What is health coaching and how does it differ from wellbeing coaching? What are the best models to use and can anyone do it? Health coaching expert Professor Stephen Palmer gives us the answers in this four-part health coaching toolkit.
Part 1: Setting the scene: definitions, theory and practice
Health and wellbeing coaching is not rocket science, although it is a specialism within the field of coaching and health. Somewhat surprisingly, studies have shown that the layperson can be successfully trained to become an effective health coach to work in primary care settings, although ongoing monitoring is important.
Health and wellbeing coaching, therefore, does not have to be the exclusive domain of licensed health professionals, although the latter may be involved in the training and supervision of lay health coaches.
Health and wellbeing
coaching is becoming popular, with organisations employing external providers to offer these services to their employees by phone or online, especially in North America. Looking after employees’ wellbeing could
have positive outcomes for the employer, too.
Training providers in the US, UK and Australia have been delivering health and wellbeing coaching courses for health professionals and coaches for over a decade, and even in a recession there are signs of growth.
So what is health coaching?
One of the original definitions of health coaching was developed by pioneers in the field:
“Health coaching is the practice of health education and health promotion within a coaching context, to enhance the wellbeing of individuals and to facilitate the achievement of their health-related goals2.”
This definition links health education and promotion to the key elements of coaching. A crucial aspect is the distancing away from the traditional medical model whereby the practitioner instructs the ‘patient’ and provides them with their targets. In contrast, the health coach actively encourages the ‘client’ to develop their
own goals.
Some practitioners make a distinction between health and wellness/wellbeing coaching.
The latter generally focus on education about health-related issues such as weight management, exercise programmes, smoking cessation, alcohol reduction and nutrition.
On the other hand, health coaching may deal with specific disease management or better health outcomes, such as reducing blood pressure, lowering cholesterol levels, controlling diabetes or managing pain3.
Health coach, Susie Burrell, provides a useful case example, illustrating the differences between the dietetic and the coaching model4 (see Table 1).
The example highlights the supportive and facilitative nature of the coaching approach. The focus is on discussing a range of factors from the client’s perspective. These go beyond the measurements and suggested dietary and exercise changes of the more traditional approach.
Theory and practice
Generally in coaching it is not essential for the coach to have expertise or an in-depth knowledge about the issues that the client wants to explore and work on. However, in health coaching it is strongly desirable that the coach has an understanding of the health and wellbeing topics that most clients want to tackle.
A lay coach should consider taking a health education course or a health coaching training programme. There are also many resources such as information sheets, booklets and websites on a wide range of health-related topics.
Some psychological theories
are also worth understanding,
and a couple of these are covered briefly in this section.
Professor Albert Bandura developed social learning theory5. He noted that people can learn through observation, modelling and imitation, although learning something does not necessarily lead to behaviour change. Bandura also developed social cognitive theory, which was underpinned by the important construct of self-efficacy, ie, your belief in your own ability to succeed at a certain task6.
Positive encouragement (sometimes described as Social Persuasion) from others, such as a coach, can often influence and enhance self-efficacy and subsequent goal achievement.
Changing health behaviours can be a challenge for the client – a supportive and facilitative health coach can make all the difference.
Sometimes clients attend their first coaching sessions and are really keen to start work immediately on developing and achieving their goals. Others, however, seem reluctant to engage in the coaching process.
Prochaska and DiClemente developed the Transtheoretical Model of Change, which helps the health coach to become more aware of where their client is in the process7. It sequentially links six key stages: pre-contemplation, contemplation, planning/decisions, action, maintenance and relapse.
It’s at the pre-contemplation stage that the client may be reluctant to engage because they may not see the need to change their health behaviours.
Figure 1 shows the stages expressed in the client’s language. In this example, it also highlights the importance of preparing the client for a possible lapse. An action plan can be developed near the end of the process that focuses on how to prevent the lapse – or tackle it.
Models and approaches
Goal-focused models or frameworks such as GROW, have been used for health coaching as well as the proprietary models developed by health coaching providers. Specific approaches include: solution focused, cognitive behavioural and multimodal coaching.
Some health coaches use Motivational Interviewing as their main approach, although it was not originally developed for this purpose, and is usually used in combination with one of the main coaching approaches.
Dietetics vs coaching model*
Juliet: A dietetics model
- Measurements taken
- Current diet assessed
- Explanation of dietary variables needing change (chocolate at night, wine)
- Suggestion of dietary changes to be made
- Suggested exercise programme
- Client to direct measurements
- Review scheduled for 4-6/52 and referral for mood
Juliet: A coaching model
- Discussion of past weight loss attempts
- Discussion of support at home
- Discussion of dietary changes required and mapped-out plan of easy changes to implement
- Client to direct review needs
- Addition of ‘feel good’ times for client
*adapted Burrell, 2006
- Next issue: Motivational Interviewing