Take Home Messages:

Coaching patients with long term health problems involves working with them to find pragmatic ways of dealing with their condition. Coaching patients is an effective way to improve the self-management of chronic illness.

Effective coaching adopts a three-pronged approach:

1. Disease education;
2. Behavioural change strategies; and
3. Psychosocial support.

Why the study matters:

Chronic disease such as long term back pain, heart disease and diabetes pose significant health concerns for western societies.

Self-management is important to achieve the best health outcomes because it fosters adherence to treatment.   

Improvements in self management of chronic conditions can result in significant benefit to the person, as well as reduced hospital admissions, surgery, disability and long term costs. Improvement in self management is one of the most cost-effective ways to improve long term health outcomes, and remains an underutilised area of health care. 

Coaching involves a professional working with the patient and encouraging them to take an active role in the self-management of their long standing illness.

Better understanding of the tools and processes involved in coaching can increase its use and effectiveness. 

What the study involved:

The article reviewed and summarised the findings of 25 research articles that investigated three types of coaching methods:

1. Disease education
2. Behavioural change strategies; and
3. Psychosocial support

Summary of study findings:

Despite limited data, the researchers concluded that coaching was an effective way of improving self management of chronic conditions, and that all three methods should included in coaching programs.

1. Disease-related education coaching involves coaching regarding the:

• Nature of the disease;
• Required medical and lifestyle treatment; and
• Consequences of disease if not controlled.

The study found that patients who received disease related education coaching reported an improvement in quality of life and greater situational control. This kind of coaching is more beneficial if combined with behavioural techniques.

2. Behavioural change-focused coaching aims to improve self management in practical, goal-oriented ways, i.e. by changing behaviours that may contribute to health conditions. Goal setting helps the client identify and address ambivalence to change, especially reluctance to adopt health care changes. Motivational Interviewing may be of assistance here.

Behavioural change-focused coaching can increase treatment compliance in patients with chronic illness.

3. Psychosocial focused coaching consists of restoring support networks and improving client abilities to cope with psychosocial factors. Here:

• Coaches are a form of emotional support for chronic disease sufferers; and
• Patients who feel their concerns have been understood, feel more in control of treatment regime.

In general:

• Patients with coaches were found to have an improvement in overall wellbeing; and
• The researchers noted that coaching delivered face-to-face, over the telephone or via the internet are all effective.

The researchers concluded that the educational, behavioural and psychosocial-orientated approaches to coaching all have a positive effect on the self-management of chronic disease. They could not determine the relative importance of the various approaches to coaching and suggested therefore that all three be employed.

Original research:

Coaching for behaviour change in chronic disease: A review of the literature and the implications for coaching as a self-management intervention

Helen Lindner, David Menzies, Jill Kelly, Sonya Taylor, and Marianne Shearer

 Australian Journal of Primary Health — Vol. 9, Nos. 2 & 3, 2003

Abstract link