Health and Wellbeing Coaching
Coaching is a conversational style and approach in which one person (the coach) helps and guides another person (the client or “coachee”) toward improved performance and quality of life. It has been defined as “a systematic, collaborative, solution-focused process in which the coach facilitates enhancement of life experience and goal attainment in the personal and/or professional life of clients” (Stober and Grant 2006, p. 3). It is often considered to have its origins in the sports sector, spreading from there to other contexts such as the workplace, health, and life in general (e.g., executive coaching, job coaching, career coaching, safety coaching, relationship coaching, health coaching, life coaching, etc.).
Just as there are several different schools or types of counseling and psychotherapy, so too there are different schools or types of coaching, including humanistic, cognitive-behavioral, solution-focused, motivational interviewing, strengths-based, positive psychology-based, compassion-focused, and mindfulness-based (Passmore. Mastery in Coaching).
Health coaching is a coaching which focuses on helping individuals take steps to protect, improve, and/or recover their health. It can be offered to both healthy people and people with health problems. When delivered to patient health and wellness coaching has been defined as “a patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability” (Wolever et al. 2013, p. 52). Wellbeing coaching is a coaching focusing on helping people take steps to protect, improve, and/or recover their wellbeing. It has been defined as “a Socratic, future focused, collaborative conversation between a coach and the client, during which the coach uses open questions, affirmations, reflective listening, summaries and information exchange to stimulate and encourage self-awareness, personal responsibility and behavioral change thought likely to lead to improved wellbeing outcomes over time” (Anstiss and Passmore 2015, pX).
Like psychotherapy, health and wellbeing coaching is a conversational approach to help a person experience improved health and wellbeing. Unlike psychotherapy – which tends to be delivered to people with mental health problems using a remedial approach to help with symptom reduction – coaching tends to work with people free from a mental health diagnosis (or where this is not the focus) in a nonmedical, solution-focused, and strengths-based way, helping the person move from languishing (Keyes 2005) or just doing “ok” toward higher levels of health, wellbeing, performance, achievement, flourishing, and quality of life. This distinction is not hard and fast however as some therapies focus on improving quality of life in people without mental illness, while some types of health and wellbeing coaching (e.g., cognitive-behavioral, positive psychology, or motivational interviewing) may help individuals experiencing clinical levels of stress, anxiety, sadness, or addictive behavior experience symptom reduction – including when used in combination, e.g., MI and CBT or CBT and positive psychology interventions (Naar and Safren 2017; Mira et al. 2018). Indeed, many clinical psychologists use positive psychology interventions in their work with patients experiencing mental health problems (Wood and Tarrier 2010).
One of the biggest problems facing health and care systems around the world is the growing epidemic of long-term conditions (LTCs) and noncommunicable diseases (NCDs) including co- and multimorbidity (Lancet 2016). In the European Union, approximately 50 m people live with one or more long-term conditions, and by 2030 an estimated 83.4 million people in the USA will be living with 3 or more chronic conditions simultaneously (Hales et al. 2017). The rising prevalence of the chronic health problems also undermines a countries or regions economic growth and sustainable development efforts, with long-term conditions being the main source of healthcare costs, representing perhaps 70–80% of total healthcare cost in EU countries (Rijken et al. 2013).
Many chronic health conditions have strong behavioral components, both in terms of behavioral risk factors which increase the risk of a person developing the health condition in the first place and behavioral factors which influence how the disease (or diseases) unfold once developed – e.g., rate of progress, risk of complications, risk of admission, and slowing or even reversal of disease progress in some instance. The GDB 2015 Risk Factor Collaborators (ref) used comparative risk assessment to estimate attributable deaths and disability-adjusted life years for 79 behavioral, environmental, occupational, and metabolic risks or clusters of risks from 1990 to 2015. The top ten contributors to global disability-adjusted life years (DALYs) included high systolic blood pressure (211.8 m DALYs), smoking (148.6 m), high fasting plasma glucose (143.1 m), high BMI (120.1 m), high total cholesterol (88.7 m), alcohol use (85 m), and diets high in sodium (83 m). Globally an estimated 1.9 billion adults are overweight or obese (WHO 2015) including over 50% of adults in OECD countries (OECD 2014). Obesity is one of the global leading causes of morbidity and mortality, and reductions in weight can result in significant health improvement and reduced disease risk (Espeland 2007; Wing et al. 2011; Donnelly et al. 2009, etc.). Physical inactivity has been estimated to be responsible for 6% of the burden of disease from CHD, 7% of type 2 diabetes, 10% of breast cancer, and 10% of colon cancer and over 5.3 of the 57 million deaths that occurred worldwide in 2008 (Lee et al. 2012).
As a response to the above trends and statistics, healthcare systems around the world are developing and implementing Chronic Disease Self-Management (CDSM) support systems. Reviews of CDSM systems generally indicate a positive impact on clinical and other outcomes (Miller et al. 2015; O’Connell et al. 2018), with one critical element of effective systems being the quality and volume of interactions between prepared, proactive healthcare professionals and teams and the patients they serve (Wagner et al. 1996). The growing interest in health and wellbeing coaching can be seen as part of this effort, with health professionals (and others) working in more person-centered ways to better engage, activate, and empower people with and without disease to make lifestyle changes to better look after their health now and into the future.
Health and wellbeing coaching also has the potential to break down some of the barriers which exist between physical health and mental health services, focusing as it does on the whole person, guiding and supporting them toward changes likely to result in both improved physical health and psychological wellbeing which are interrelated and mutually influencing. Good psychological wellbeing seems to contribute to good physical health, and good physical health contributes to good wellbeing in a potentially virtuous circle or upward spiral. Conversely, poor psychological wellbeing can contribute to the development of physical health problems, and physical health problems can adversely influence psychological wellbeing in a potentially vicious circle or downward spiral.
Structure of This Chapter
This chapter will explore the theoretical basis for coaching for health and wellbeing, before exploring what happens in practice, evidence of effectiveness, and some suggestions for the way forward for this important and emerging body of professional practice.
Health and Wellbeing Coaching
Several psychological theories inform good practice in health and wellbeing coaching. Humanistic psychology arose as a reaction to psychodynamic and behavioristic approaches and hence was labelled a “third way” or third force in psychology. Its theoretical assumptions include that human beings are intrinsically good, that they are more than the sum of their parts, and that they contain within them a dynamic force (or “actualizing tendency”) which seeks to unfold over time. Abraham Maslow (1954) suggested “self-actualization” was an innate human need, and Carl Rogers (1961) articulated the concept of the “fully functioning person.” To best help a person unfold and reach their potential, humanistic theory suggests coaches create and maintain conditions of warmth, nonjudgment, unconditional positive regard, and empathy.
Positive psychology builds on humanistic psychology foundations, being the title of the final chapter in Maslow’s 1954 book Motivation and Personality (Maslow 1954). Positive psychology has been defined as “the study of the conditions and processes that contribute to the flourishing or optimal functioning of people, groups, and institutions” (Gable and Haidt 2005, p. 104). Seligman’s wellbeing theory (2011) suggests that human flourishing and wellbeing is made up of five distinct but related “pillars”: positive emotions (positively valence feelings such as happiness, joy, love, acceptance, etc.), engagement (feeling absorbed, interested, and connected), positive relationships (feeling socially integrated, cared about, supported, and satisfied with one’s connections), meaning (believing one’s life is valuable and feeling connected to something greater than oneself), and accomplishment (making progress toward goals, capable of daily activities, and having feelings of achievement). Seligman suggests each of these five elements is intrinsically motivating, i.e., pursued and experienced for it’s own sake, and can be defined and measured separately from the other pillars. To best help a person thrive and flourish in life, wellbeing theory suggests coaches guide, support, and encourage their clients toward actions which strengthen one or more of these five pillars.
Another multicomponent model of psychological wellbeing, self-determination theory posits the existence of three basic psychological needs or “nutriments” – autonomy, competence, and relatedness – and suggests that human thriving and flourishing is best realized when individuals behave in ways that satisfy these three basic psychological needs (Ryan et al. 2008). They also suggest that human flourishing is more likely when individuals pursue intrinsic goals and values (e.g., personal growth, relationships, community, and health) rather than extrinsic goals and values (e.g., wealth, fame, image, and power), behave in autonomous and freely chosen rather than controlled ways, and act with a sense of awareness in a mindful way.
Of course, knowing what to do and why it might be helpful to do it does not always result in behavior change. Self-efficacy theory (Bandura 1977) states that an individual’s confidence in their ability to change (their self-efficacy) is an important determinant of both their readiness to initiate behavior change and to persist in the face of obstacles. Four of the main determinants of self-efficacy are previous mastery experiences, vicarious learning (learning from others), persuasion from an authority and feedback. To maximize the chances of clients changing their behavior, health and wellbeing coaches may spend some time strengthening one or more of these determinants of self-efficacy.
Behavior change toward improved health and wellbeing may not happen rapidly, nor in a one-off way resulting in permanent behavior change. It may happen in stages (stage models) and be characterized by periods of progress followed by relapse back into previous behavior patterns (Marlatt and Gordon 1985). The transtheoretical model (Prochaska and DiClemente 1984) describes several different processes of behavior change along with several different stages: pre-contemplation (not thinking about change), contemplation (thinking about change), preparation (getting ready to change), action (starting to change), maintenance (keeping going, staying changed), and termination (where the new behavior is so engrained and habitual that the individual cannot imagine ever going back to an earlier stage). A common process of change is relapsing, of returning to an earlier stage of change, for instance, someone who has stopped smoking for 2 years but then goes back to smoking. This relapse process itself may also unfold in stages, e.g., a slip (one cigarette), a lapse (smoking for the weekend), and a relapse (going back to regular smoking). Health and wellbeing coaching often use this “stages of change” theoretical framework to tailor their approach to perceived client readiness to change, e.g., by not rushing ahead into goal setting and planning techniques when the clients are still unsure as to whether or not they want to change (i.e., in contemplation).
One of the goals of health and wellbeing coaching is to help the client develop improved self-management and self-regulation skills. Self-regulation theory (Baumeister, MacKenzie et al. 2012) and the related theories of Goal Setting (Locke and Latham 2006), Self-Control (Scheier and Carver 1988), Self-Discrepancy (Barnett, Moore and Harp, 2017) and Cognitive Dissonance (Harmon-Jones, Harmon-Jones and Levy, 2015) suggest that human beings consciously and deliberately attempt to manage their thoughts, feelings and behaviours to help them reach their goals and make progress towards internalised standards such as their desired or preferred future self. People use self-monitoring to determine their progress and take corrective action to maximize their chances of success. Willpower is required to help a person persist in the face of obstacles and resist unhelpful urges, desires, and counter-motives. Willpower seems to be something which can become depleted over time which may be one cause of self-regulatory failure. Health and wellbeing coaches may use these theories of self-regulation to help clients become more aware of any discrepancy between their current behavior, their goals, and their values (which may lead to motivation to change); to clarify and set helpful and realistic goals; and to develop and implement personalized plans which, if acted upon, would help reduce any discrepancy. Theories of self-regulation may also inform client skills development, including developing skills of self-monitoring, urge control, stress reduction, compassionate self-correction, and problem-solving.
In addition to being confident about being able to change (good self-efficacy) and having the self-management skills to make successful change more likely, people benefit from good levels of hope. Hope has been defined as “a positive motivational state that is based on an interactively derived sense of successful agency (goal directed energy) and pathways (planning to meet goals)” (Snyder et al. 1991, p. 287). Health and wellbeing coaches can use hope theory to ensure they focus in a balanced way on both valued client goals (providing direction and an endpoint for hopeful thinking) and “pathway thoughts” about the routes which may be taken to reach these goals and their ability to travel them successfully.
And finally, people will be more likely to start and sustain behavior change if the process is associated with pleasant and positively experienced emotions and feelings rather than unpleasant and negatively experienced ones. Recognizing that much more was known about the function of negative emotions (anxiety, anger, hate, sadness, guilt, shame, etc.) than positively experienced ones (joy, hope, love, acceptance, curiosity, etc.), Fredrickson (Fredrickson DATE) theorized that the evolved purpose of positive emotions was to broaden attentional focus and to build importance resources and assets for the future, such as positive relationships and connections, skills, know-how, etc. Health and wellbeing coaches may use this “broaden and build” theory to guide their clients toward behaviors and actions likely to result in more frequent, intense, or longer-lasting positive emotional states, which will both help the behavior become self-reinforcing while simultaneously helping clients develop and build resources for the future.
Health and wellbeing coaching is an emerging body of professional practice, encompassing a range of approaches, strategies, and methods each with their own momentum. It is being delivered by a wide range of different practitioners (nurses, dieticians, physiotherapists, doctors, health and fitness professionals, teachers, HR professionals, social workers, peers, etc.) in a wide range of different settings (in-patients, out-patients, GP and primary care, community, workplaces, leisure centers, people’s homes, coffee shops, schools, and prisons). Many practitioners will be doing health and wellbeing coaching without recognizing or labelled it as such.
Health coaching tends to focus on helping clients or patients take steps toward improved physical health by reducing their risk factors for disease and disease progression (such as poor diet, excessive alcohol intake, smoking, or an inactive lifestyle) and increasing their protective factors (such as getting enough sleep, living an active lifestyle, coping better with stress, making better food choices, taking up screening, or taking prescribed medication). Wellbeing coaching tends to focus on helping clients take steps toward improved psychological health, wellbeing, and happiness, with mental or psychological wellbeing being defined as “A dynamic state in which the individual is able to develop their potential, work productively and creatively, build strong and positive relationships with others and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and achieve a sense of purpose in society” (UK Governments Mental Capital and Wellbeing Project 2008, p. 10). (From this it can be seen that wellbeing coaching involves more than just guiding, encouraging, and supporting people to make lifestyle changes to reduce their risk of physical health problems.)
Several different “brands” or types of wellbeing-focused coaching exist including positive psychology coaching, defined as an “evidence-based coaching practice informed by the theories and research of positive psychology for the enhancement of resilience, achievement and wellbeing” (Green and Palmer 2019, p. 10; wellbeing therapy (Fava 1999); quality of life therapy (Frisch 2006); acceptance and commitment coaching (Anstiss and Blonna 2014); compassionate mind coaching (Anstiss and Gilbert 2014); and mindful coaching (Hall 2013). Regardless of the type, wellbeing coaching commonly involves positive psychology interventions (PPIs), defined as “treatment methods or intentional activities that aim to cultivate positive feelings, behaviours or cognitions” (Sin and Lyubomirsky 2009). PPIs are broad in focus and include interventions and exercises involving the exploration and cultivation of personality strengths, gratitude, acceptance, positive relationships, forgiveness, pleasure, hope, increasing contact with nature and time spent in the psychological states of flow, as well as feelings of engagement, meaning, purpose, and achievement.
Health and wellbeing coaching can be delivered in both one-to-one and group formats, as a face-to-face or remote intervention (e.g., telephone, video, e-mail, messaging, discussion forums, etc.) or via a combination of these modalities. It can be delivered in real time or “asynchronously” – where elements of the conversation between coach and client are separated by hours or days. It can be delivered as a formal, planned coaching or behavior change program or service or as an “opportunistic” intervention – e.g., in primary care about smoking or diet or in the emergency room as a brief conversation about alcohol use. It may last under a minute or be spread out over several sessions over several weeks or months.
As part of the move toward an agreed certification process for health and wellness coaches, Jordan et al. (2015) conducted a job task analysis, initially with 15 subject matter experts in health and wellness coaching from diverse backgrounds, followed by a survey of over 4,000 health and wellness professionals. The analysis found the tasks of these coaches to include explaining the coaching process; clarifying desired outcomes, priorities, strengths, and challenges; exploring motivation and readiness to change; developing a coaching agreement; helping clients describe their ideal future; helping clients establish goals and take steps toward them; and helping clients maintain progress. They found the skills required for successful coaching to include establishing and maintaining rapport and trust, displaying empathy, active listening, asking open questions, structuring the conversation, increasing motivation for behavior change, providing information and resources, enhancing self-efficacy, building client autonomy, and self-management. They also outlined a job definition for health coaches, stating that they are “professionals from diverse backgrounds and education who work with individuals and groups in a client-centred process to facilitate and empower the client to achieve self-determined goals related to health and wellness.” They felt that successful coaching takes place when coaches “apply clearly defined knowledge and skills so that clients mobilize internal strengths and external resources for sustainable change.”
While skill in the use of proven coaching and behavior change techniques (Michie et al. 2011) is helpful, the effective health and wellbeing coach pays equal attention to aspects of the relationship with their client. In a series of systematic reviews and meta-analyses for the American Psychological Association, Norcross (2011) identified several “evidence-based relationship factors” which contribute significantly to the effectiveness of conversations about health and wellbeing, including empathy, alliance, goal congruence, and feedback.
One particularly well-described and well-evaluated approach to health and wellbeing coaching is motivational interviewing. First described in 1983 (ref), motivational interviewing (MI) has been defined as “a collaborative, goal-oriented style of communication with particular attention to the language of change, designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the persons on reasons for change within an atmosphere of acceptance and compassion” (Miller and Rollnick 2013, p. 29). The spirit of the approach is a PEACEful one, involving partnership, empathy, acceptance, compassion, and evoking. The principles of the approach include resisting the righting reflex (the common tendency to jump in and fix a person with unasked for advice), understanding their motivation and reasons for change, listening with accurate empathy, encouraging optimism and hope, avoiding argumentation, supporting and strengthening self-efficacy, and developing discrepancy. The four processes of motivational interviewing are described as engaging (getting a good relationship started and maintained through the conversation), focusing (deciding what is to be talked about), evoking (drawing reasons, concerns, hopes, and ideas out of the client, rather than putting them in), and planning (helping the client decide whether or not to change and if they do wish to change, what to do, when, how often, with what kind of support from others, what kind of follow-up (if any), and with what kind of plan for dealing with obstacles, high-risk situations, and any slip, lapse, or relapse). The “microskills” used in motivational interviewing (and not unique to the approach) are referred to as OARS: open questions, affirmations (noticing and commenting on what is right with the person), reflective listening (accurate empathy), and summarizing. One of the unique aspects of MI however is the attention paid to what the client actually says, with the coach trying to elicit, recognize, and strengthen “change talk” – client utterances indicating an interest in, wiliness to, or ability to change. Different categories of change talk can be remembered by the acronym DARN-CATS: desire (I would like to…, I want to…), ability (I can…, I have done…, I know how to…), reasons (it would help me in this way…), need (I need to…, I’ve got to…, I know I should…), commitment (I am going to…), activation (I am ready to…), and taking steps (I have already started to…).
There have been hundreds of systematic reviews and meta-analyses of health coaching. These typically show health coaching to have positive effects in helping people change one or more health behaviors, e.g., physical activity, diet, alcohol, smoking, medication taking, screening uptake, etc., and for it to be helpful in a range of different health conditions including cancer, heart disease, obesity, diabetes, pain, and COPD.
After reviewing interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor modification in adults, the American Heart Association et al. (2010) found the strongest level evidence for the following behavior change strategies and techniques: interventions to target dietary and PA behaviors with specific, proximal goals, providing feedback on progress toward goals, providing strategies for self-monitoring, establishing a plan for frequency and duration of follow-up contacts (e.g., in-person, oral, written, electronic) in accordance with individual needs, assessing and reinforcing progress toward goal achievement, using motivational interviewing, and using a combination of two of the above strategies (e.g., goal setting, feedback, self-monitoring, follow-up, motivational interviewing, self-efficacy) in an intervention.
HEE (2014) conducted a rapid review and identified 275 studies about health coaching along with 67 studies looking at training health professionals to support behavior change. They concluded that there was evidence that health coaching can support people to adopt more healthy lifestyles, including physical activity, health eating, and reduced smoking, with mixed evidence about the impact of health coaching on physiological variables such as cholesterol, blood pressure, and blood sugar levels. They found insufficient evidence that health coaching reduced healthcare usage or cost. They did not find one type of coach to be more effective than another, and that training might best be of between 2 and 5 days duration and involve practice, observation, role play, and follow-up refresher training.
Hill et al. (2015) performed a systematic review of health coaching interventions to determine effectiveness for specific outcomes as well as optimal approaches and techniques. Their analysis showed that 94% of studies reported a positive intervention effect on at least one outcome variable and concluded that health coaching shows promise as a technique for eliciting positive behavior change. They also attempted to cross-tabulate specific behavior change techniques with specific outcomes to identify optimal approaches and the more effective techniques. Of possible 40 behavior change techniques (BCTs) described in the CALO-RE classification system (Michie et al. 2011), 25 different BCTs were used in the 16 studies reviewed. The mean number of BCTs described per study was 6.8 (range of 2–15 BCTs). Three issues prevented them drawing firm conclusions about the relative effectiveness of different techniques: the diversity of intervention approaches, the lack of detail in reported studies, and the diversity of outcomes.
The Health Services Research and Development Service of the Department of Veterans Affairs (Gierisch et al. 2017) conducted a systematic review to determine the effects of self-identified coaching interventions among adults with chronic medical conditions on clinical, behavioral, and self-efficacy outcomes. Forty-one trials met eligibility criteria. Compared to nonintervention controls, the review found health coaching to have a statistically significant effect on HBA1c, physical activity levels, BMI, dietary fat intake, and self-efficacy – but with weaker or no effect when compared to active controls given something other than health coaching. One of the main weakness of this review is that it would have excluded hundreds of studies not self-identifying as health coaching – e.g., studies of motivational interviewing and other behavior change interventions.
Dejonghe et al. (2017) undertook a systematic review to determine the long-term effectiveness of health coaching intervention in rehabilitation and disease prevention. Fourteen studies met the inclusion criteria, seven for rehabilitation and seven for prevention. Three studies in each setting showed statistically significant long-term effectiveness for the main outcome. Similar to Hill et al. (2015), the wide variation in methods, the poor description of methods, and the heterogeneity of outcome measures prevented them drawing any firm conclusions about the most effective or optimal health coaching techniques.
The US Preventive Services Task Force (USPSTF 2017) reviewed the evidence on primary care-relevant counseling interventions to promote a healthy diet and physical activity. They found adequate evidence that behavioral counseling interventions provide at least a small benefit for reduction of CVD risk in adults without obesity who do not have the common risk factors for CVD (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). The found behavioral counseling interventions to improve healthful behaviors, including beneficial effects on fruit and vegetable consumption, total daily caloric intake, salt intake, and physical activity levels, as well as improvements in systolic and diastolic blood pressure levels, low-density lipoprotein cholesterol (LDL-C) levels, body mass index (BMI), and waist circumference that persisted over 6–12 months.
Motivational interviewing specifically has been the subject of over 1,000 trials and over 100 systematic reviews and meta-analyses. These show that motivational interviewing can help people to become more active, eat better, lose weight, keep weight off, reduce their blood pressure, reduce their risk of diabetes, take their medication as prescribed, become less anxious, become less depressed, change their drinking patterns, and stop smoking (Miller et al. 2002; Brodie and Inoue 2005; Macdonald et al. 2012; Spencer and Wheeler 2016; Ekong and Kavookjian 2015; Burgess et al. 2017; Al-Ganmi et al. 2016; Wadden 2015; Armstrong et al. 2011; Hardcastle et al. 2013).
Rubak et al. (2005) evaluated the effectiveness of motivational interviewing in different areas of disease to identify factors shaping outcomes. Seventy-two randomized controlled trials were examined the first of which were published in 1991. Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration, and standard ethanol content. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 min, 64% of the studies showed an effect. They concluded that motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioral problems and diseases.
Lundahl and Burke (2009) highlighted the evidence from the three published meta-analyses of MI and a recent meta-analysis of their own. They concluded that MI is significantly more effective than no treatment and generally equal to other treatments for a wide variety of problems ranging from substance use (alcohol, marijuana, tobacco, and other drugs) to reducing risky behaviors and increasing client engagement in treatment.
Olsen and Nesbitt (2010) performed an integrative review of health coaching studies to try to identify elements of effectiveness and key program features. Significant favorable changes in one or more of the behaviors of nutrition, physical activity, weight management, or medication adherence were identified in 6 of the 15 studies (40%). Common features of effective programs were use of motivational interviewing, goal setting, and collaboration with healthcare providers.
Morton et al. (2015) conducted a systematic review to examine the evidence base for MI interventions in primary care settings with nonclinical populations to achieve behavior change for physical activity, dietary behaviors, and/or alcohol intake, while also exploring the specific behavior change elements included in MI interventions. Of the 33 papers meeting inclusion criteria, approximately 50% (n = 18) demonstrated positive effects on health behavior change.
McKenzie et al. (2015) conducted a systematic review of motivational interviewing in healthcare to explore the approaches potential in addressing lifestyle factors relevant to multimorbidity. While they did not identify a study specifically examining MI as an intervention for multimorbidity, they identified 12 meta-analyses exploring lifestyle factors relevant to multimorbidity and concluded that MI is as effective as other treatments for each of these lifestyle factors and can be delivered by a range of different practitioners.
In a review of behavior change strategies to improve physical activity after cancer treatment, Berkman et al. (2018) recommended that “given its effectiveness in changing health behaviours across multiple chronic disease populations …motivational interviewing should be the main focus of future physical activity interventions in the cancer survivor population.”
There is also a growing body of evidence that coaching people to people to experiment with positive psychology interventions can help them protect and improve their health and wellbeing (Duckworth et al. 2005; Wood and Tarrier 2010; Sin and Lyubomirsky 2009; Parks and Titova 2016; Schotanus-Dijkstra). While most of the research on PPIs has been conducted with nonclinical samples (Seligman et al. 2005), PPIs have been shown to improve psychological wellbeing and reduce psychological distress in mildly depressed individuals, patients with mood disorders, and patients with psychosis and to improve quality of life and wellbeing in breast cancer patients (Casellas-Grau et al. 2014; Huffman et al. 2015). For instance, Chakhssi et al. conducted a systematic review and meta-analysis of PPIs in clinical populations, representing 1864 patients with clinical disorders. They found that PPIs showed significant small effects for wellbeing and depression and significant moderate improvements for anxiety.
Conclusions and Future Directions
Health and wellbeing coaching is an emerging body of professional practice, encompassing a range of approaches, strategies, and methods with the potential to contribute to the achievement of UN Sustainable Development Goals. It might do this via helping to ensure healthy lives; promoting wellbeing; improving nutrition; reducing poverty; helping with sustainable consumption (e.g., by encouraging dietary change); promoting sustained economic growth and full and productive employment (by preventing and helping reduce the impact of long-term conditions); making cities and human settlements inclusive, safe, resilient, and sustainable (e.g., by reducing pressure on healthcare systems and families); and helping to build effective, accountable, and inclusive institutions at all levels.
Differing from the “diagnose and treat” model of clinical practice, health and wellbeing coaching is informed by and underpinned with a strengths-based, solution-focused style, working collaboratively with people with and without disease, helping them to experience higher levels of health, wellbeing, happiness, resilience, flourishing, and quality of life. The evidence suggests that health and wellbeing coaching can help healthy people stay healthy and help people with one or more health problems make behavior changes and better self-manage their health and wellbeing, sometimes slowing down, modifying, and even reversing disease processes.
What approaches and techniques work best for who, when delivered by which practitioners with what level of training, in which settings, and for how long?
How can the positive effects which health and wellbeing have been shown to deliver be extended for more than 6–12 months?
What is the optimal mix of formats – e.g., face to face, group, peer delivered, text, e-mail, video, avatar-based and automated, etc.?
What is the best way to train, enable, and support the healthcare workforce to deliver higher volumes of accessible, quality-controlled health and wellbeing coaching?
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