Is Health Coaching by Telephone Effective?

Health Coaching Via Telephone: Is it Effective?

By: Melinda Huffman, BSN,MSN,CCNS,CHC

According to Dr. John Piette, “Individuals often remember little of what they are told during outpatient encounters.” Many people are not well prepared to manage their conditions without intermittent help and guidance along the way. Managed care organizations have had plenty of experience in using the telephone as a primary means of communication with members, but other healthcare providers have been slow to adopt telephony as a means to guide care. With health coaching and motivational interviewing emerging as a unique and different way of improving outcomes and communicating with individuals, it only seems reasonable that we pay proper respects to phone communication as a means to implement this fresh, new approach.

There are several reasons to consider the telephone as an effective means by which a healthcare provider can communicate with individuals seeking support, guidance, and information about their health risk, condition(s), or illness:

  • Ninety-eight percent of American households have phone communication
  • Enhanced timeliness of appointments
  • Affords more frequent contact
  • Cellular communication affords mobility for the users; no specific locale needed for a meeting place
  • Improved adherence to treatment plans
  • Healthcare costs continue to soar

A study conducted by Thomson Reuters and American Specialty Health concluded that a program of telephone-based health coaching for weight management can change employees’ behavior and reduce their health risk factors. At the end of one year, the study of 890 employees demonstrated significant decreases in risk prevalence for poor eating habits (21.3% reduction) and poor physical activity (15.1% reduction). All of the biometric measures related to overweight and obesity also decreased, including percent overweight or obese (5.8% reduction), weight (4.5 pounds reduction), and body mass index (0.9% reduction).

Pinnock et al. found that assessments conducted via phone increased the proportion of those with asthma who received appropriate monitoring versus those receiving face-to-face encounters in the clinic setting. While there was no difference in “quality of life” in both groups, patients’ access was increased and outcomes were comparable with telephone communication.

Simon, et al found that using the telephone to engage the depressed patient in cognitive behavioral therapy was substantially effective. After six months, those who received counseling over the phone were more likely to have improved depressive symptoms and were more satisfied with treatment.

As you evaluate your current telephone program or as you consider implementing interventions via phone, Piette listed several factors that should be considered:

  1. Content should be clearly structured
  2. Don’t try and accomplish too much in one setting
  3. Target those individuals who are likely to benefit most in your population
  4. Most effective programs are linked to outpatient clinical follow-up
  5. Incorporate outcome measures to validate program’s impact

Telephone outcomes that can be considered for measurement include, but aren’t limited to:

  1. Confidence level of the individual to reach goal(s)
  2. Number of phone appointments kept
  3. Satisfaction with phone encounters
  4. Improvement in symptoms, weight, exercise, diet, stress

To improve health outcomes in the population you serve, consider a wider use of the telephone as an adjunct to the individual’s treatment plan or if you already use the telephone to provide interventions, make sure that your active listening skills are sharp, that distractions are minimal to none, that you have an appointment for the call, and that you have an agreed upon agenda for the call!

©2010 NSHC All rights reserved.

 

5 Strategies for Weight Loss (evidence based)

Greetings! All the best to whoever reads this article.  The following paragraphs will cover 5 strategies to help you and anyone you know take the steps towards achieving their weight loss goals.

  1. Understand Your Motivation for Weight Loss and Set SMART Goals

What are the reasons that foster a desire to lose weight? Is it a health issue? Is it an emotional one? What are some realistic steps you can take to work towards your goals?

2. Identify Your Beliefs and Values around Food, Weight, Body Image, and Self-Worth

If you don’t like fitness, what are the reasons? Try to peel away the onion to see what the core values and beliefs you have about weight, eating, fitness, body image, and self-worth. Long-term changes may not last if you’re not keenly aware of the drivers of your inner motivation.

3. Mindful Eating Approach to Weight Management

Whether it is a bushel of broccoli or a bag of cookies, anytime you eat in excess to what your body needs for fuel the excess is stored as fat. One way of preventing excess fat is eating just enough fuel that your body requires for its needs. Not too much (will cause weight gain) or too little (will decrease metabolism). One way of providing your body with the right amount of fuel is through mindful eating.

Mindful Eating is eating with the awareness of your hunger and satiety cues. Basically, you eat when you feel physical symptoms of hunger and stop when satisfied. There is a difference between true and false hunger. With several other mindful eating strategies and bringing attention and intention to how you eat, the excess holiday weight will come off naturally.

Those with a strong emotional connection to overeating have found journaling to be particularly helpful. An Awareness Journal is different from a Food Diary. The food diary allows you to record the quantity, type of food and the time it is eaten. Conversely, thoughts, feelings, and physical signs of hunger and fullness are recorded in an Awareness Journal. What thoughts and feelings do you say to yourself when having an overeating episode or when you have a “good day” of restrictive eating? What, if any, associations are there? Carefully reflect on these and enter them in the Journal.

Additionally, make SMART goals (Specific, Measurable, Accountable, Realistic, and Timed)! For example when it comes to fitness, instead of having a general goal of working out 4 times a week; instead, a SMART goal would be “I will do cardio once a week for at least 30 min, yoga once a week for at least 20 min and weight training twice a week for at least 20 min”.

4. Engage in “Change Talk”

The research of Drs. Miller and Rollnick have discovered that the more one talks about change, the more likely one is to change. Keep talking about change and surround yourself in the environment, or mood of change, because the more you think, talk, behave positively towards change, the more likely change will happen. When you take a step towards your goal, congratulate yourself and use those positive feelings to move another step closer.

Are you ambivalent towards change? Do you have the desire, but find yourself in negative or limiting thought patterns? Ask yourself how you can change them into more positive thoughts. For example, when you find yourself in February or March exercising less than four times a week and thoughts of “I enjoy yoga, but I’m too busy”…”, but I’m too tired” creeping in, carefully consider what you can effectively do about the factors preventing you from moving forward to your goal. What are the options?

Perhaps changing those negative thoughts into statements like: “My health is important to me”, “I will make time for fitness”, “I feel great when I exercise”…and” I want more of that” will be more productive alternatives!

5. Recognize Your Readiness for Change

Of the six stages of change (pre-contemplation, contemplation, preparation/determination, action, maintenance, relapse) what stage are you currently in? If you’re in the contemplation stage (recognize there’s a problem, but not ready to change) what are some small steps to get you closer to the determination stage then action stage?

Ask yourself on a scale from 1-10 how important it is for you to create the change you want to get to achieve your SMART goal. Also, on a scale from 1-10 how confident are you that you can make the change? Once you are actively pursuing your goal(s), continually assess your score and bring in the support you need to keep the score high!

 

 

©2010 NSHC All rights reserved.

Is Health Coaching Effective?

Abstract:
Because health coaching is so new, outcomes of its use and implementation are somewhat limited, especially its impact on cost. However, a brief review of the literature shared here reveals findings that we hope you’ll find useful in your work, as many of you have requested to know what types of results others are obtaining in health coaching and in what populations. If you are aware of other organizations or individuals who have achieved various outcomes in health coaching/motivational interviewing, please these send our way with your references, and we’ll send this information out to everyone on our email list! Thanks!

Evidence-based practice is highly encouraged in healthcare, and it’s no different in health coaching! It is the author’s opinion that motivational interviewing (MI), the primary evidence-based foundation for the NSHC’s health coaching education and certification program, has been the single most influential method to date of addressing the patient’s agenda and self- motivation for behavior change. Why?

Dr. William Miller began describing its use in the early1980s as a clinical intervention for those patients in whom problem drinking was particularly difficult to abate. He found that MI was as effective as other methods to assist these patients, but achieved results more quickly. Because of this success, MI began to be used in the early 1990s to help those with chronic conditions change their behavior, in which one finding the motivation to change is also problematic. Dr. Miller has conducted numerous studies on the subject of MI. While health coaching takes on many forms today, clearly the work of Dr. Miller and his colleagues was the catalyst for the fresh, new approach: evidence-based health coaching that the National Society of Health Coaches (www.nshcoa.com) promotes today.

Dr. S. Butterworth et al. of Oregon Health and Science University studied the response of 276 self-selected medical center employees in a 3-month study¹ using MI-based health coaching. The intervention included a minimum of one initial session and two follow-up contacts. The Short Form 12 Health Survey was used to describe health status. The treatment group showed significant improvement in health status versus the control group.

Mayo Clinic 2005² health coaching outcomes revealed the following:

  • 64% increased exercise time
  • 42% tobacco users quit at 6 mo and 37% at 12 mo
  • 61% increased healthy eating choices

Dept of Cardiology, St. Vincent ’s Hosp, Melbourne, Australia³

  • At 6 mo, serum Total-C and LDL-C levels significantly lower
  • Being coached had an effect of equal magnitude to being prescribed lipid-lowering drug therapy.

HCIN 2010 Benchmarks Survey4

  • 34.4% decreased claims cost
  • 36% say ROI increased from 2 to >4:1; 64% said too early to tell about ROI

Ribak et al. performed a systematic review and meta-analysis that was published in the British Journal of Medical Practice in 2005 that found many positive outcomes in the use of motivational interviewing in the studies evaluated.

  • 95% confidence level for combined effect estimates for BMI, total blood cholesterol, systolic BP
  • Three of four studies revealed an equal effect on physiological and psychological diseases at 72 and 75% respectively.
  • In 64% of the studies, the use of motivational interviewing showed an effect even in brief 15-minute encounters.

References:

  1. Butterworth,S., Linden ,A., McClay,W., Leo, M.C., (2006). Effect of motivational interviewing-based health coaching on employees’ physical and mental health status. Journal of Occupational Health Psychology, 11(4), 358-365.
  2. Healthcare Intelligence Network. (2007). Coaching in the healthcare continuum: Models, methods, measurements and motivation. Manasquan , NJ : author.
  3. Vale, M.J., Jelinek,M.V., Best, J.D., & Santamaria, J.D. (2002, March). Coaching patient with coronary heart disease to achieve the target cholesterol: A method to bridge the gap between evidence-based medicine and the “real world”- randomized controlled trial. Journal of Clinical Epidemiology, 55(3), 245-52.
  4. Healthcare Intelligence Network. (2010). 2010 Health coaching benchmarks. Manasquan, NJ: author
  5. Rubak,S., Sandbæk,A., Torsten, L., & Christensen, B. (2005, April). Motivational interviewing: A systematic review and meta-analysis. British Journal of General Practice. Review Article, p305-312. Retrieved Sept 28, 2010, from http://www.motivationalinterview.org/library/RubakMIreview.pdf

©2010 NSHC All rights reserved.I

How to be Happier – a Guide to Mindful Meditation

I’ve been fascinated with meditation for years, the idea that by simply sitting one can experience insights and transformations is intriguing.  The fact that various meditation techniques are ubiquitous in spiritual disciplines across the continents and through time is telling of their importance for growth.  Yet for many modern
scientifically minded westerners the idea of engaging in a spiritual discipline evokes all kinds of psychological resistances. Many meditation schools make unverifiable claims or are instructed with a language embedded in a culture and a philosophy that does not lend itself for export in our modern world.  However, in the last few decades mindfulness meditation was distilled and exported into the West.  Mindfulness meditation contains no doctrine or ‘woo-woo’ attached to its practice and philosophy.  Mindfulness can be thought of as simply paying attention to the aspects of experience.  When we are mindful of our experience we  become conscious of our bodily sensations, our body movements, our perceptions (internally generated sights, smells, sounds, etc.), our emotions, and our thoughts (cognition).  In the practice of mindfulness we become an uninvolved observer of our experience, that is, we allow thoughts, feeling, and emotions, etc., to arise and fall without us examining, judging, or inspecting them.  Most mindfulness meditation practices have a central object of attention , such as the breathe which one orientates themselves towards, and as inevitable aspects of experience pull the attention away one simply and nonjudgmentally pull themselves back to the meditation object, in this case the breathe.
Here is a mindfulness meditation technique for beginners:
1. Find a quiet and comfortable place. Sit in a chair or on the floor with your head, neck and back straight but not stiff.
2. Try to put aside all thoughts of the past and the future and stay in the present.
3. Become aware of your breath, focusing on the sensation of air moving in and out of your body as you breathe. Feel your belly rise and fall, the air enter your nostrils and leave your mouth. Pay attention to the way each breath changes and is different.
4. Watch every thought come and go, whether it be a worry, fear, anxiety or hope. When thoughts come up in your mind, don’t ignore or suppress them but simply note them, remain calm and use your breathing as an anchor.
5. If you find yourself getting carried away in your thoughts, observe where your mind went off to, without judging, and simply return to your breathing.
Remember not to be hard on yourself if this happens.
6. As the time comes to a close, sit for a minute or two, becoming aware of where you are. Get up gradually.

Meditation is a discipline.  It requires training to become proficient at paying attention.  We live in a busy world, and most of the time we are easily distractible and our attention constantly switches and orientates all over the place. Meditation can be difficult to start and to maintain a routine. Yet the outcomes of meditation and experiences one may encounter are profound.  There are now hundreds, if not thousands of studies on meditation proving profound benefits to stress levels, the immune system, and the felt sense of peace and acceptance.  As well as thousands of years of anecdotal reports of various kinds of spiritual transcendence and growth.  Once again, many of the explanations and mechanisms of growth are embedded in religious philosophy that does not lend itself for understanding for the scientifically minded. However, through the work of Dr. Daniel Siegel, an eminent researcher in the areas of the developing brain, interpersonal neurobiology, and attachment we now have a language for which we can discuss possible mechanism of the growth associated with mindfulness meditation.
Before we can discuss the benefits of meditation on the mind we must first discuss the brain.  In particular I want to draw attention to an area of the brain known as the medial prefrontal cortex. In the words of Dr. Daniel Siegal:
“The prefrontal areas coordinate and balance input from the cortex, limbic, brainstem, and bodily regions as these are connected even to the input from other brains (that is, other people). In this way, the prefrontal cortex integrates social, somatic, brainstem, limbic, and cortical systems all into one functional whole.”
The prefrontal cortex is a pivotal area for everything involved in being human.  What the paragraph above says is that our brains have different regions of brain tissues specialised for processing our social experience, or felt presence in the body (somatic), and our emotions (limbic).  All the information processing in these areas is then sorted by the prefrontal cortex and integrated into our conscious experience. Thus the prefrontal cortex is a central hub for our sense of self and the felt experience of the here and now playing a role in our decision making and integration of various aspects of experience. Now, let’s further explore and prefrontal cortex and its 9 functions according to Daniel Siegel and then relate it to the benefits of mindfulness meditation.
The nine functions of the pre-frontal cortex, according to Daniel Siegel:
1. Body Regulation — Functions of the body such as heart rate, respiration and digestion that are controlled by the nervous system.
2. Attunement — When we attune to others we allow our own internal state to shift, to come to resonate with the inner world of another.
3. Emotional Balance — Even the healthiest person may be temporarily thrown off and feel out of balance but the middle pre-frontal region functions to bring us back to equilibrium. The ability to stay focused on the inside when the storms of life are raging on the outside.
4. Response Flexibility — This ability to pause before responding is an important part of emotional and social intelligence.
5. Empathy — The capacity to create mindsight images of other people’s minds. These you-maps enable us to sense the internal mental stance of another person, not just to attune to their state of mind.
6. Self-Knowing — Mental time travel in which we connect the past to the present and the anticipated future.
7. Fear Extinction — After experiencing a frightening event, we may come to feel fear in the face of a similar situation. But the middle prefrontal region has direct connections that pass down into the limbic area and make it possible to inhibit and modulate the firing of the fear-create amygdala.
8. Intuition — Can be seen as how the pre-frontal cortex gives us access to the wisdom of the body. This region receives information from throughout the interior of the body, including the viscera (heart, intestines) and uses this input to give us a “heart felt sense” of what to do or a “gut feeling” about the right choice.
9. Morality — Moral reasoning seems to require the integrative capacity of the pre-frontal cortex to sense the emotional meaning of present challenges and to override immediate impulses in order to create moral action in response to challenges.
Any activity which bolsters improvements across these 9 domains has the potential to radically transform a persons life.  Studies have shown repeatedly that experienced mindfulness meditators can alter their grey matter in regions of the prefrontal cortex.  Grey matter being a measure the functionality of the region, thus, that is to say, that meditation causes changes in the brain that result in improved function of the
prefrontal cortex. Its not a far leap to look at the functions of prefrontal cortex such as increased empathy and morality to see its connection with spiritual disciplines.  Also as Dr. Siegel points out the intuition associated with a better mind body awareness to our gut feelings or gut-nervous system may be an explanation for what people mean when they discuss listening to the mind and heart in various religious philosophies.
The research is becoming quite clear as to the possible mechanisms by which meditation provides its benefits. The idea that meditation as merely a spiritual practice for the religious is unnecessary and frankly it turns off many people from practicing a discipline that can cause radical personal transformation which can in turn benefit the wider social environment.  As such, I’m deeply encouraged when I hear that mindfulness is now being taught to many kids in elementary schools.  Now if only we could integrate the practice into the lives of all those who grew up without it.
Did you read this article and find some value?  Give me some feedback in the comments to help me improve my writing.  Or tell me about your experience (or non-experience) with meditation 🙂