The global increase in the percentage of deaths attributable to chronic disease has been recognised in recent years. The WHO predicts that of the 64m deaths predicted in 2015, 41m will be due to chronic disease.
For healthcare systems to manage this, it is also recognised that there needs to be a shift to engage patients in self-management.
Unfortunately, many programmes aimed at empowering patients focus on didactic information-giving and advice about lifestyle changes. It has been demonstrated that in disease management programmes, medical professionals may use an approach that is authoritarian, confrontational, forceful or guilt-inducing and there is evidence that such attitudes will limit progress and are correlated with negative outcomes.1
Additionally, a negative cycle can be initiated, as indicated by a study where higher patient resistance to quitting smoking led to an increase in confrontational and other negative behaviours in healthcare professionals attempting to promote behaviour change.2
For GPs, it is often those patients who resist advice who are the most challenging and may be labelled 'heartsink'. To use a new approach with such patients and achieve success can be very rewarding.
Health coaching involves releasing patients' potential to maximise their own health.
It helps patients to acquire the knowledge, skills, tools and confidence to become active participants in their care, so they can reach their self-identified health goals.3
The London Deanery Coaching and Mentoring Team, led by Dr Rebecca Viney, has developed a Coaching for Health programme to teach these techniques to doctors from all specialties.4
Approaching the patient's health from the patient's perspective requires a shift in the consultation dynamic from a paternalistic, directive stance to a more equal, patient-focused, collaborative one.3
Rather than just an acknowledgment of the patient's ideas, concerns and expectations, coaching explores patients' personal health beliefs and empowers them to select health goals pertinent to their life.
Using positive psychology and motivational interviewing techniques, the clinician's belief in the individual's resourcefulness and success is powerful in shifting the perspective from one of being disempowered and feeling a failure to a position of acknowledging achievements and setting realistic, manageable (patient-selected) goals, with specified endpoint rewards.
Focusing on motivation and goals, rather than on individual behaviour, can result in impact on more than one lifestyle behaviour at a time.
There is evidence that medication adherence, acute admissions to hospital and perceived health status (proportionate to health expenditure) improve with approaches that enhance self-efficacy, compared with information giving.3,5
Health literacy is the degree to which patients have the capacity to obtain, process and understand basic health information and services needed to make appropriate decisions.6
In the UK, about 11.4% of adults have low health literacy.7 This affects screening uptake, medication adherence and self-care. On average, only 50% of medications are taken as prescribed.3
Smoking, poor diet, lack of exercise and lower self-reported physical and mental health correlate with low health literacy across socioeconomic groups.8
For commissioners, effective approaches with these patients can translate into reducing emergency treatment and admissions,7,9 lengthy hospital stays and medicines wastage and complications.8
- Dr Miller is a GP and tutor in London and coach/mentor for the London Deanery. Opinions expressed are the author's own.
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1. Moyers TB, Martin T. J Subst Abuse Treat 2006; 30(3): 245-51.
2. Francis N, Rollnick S, McCambridge J et al. Addiction 2005; 100(8): 1175-82.
3. Bennett H, Coleman E, Parry C et al. Fam Pract Manage 2010; 17(5): 24-9.
4. London Deanery. Coaching for Health. http://mentoring.londondeanery.ac.uk/coaching-for-health
5. Linden A, Butterworth SW, Prochaska JO. J Eval Clin Pract 2010; 16: 166-74.
6. Nielsen-Bohlman L, Panzer AM, Kindig DA (eds). Health Literacy - A Prescription to End Confusion. Washington, DC, The National Academies, 2001.
7. Von Wagner C, Knight K, Steptoe A et al. J Epidemiol Comm Health 2007; 61: 1086-90.
8. Wolf MS, Gazmararian JA, Baker DW. Arch Intern Med 2005; 165: 1946-52.
9. Davis TC, Wolf MS. Fam Med 2004; 36(8): 595-8.