy around health and healing places them in a unique position to overcome some of the inherent problems with modern patient care and to successfully guide patients to reach their health goals. The goal of health coaching is to support patients towards implementing and sustaining behaviours, lifestyles, and attitudes that are conducive to optimum health. Ultimately, the coach is aiming to transfer self-management and decision-making skills to patients. The coach works with the patient on a voyage of guided self discovery and empowerment.

As a result the nature of the relationship between the coach and the patient is one characterized by on-going support and collaboration and based upon patient accountability and responsibility. The patient takes a very active role in defining and setting health goals, and in clarifying and outlining what support and resources they will need to meet these goals. The coach, in turn, utilizes this information to devise a programme specifically for the patient and his or her individual needs, concerns and problems. Throughout the duration of the coaching programme the coach and the patient are continuously engaged as the pair work together to address any emotional, behavioural or psychological impediments that my arise and hamper the patient's progress.

Comparing The Old vs the New
Now compare and contrast the on-going supportive, collaborative, personalized and empowering nature of the health coach and patient relationship with that of the practitioner and patient relationship so typical of the Diagnose and Prescribe approach to care. Table 1 illustrates the key characteristics of each approach.

Table 1: Characteristics of health coaching and traditional patient care compared

  

Is it any wonder that the results attained by the health coaching process have proven to be that much more successful, sustainable and long lasting than those of the highly time constrained, impersonal, prescriptive, unsupportive and paternalistic nature of the Diagnose and Prescribe approach? Common sense would suggest not. Any health care approach that provides patients with the on-going support, collaboration, motivation and knowledge to successfully implement and sustain behaviours, lifestyles, and attitudes that lead to optimum health is bound to. Unfortunately, common sense alone is not enough of a recommendation. What we look for these days is a strong evidence base for a new health approach or treatment.

What's the Evidence?
Although health coaching is a relatively new concept here in the UK and in Europe, it is extremely popular in the USA where it is widely used in public healthcare, in GP surgeries and hospitals, as well as in private and CAM healthcare and in corporate health. Health coaching has been widely researched and the evidence is highly convincing for its use in creating and sustaining lasting changes in patient health.[1,2,3] Most of the research has focused on the impact that the coaching approach has had on the management and treatment of chronic diseases such as asthma, diabetes, obesity, and cardiovascular disease.[4,5,6,7,8] Each study highlighted the importance of the supportive and collaborative nature of the coaching relationship, as well as the undoubted merits of educating and empowering the patient to take charge of their own health. The success of the approach was to be found in the ability of health coaching to activate a patient's own motivation for change and adherence. The source of this motivation, ultimately, was found to arise from the personal and close nature of the coach and patient relationship. In the end, patients were able to make considerable and sustained improvements in their health because they were able to work continuously with someone who not only educated them but also supported, motivated, and inspired them.

The Future for Health Coaching
With such a strong evidence base behind it the future does indeed look bright for health coaching. I believe it is a term you will hear more and more of in the UK and Europe over the next few years across all forms of health care, both CAM and allopathic. When you consider the success of health coaching in helping patients manage and treat chronic disease you can see how applicable the method could be to the NHS and in private health care. This is particularly relevant when you consider that chronic disease accounts for 78% of all healthcare spending in the UK and that by 2025, with an increasingly aged population, half of the people in the country will likely suffer with one.[9]

One can also see how health coaching could easily take off in the CAM field. With the widespread success and popularity of life and business coaching in the UK, the notion of the coaching process is already well entrenched in the nations' psyche. It should not require too much of a shift in thinking to embrace the notion of the health coach and apply the coaching process to lifestyle and health behaviours. Indeed, many of my colleagues in the CAM field often mention that the one thing that all their clients and patients would benefit most from is more support. Moreover, I also believe that a great deal of patients and clients are themselves seeking a more holistic and integrative approach to health. Whether it is as a result of a desire to live with more meaning and purpose or more in alignment with their unique strengths and values, more and more people are recognizing the impact that their work, their relationships, their environment and their behaviours and emotions have on their health and well-being.

As a result I believe there will be a greater demand for therapists who bring an integrative and holistic philosophy and practice to the CAM field. In this respect the health coach, because of their unique combination of skills and training, is, therefore, perfectly positioned to meet this demand. It is my belief that over the next few years you will see the role of the health coach grow considerably in the CAM field with it eventually supplanting, or at the very least augmenting, the role of the nutritionist. Whether in CAM or the NHS it is evident that patients require a new approach to care that offers them far greater support and guidance and involves them much more in their treatment plan. I believe that the health coach can best provide this approach and that, as a result, it is a term you will be hearing more and more of over the next few years.

References
1. Rollnick S, Miller WR & Butler CC. Motivational interviewing in health care: Helping patients change behavior. New York: Guilford Press. 2008.
2. Bennett JA, Perrin M & Hanson G. Healthy Aging Demonstration Project. Nurse coaching for behavior change in older adults. Research in Nursing and Health, 28(3), 187-197. 2005.
3. Miller, K. Coaching patients on cardiovascular health goals. American Family Physician, 70(12), 383. 2004.
4. Brodie, D. A., & Inoue, A. Motivational inter- viewing to promote physical activity for people with chronic heart failure. Journal of Advanced Nursing, 50(5), 518. 2005.
5. Whittemore R et al. A nurse-coaching intervention for women with type 2 diabetes. The Diabetes Educator Sep-Oct;30(5):795-804. 2004.
6. Fisher EB et al. A randomized controlled evaluation of the effect of community health workers on hospitalization for asthma: the asthma coach. Archives of Pediatrics and Adolescent Medicine Mar;163(3):225-32. 2009.
7. Edelman D et al. A multidimensional integrative medicine intervention to improve cardiovascular risk. Journal of General Internal Medicine Jul;21(7):728-34. 2006.
8. Tucker LA et al. Telephone-based diet and exercise coaching and a weight-loss supplement result in weight and fat loss in 120 men and women. American Journal of Health Promotion Nov-Dec;23(2):121-9. 2008.
9. Murphy E, Case management and community matrons for long-term conditions. British Medical Journal. 329: 1251-2. 2004.

Further Information
If you are interested in working with a health coach to change your lifestyle and health behaviours and make real and long lasting improvements in your own health the feel free to contact Simon at the Integral Life Practice on +44 7866 737087 or simon@integrallifepractice.co.uk

If you are a practitioner or therapist working in the CAM or medical field and you are interested in training to be a health coach then Dr Mark Atkinson at The Academy of Lifestyle Medicine which will be running the UK's very first Integrative Health and Wellbeing Coach training programme from March 2012. To find out more please contact Dr Mark Atkinson at The Academy of Lifestyle Medicine on Tel: 0845 094 8612 or visit www.drmarkatkinson.com/training