Supporting Health Behavior Change Through Coaching

Mayo Clinic Proceedings recently published an article entitled “Supporting Sustainable Health Behavior Change: The Whole is Greater than the Sum of Its Parts.”  Simon Matthews, Wellcoaches Faculty member, was a co-author on this informative piece describing behavior change through health and well-being coaching (HWC). The Purpose of the article is to equip clinicians with tools and related evidence allowing them to encourage behavior change in their patients.  The authors focused on key health-promoting behaviors including:

1. Eating a well-balanced diet

2. Increasing physical activity

3. Managing stress well

4. Improving sleep

5. Avoiding/mitigating risky substance and unnecessary medication use

6. Nourishing social connections

HWC is described in this paper as an effective behavior change intervention.  The “coach approach” was clearly elaborated and summarized as a patient-centered, concordant communication style that encouraged provision of autonomy and permissive flexibility – key personal attributes for supporting long-term healthy behavior change.  A takeaway here is that health and well-being coaches should always be keen on promoting client or patient autonomy and permissive flexibility.

The power of autonomy is featured in this paper as the essence of patient-centered coaching.  Autonomy is a psychological need emphasizing freedom from external control and acting from personal motivation.  Autonomy is recognized as a key component of the Self Determination Theory (SDT).  SDT is a foundational theory of HWC and much of the intervention’s success relies on promoting autonomy.  Relatedness and Competence are also components of SDT that can also be advanced by HWC.

Permissive flexibility (PF) appears to be an important determinant of healthy behavior maintenance.  PF allows an individual to adapt to changing demands, resources, perspectives, desires, and emotions while connecting to personal values.  Higher PF allows a person to more likely be successful at maintaining weight loss or adhering to a physical activity program.  To the extent that HWC can increase PF, it should increase the likelihood of intervention success.

Another theme of this paper is behavior change sustainability.  The authors made it clear more research was needed in this area, especially beyond six-months after HWC intervention.  It seems critical to understand the HWC dose and strategies that best ensure long-term patient success.  However, the authors do offer an “expanded” view on sustainability saying that we should consider it a worthwhile outcome if HWC supports a patient for only a limited period of time in managing chronic disease.  This is particularly true when health care providers also benefit from this process, leading to a mitigation of potential feelings of burnout.  We may come to find HWC effects do not persist for long after the coaching process is halted.  This is not unlike what happens with prescription of medication, exercise, or diet – meaning that, if the intervention is stopped the beneficial effects will fade over days, weeks, or months.  It is very possible we come to find that, HWC is a lifelong process.  Maybe the successful client requires lower levels of intervention later in the treatment process – e.g., a “booster” HWC session every three months.  There are important research questions around this topic of sustaining healthy behavior change through HWC that need to be more fully explored.

The point of adding a qualified health and well-being coach as a member of the patient care team was made more than once in this article.   Articles like this one are providing a roadmap for health and well-being coaches to chart their future.  As a coach, now is the time to consider partnering with a clinical team and providing support for both patients and the healthcare team.  A good coach can help on both ends of this relationship, promoting healthy patient behavior change while reducing clinician burden and potential for burnout.  Also remember that, in the right clinical settings, HWC services may be eligible for insurance reimbursement – this was addressed in our last Wellcoaches Newsletter blog.  Time to take advantage of these opportunities!

REFERENCES

Matthews JA, Matthews S, Faries MD, Wolever RQ. Supporting Sustainable Health Behavior Change: The Whole is Greater Than the Sum of Its Parts. Mayo Clin Proc Innov Qual Outcomes. 2024 May 18;8(3):263-275. doi: 10.1016/j.mayocpiqo.2023.10.002.