Are Popular Health Coaching Training Programs Evidence-Based?

An informal review of the popular health coach training programs and curricula indicates that most are based on “life coaching” models. Life coaches use mentoring, values assessment, behavior modification, goal-setting and other approaches to help their clients succeed in life. Most health coaching programs represent a collection of various psychological concepts and techniques—typically with a cursory overview of motivational interviewing. While some claim to represent the “psychology of health coaching”—and cite psychological terms and studies—experts in the behavioral sciences typically play no role in their design or review.

Additionally, most health coaching training programs are neither competency-based, nor founded on modern learning and development best practices. These programs are not effective for building the required threshold competence in evidence-based approaches such as motivational interviewing.6 Indeed, most training programs are based on testimonials or client success stories. Some include health coach business plans, marketing kits, referral networks or lapel pins. One promises to help new health coaches: “Make more money than ever imagined as a health coach.” Others claim to help individuals become “Health Coach Entrepreneurs,” who “earn at least $171 per hour without leaving home.”

Experts in evidence-based health coaching have commented on popular health coach training and certification programs. Dr. Susan Butterworth, the recipient of two NIH grants to study the efficacy and impact of health management interventions, and a member of the HealthSciences Institute Advisory Board member, recently notes: “With few exceptions, the health coaching training programs and certifications that we have seen are not based on behavior change science. The models and interventions that they advocate have not been objectively evaluated, particularly for use with people with chronic health conditions or for use in health care encounters.”7 While life coaching-based health coaching approaches may have value, as Butterworth, Linden and McClay recently wrote in a comprehensive review of health coaching in health management programs: “Motivational interviewing is the only technique to have been fully described and consistently demonstrated as causally and independently associated with positive behavioral outcomes.”8

Putting Evidence-Based Health Coaching Into Practice

The life coaching perspective and coaching-based approaches have value in that they put the focus squarely on the patient and his or her goals. This is clearly an improvement over the patient education-oriented approaches that have historically been used in health care. However, health coaching can be either patient centered and effective, or, patient centered and ineffective or unproductive. To prepare health-coaching specialists—and to support wider adoption of basic health coaching techniques by health professionals in all settings—it is essential that health coaching be based on a formal, structured practice model. Health coaching should also reflect evidence in related areas including disease prevention, nutrition, weight management and physical activity—as well as medical care and self-care support for common chronic diseases. These steps are essential for delivering optimal value to the patients who receive coaching services, as well as the purchasers who expect that their investments in chronic disease prevention and management yield measurable results. Patient-centered, effective approaches such as motivational interviewing may appear simple, but they can be difficult to apply in practice. Consequently, best practices in learning and competency development, and workplace performance measurement and management, must be applied to support proficiency. It is critical that health coaching not devolve into patient-led encounters or aimless discussion.

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References

1. Poor medication adherence costs $290 billion a year. Mobihealthnews website, 2009. Available at: http://mobihealthnews.com/3901/poor-medication-adherence-costs-290-billion-a-year/. Accessed November 18, 2009.
2. The world health organization warns of the rising threat of heart disease and stroke as overweight and obesity rapidly increase. World Health Organization website, 2009. Available at:  http://www.who.int/mediacentre/news/releases/2005/pr44/en/index.html. Accessed November 18, 2009.
3. Johnson A. Disease management: the programs and the promise. Milliman USA Research Report, 2003.
4. Linden A & Roberts, N. Disease management Interventions: what’s in the black box. Disease Management. 2004;7:275-288.
5. HealthSciences Institute & DMAA: The Care Continuum Alliance. Population Health Improvement Professional Development Survey. November 2007.
6. Miller WR, Yahne CE, Moyers TB et al. A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology. 2004;72:1050-1062
7. Purchasers see value in evidence-based disease management and health coaching. HealthSciences Institute website. Available at: http://www.healthsciences.org/enews2009/Purchasers_See_ Value_in_Evidence-Based_DM_Health_Coaching.html. Accessed November 17, 2009.
8. Butterworth S, Linden A, McClay W. Health coaching as an intervention in health management programs. Disease Management Health Outcomes. 2007;15:299-307.