Realizing The Promise of Health Coaching

The Role of the Behavioral Sciences in Health Care

The World Health Organization estimates that 80% of heart disease, stroke and type 2 diabetes—and 40% of cancer—could be avoided through healthy diet, regular physical activity and avoidance of tobacco use.1 Better treatment adherence, lifestyle management, and self-care could also prevent both disability, and costly disease-related complications and hospitalizations among patients with chronic conditions. Poor medication adherence alone costs an estimated $290 billion in the United States each year.2 Fortunately, the behavioral sciences offer some practical, effective—but poorly utilized—ways to address these issues.

Health Coaching as an Evidence-Based Practice

Professionals, employers and health care organizations have recently embraced health coaching approaches that target patients at risk of, or affected by, chronic conditions. However, with the increased popularity of health coaching, questions have been raised about its effectiveness and value. In health care, effectiveness is demonstrated through both objective, peer-reviewed research and expert consensus.

That raises the question: Should evidence and expert consensus be the bases for health coaching practice as it is for other health care specialties from cardiology to nutrition?

Some might argue that health coaching should be an intuitive practice, or that it is more “art” than “science.” Others think that formalizing health coaching will diminish its “patient-centeredness.” (Physicians have made similar arguments against evidence-based medicine). Though health coaching may be less well-defined than other medical interventions, the fact remains that some health coaching techniques are highly effective. Other popular techniques, however, are unproven, and some are unproductive or ineffective. To work, health coaching should be both patient-centered and effective.

Is “Usual” Health Coaching Evidence-Based?

Given the lack of consistency in how health coaching is defined, practiced and assessed, it’s difficult to determine whether or not “usual” health coaching is evidence-based. Today, individuals ranging from nutritional supplement dealers, fitness trainers, massage therapists, life coaches and nurses refer to themselves as “wellness coaches” or “health coaches.” Yet few have been exposed to or trained in structured, evidence-based health coaching practice. In health care settings, it has long been assumed that health coaching is a “soft” competency that is “innate” in nurses and other clinicians. Even among specialty disease management organizations, gaps in staff experience and preparation for evidence-based health coaching practice have been documented.3,4 While more wellness, disease management and care management programs are introducing more staff to evidence-based models and approaches, few require any external certification or competency assessment in this new approach to care.5 It is impossible to verify common claims of “behavioral science-based” services—in the absence of any formal, standardized certification or other measurement of staff proficiency or performance.

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