Health Coaching Across the Population Health Improvement Continuum

No consensus exists on how to define health coaching and how to practice health coaching. Similarly, there is little agreement on who should be doing health coaching and who should be receiving health coaching. Nor, are there standards for measuring the effectiveness of health coaching encounters.

Employers may offer healthy employees health coaching services to assist in smoking cessation, healthy diet, weight management or physical activity.

Primary care providers may offer patients with chronic diseases health coaching to support knowledge, adherence, disease self-care support, or lifestyle management.

Clinicians in chronic care improvement or disease management programs may also offer brief, phone-based health coaching to support receipt of evidence-based medical care, treatment adherence and daily self-care.

Care managers or case managers, who may not refer to themselves as “health coaches,” may provide all of the above and more to individuals with multiple or complex health care conditions.

While a variety of specific health coaching interventions may be delivered based on the needs of the population(s) served and the setting(s) in which they are delivered, health coaching services can generally be described as either preventive or therapeutic:

Preventative Health Coaching

Is often referred to as “wellness coaching.”

May be offered by non-clinicians or clinicians.

Targets individuals with or without chronic conditions.

Supports physical activity, healthy diet, or weight management as components of general or targeted disease prevention.

Is designed to slow progression of disease, prevent complications, or support function and independence, e.g., a weight-bearing activity program for an individual with osteoporosis.

Therapeutic Health Coaching

Is often referred to as “health coaching.”

Is typically delivered by clinicians, e.g., nurses, physicians, pharmacists, nutritionists.

Targets individuals affected by one or more chronic conditions.

Support physical activity, healthy diet, or weight management as components of an evidence-based therapeutic care plan.

Is designed to slow progression of disease, prevent complications, or support function and independence, e.g., a weight-bearing activity program for an individual with osteoporosis.

When health coaching services are delivered to individuals with one or more chronic conditions, professionals are typically practicing preventative and therapeutic health coaching. For example, when working with patients with diabetes, it is important to support optimal medical management through regular A1c testing, and medication management of glucose and lipids. However, clinicians will also be supporting critical lifestyle management issues including diet, weight management and physical activity. In both preventative or therapeutic health coaching encounters, health coaches routinely encounter similar engagement, motivation, and behavior change barriers and opportunities.

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