Health professionals give people advice about changes they need to make for their health every day. They can give patients copious amounts of advice both verbally and written, but the only way people are going to change is if they are psychologically ready, motivated, committed, and have the skills to do so .
People often need help to make psychological changes before they can begin to make the behavioural changes they need in order to improve their health. As dietitians and undergraduate dietitians alike, we can assist people to reach these psychological changes by using various forms of health coaching techniques. Such techniques include: disease-related education-focused coaching, behaviour change-focused coaching, and psychosocial-focused coaching . Any of these techniques can be used depending on the needs of the patient, and the stage of behaviour change they are at .
Disease-related education-focused coaching is commonly used when coaching people with diabetes . The idea is to discuss the nature of the illness, the treatments (both medical and lifestyle) that are needed, and the consequences of not following the suggested treatments . It is expected that by giving clients this information they will be able to make behaviour changes, but two systematic Cochrane reviews in diabetes self-management have suggested that while knowing all the disease-related information is beneficial, change is more likely to happen when behavioural education is used in conjunction with disease-related education . If a disease-related approach is taken it is best to coach clients to understand the information, and to ask questions when they are unsure.
Behaviour change-focused coaching has shown positive results in both the prevention of disease progression as well as the reduction of risky behaviours associated with chronic illness . It incorporates motivational interviewing, goal setting, and the well-known ‘readiness to change’ approach [2, 3]. It works on helping the client improve self-confidence and intrinsic motivation in terms of managing their own illness, and leaves the client feeling in control of their health [3, 4].
Finally, psychosocial-focused coaching takes into account the emotional distress that comes with having a chronic illness, and the role of the health practitioner is to make the patient feel that their fears and concerns are understood (similar to a counsellor) [2, 5]. When the client feels that the practitioner understands their emotional distress and that it has been taken into account when developing a treatment regime, the patient is more likely to adhere to the suggested treatment .
By Aimee Werner (new graduate dietitian)
1.Gale J. A Practical Guide to Health Behaviour Change Using the HCA Approach. Health Coaching Australia, 2012
2.Lindner H, Menzies D, Kelly J, Taylor S, Shearer M. Coaching for Behaviour Change in Chronic Disease: A review of the literature and the implications for coaching as a self-management intervention. Aust J Prim Health. 2003; 9(2&3)
3.Spahn J, Reeves R. State of the Evidence Regarding Behavior Change Theories and Strategies in Nutrition Counseling to Facilitate Health and Food Behavior Change. J Am Diet Assoc. 2010; 110:879-891
4.Rollnick S, Miller W. What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy. 1995; 23: 325-334
5.Bunker S. A Brief Review of Health Coaching Interventions for People with Chronic Conditions. ADMA Newsletter. 2011; 8(2): 11-12