Health Coaching: a 4-step program for health behavior counselling in primary care practice

Intro

Health behavior counselling has a potential for high impact upon individual behavior and health outcomes, and thus on a population’s burden of disease. Physicians in primary care see most members of the population within behaviorally relevant intervals, and they are in a position to implement effective counselling. However, this potential is still underutilized since concepts like empowerment, shared-decision-making and health-literacy have not yet been systematically operationalized for patient-centered and patient-driven counselling in office practice.

Goal

„Health Coaching“ was developed by the Swiss College of Primary Care Medicine to facilitate office-based counselling for health behaviors relevant in prevention, health promotion and clinical care in general.

Features of Health Coaching

„Health Coaching“ ...

uses philosophy and tools from Motivational Interviewing to give the patient the active role and assign the physician the role of a coach, thus mobilizing and supporting a patient’s health literacy
offers a simple 4-step counselling algorithm to assist the patient in developing awareness, building motivation for choosing a target behavior, preparing specific behavioral targets and implementing a personal health project.
uses blended learning for physician training: self-assessment; self-guided learning through web-based resources; skills training (with standardized patients); self-awareness sessions; practice visits; and expert supervision.

The four steps in Health Coaching

Health Coaching in doctors' office consultations follows the cyclical nature of health behavior change, according to experiences from the Transtheoretical Model (TTM). It advances in four steps: sensitize, motivate, plan, accompany (a distinctly more patient-centered version of the traditional "ask, assess, advice, arrange"). It is the patient who chooses the topic of interest, and how fast and how far he or she wants to go - the patient gets the main role, the doctor becomes the coach of the patient.

Compared to traditional practice, „Health Coaching“ means a significant re-distribution of roles between patient and doctor and develops a new, more equitable partnership based on each partner’s self-responsibility and specific strengths, with the prospect of more sustainable long-term results.

The current state of the project

The program is currently being field-tested by formative and summative evaluation for acceptance, feasibility and resource use (12 months, 20 primary care offices, approx. 4000 patients); the starter-package focusses on six health behaviors that contribute most to the population-wide burden f disease (nutrition, weight, physical activity, alcohol, tobacco and stress). Future program dissemination may include extension to other health behaviors, to medical topics (e.g. disease-management, rehabilitation, mental health) and to other settings (e.g. hospital).

Support for the Project Health Coaching

The Swiss College of Primary Care Medicine has enlisted political as well as financial support for the pilot project, from federal and cantonal authorities, non-profit foundations and leagues, and from private industry (in concreto: Federal Office of Public Health, Conference of Cantonal Health Departments, Health Promotion Switzerland, National Tobacco Prevention Foundation, Oncosuisse Foundation, HelvetiaSana Foundation, Novartis Suisse, MSD Suisse, Vivre sans tabac, Sanofi-Aventis and the Swiss Heart Foundation).

See a poster about Project Health Coaching

presented at the International Conference on Communication in Health Care, Verona / Italy (5 -8 September 2010)

HEALTH COACHING: A 4-step program for health behavior counselling in primary care practice. (Ulrich Grüninger, Ruedi Hösli, Margareta Schmid, Stefan Neuner, and the family physicians participating in the pilot project. Swiss College of Primary Care Medicine, Berne /Switzerland)

For more information see the german part of this website or a description in French: Grüninger, U. et al. (2009) Coaching santé : Un programme pour la promotion de la santé et la prévention au cabinet du médecin de famille, élaboré par le Collège de médecine de premier recours (CMPR); Bull Méd Suisse 90(45): 1729-1732)

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Ein Projekt des Kollegiums für Hausarztmedizin (KHM) Gesundheitscoaching Kurzdarstellung Adressen / Kontakt Infos / Unterlagen Déscription en français English abstract Das Programm Für PatientInnen Für ÄrztInnen Pilotprojekt St. Gallen Abläufe Unterstützung Ärzte Träger, Organisation Finanzen, Kooperation Nach dem Pilotprojekt Kontakt Pilotprojekt SG Mitmachen ... Closed User Group	Health Coaching: a 4-step program for health behavior counselling in primary care practice Intro Health behavior counselling has a potential for high impact upon individual behavior and health outcomes, and thus on a population’s burden of disease. Physicians in primary care see most members of the population within behaviorally relevant intervals, and they are in a position to implement effective counselling. However, this potential is still underutilized since concepts like empowerment, shared-decision-making and health-literacy have not yet been systematically operationalized for patient-centered and patient-driven counselling in office practice. Goal „Health Coaching“ was developed by the Swiss College of Primary Care Medicine to facilitate office-based counselling for health behaviors relevant in prevention, health promotion and clinical care in general. Features of Health Coaching „Health Coaching“ ... uses philosophy and tools from Motivational Interviewing to give the patient the active role and assign the physician the role of a coach, thus mobilizing and supporting a patient’s health literacy offers a simple 4-step counselling algorithm to assist the patient in developing awareness, building motivation for choosing a target behavior, preparing specific behavioral targets and implementing a personal health project. uses blended learning for physician training: self-assessment; self-guided learning through web-based resources; skills training (with standardized patients); self-awareness sessions; practice visits; and expert supervision. The four steps in Health Coaching Health Coaching in doctors' office consultations follows the cyclical nature of health behavior change, according to experiences from the Transtheoretical Model (TTM). It advances in four steps: sensitize, motivate, plan, accompany (a distinctly more patient-centered version of the traditional "ask, assess, advice, arrange"). It is the patient who chooses the topic of interest, and how fast and how far he or she wants to go - the patient gets the main role, the doctor becomes the coach of the patient. Compared to traditional practice, „Health Coaching“ means a significant re-distribution of roles between patient and doctor and develops a new, more equitable partnership based on each partner’s self-responsibility and specific strengths, with the prospect of more sustainable long-term results. The current state of the project The program is currently being field-tested by formative and summative evaluation for acceptance, feasibility and resource use (12 months, 20 primary care offices, approx. 4000 patients); the starter-package focusses on six health behaviors that contribute most to the population-wide burden f disease (nutrition, weight, physical activity, alcohol, tobacco and stress). Future program dissemination may include extension to other health behaviors, to medical topics (e.g. disease-management, rehabilitation, mental health) and to other settings (e.g. hospital). Support for the Project Health Coaching The Swiss College of Primary Care Medicine has enlisted political as well as financial support for the pilot project, from federal and cantonal authorities, non-profit foundations and leagues, and from private industry (in concreto: Federal Office of Public Health, Conference of Cantonal Health Departments, Health Promotion Switzerland, National Tobacco Prevention Foundation, Oncosuisse Foundation, HelvetiaSana Foundation, Novartis Suisse, MSD Suisse, Vivre sans tabac, Sanofi-Aventis and the Swiss Heart Foundation). See a poster about Project Health Coaching presented at the International Conference on Communication in Health Care, Verona / Italy (5 -8 September 2010) HEALTH COACHING: A 4-step program for health behavior counselling in primary care practice. (Ulrich Grüninger, Ruedi Hösli, Margareta Schmid, Stefan Neuner, and the family physicians participating in the pilot project. Swiss College of Primary Care Medicine, Berne /Switzerland) For more information see the german part of this website or a description in French: Grüninger, U. et al. (2009) Coaching santé : Un programme pour la promotion de la santé et la prévention au cabinet du médecin de famille, élaboré par le Collège de médecine de premier recours (CMPR); Bull Méd Suisse 90(45): 1729-1732)