Article Figures & Data
Tables
Status n Written Exam Score (%) Oral Exam Score (%)a Training Sessions Attended (%) Completed study 17 83.2% 86.0% 93.2% Passed exam but dropped out after training and during study 9 88.3% 91.2% 91.8% Completed training but did not pass exam 6 61.6% 22.1% 80.6% Dropped out during training 5 N/A N/A 20.0% All trainees 37 80.6% 75.5% 80.9% ↵a Oral exam scores averaged only for English-speaking coaches; Spanish-language oral exam scores were not recorded.
Coach Characteristic Completed Study No. (%) Did Not Complete Study No. (%) Total No. (%) Sex (n = 37) Female 10 (58.8) 15 (75.0) 25 (67.6) Male 7 (41.2) 5 (25.0) 12 (32.4) Primary language (n = 37) English 12 (70.6) 15 (75.0) 27 (73.0) Spanish 5 (29.4) 4 (20.0) 9 (24.3) Other 0 (0.0) 1 (5.0) 1 (2.7) Born in United States (n = 33) Yes 7 (41.2) 6 (37.5) 13 (39.4) No 10 (58.8) 10 (62.5) 20 (60.6) Self-reported race/ethnicity (n = 33) Black/African American 6 (37.5) 8 (53.3) 14 (45.2) Latin/Hispanic 6 (37.5) 4 (26.7) 10 (32.3) White/Caucasian, non-Hispanic 2 (12.5) 1 (6.7) 3 (9.7) Asian/Pacific Islander 1 (6.3) 1 (6.7) 2 (6.5) Native American 1 (6.3) 0 (0.0) 1 (3.2) Other 1 (6.3) 2 (13.3) 3 (9.7) Married/Long-term relationship (n = 31) No 11 (68.8) 8 (53.3) 19 (61.3) Yes 5 (31.3) 7 (46.7) 12 (38.7) Education level (n = 32) Did not graduate from high school 2 (12.5) 6 (37.5) 8 (25.0) High school graduate or “GED” 5 (31.3) 1 (6.3) 6 (18.8) Some college 4 (25.0) 5 (31.3) 9 (28.1) College graduate 5 (31.3) 4 (25.0) 9 (28.1) Employment status (n = 31) Full-time paid (>30 hours/week) 3 (18.8) 1 (6.7) 4 (12.9) Part-time paid (<30 hours/week) 3 (18.8) 4 (26.7) 7 (22.6) Retired 5 (31.3) 3 (20.0) 8 (25.8) Unemployed 3 (18.8) 4 (26.7) 7 (22.6) Other 2 (12.5) 1 (6.7) 3 (9.7) Annual income (n = 32) <$5000 5 (31.3) 4 (25.0) 9 (28.1) $5000–10,000 2 (12.5) 4 (25.0) 6 (18.8) $10,000–$20,000 6 (37.5) 6 (37.5) 12 (37.5) >$20,000 3 (18.8) 2 (12.5) 5 (15.6) Exit Survey Statement Scale Average (Strongly Disagree = 1; Strongly Agree = 5) Coaches who “Agree” or “Strongly Agree” (%) I am interested in serving as a peer health coach in the future. 5.00 100.0 Those in charge of the program (study staff) supported my work as a peer coach. 4.87 100.0 The role-play activities during the training sessions helped me prepare for health coaching patients 4.80 100.0 I felt comfortable providing information I learned in training to patients. 4.80 100.0 I was satisfied with the content of the training sessions (training from instructor, training booklet and tools given to assist with patients) 4.73 100.0 Overall, I was satisfied with my experience as a peer coach. 4.73 100.0 I felt comfortable coaching patients who receive primary care from clinics other than the clinic I attend to receive care. 4.70 100.0 The content of the monthly meetings helped me be a better health coach. 4.67 93.3 Peer coaching helps patients control their diabetes. 4.60 100.0 After the training, I felt confident in my ability to serve as a peer health coach. 4.60 93.3 The training sessions were effective in preparing me to coach patients. 4.60 86.7 I felt like most of my patients appreciated working with me as their health coach. 4.47 93.3 I was satisfied with the monthly meetings overall. 4.40 93.3 I felt the clinic supported my work as a peer coach. 4.40 86.7 The support of other coaches helped my work as a peer coach. 4.13 80.0 I approached other coaches for advice about my patients. 3.93 66.7 I felt comfortable tracking my encounters with the patients I coached. 3.87 66.7 I interacted with other coaches outside of trainings and monthly meetings. 3.67 66.7 I felt like most of my patients were willing to change behaviors to improve their diabetes during the time we worked together. 3.53 53.3 Observed Skill Health Coaches Demonstrating the Skill (%; n = 13) Greeting Coach is friendly and greets client. 92.3 Coach asks client about his or her overall health, day, etc. 69.2 Agenda setting Coach asks client what he or she wants to talk about. 38.5 Coach asks client if it is OK to talk about things coach wants to talk about. 23.1 Ask-tell-ask Coach listens to client in a respectful manner (doesn’t interrupt, isn’t judgmental, doesn’t scold). 92.3 Coach asks client questions relevant to the topic at hand. 61.5 Coach provides information ONLY when client asks or client doesn’t know. 30.8 Coach provides accurate information. 53.8 Coach did not know the information and said, “I don’t know, but I will find out and get back to you.” 23.1 Medication reconciliation: Coach asks… Name of medication 53.8 Dose of medication 23.1 What medication is for 30.8 How often to take medication 46.2 If patient takes it as prescribed 30.8 If not, why not 15.4 Refills 7.7 Coach goes over medications one at time. 8.3 Action plan Coach asks client what he or she wants to work on. 30.8 Coach helps client troubleshoot barriers. 30.8 Coach asks when client wants to start. 30.8 Coach asks client about confidence. 23.1 Coach sets date/time to follow up. 33.3 Closing the loop Coach makes sure client understands what was said by closing the loop in a respectful manner. 25.0 Peer Coaches’ Overall Evaluation Quotations From Peer Coaches Peer Coaches’ Overall Evaluation Quotations From Peer Coaches Use of evidence-based health coaching The peer coaches did not perceive the training as teaching them the 5 principles of Evidence-Based Health Coaching and did not always utilize the coaching techniques emphasized in the training. Some felt that the training was not sufficient to prepare them for the reality of coaching other patients. I actually learned way more about diabetes talking with those patients than I ever did in the class, and you realize how limited the class really is, once you go in and actually see what the nurse or the doctor is actually saying to the patient.
Most of the people that they’re dealing with, they have a very limited education. And just to get some very basic points about getting them to understand what an A1c is, what the numbers mean, why your blood pressure should be this way, that in itself is a challenge.Of the 5 principles of Evidence-Based Health Coaching, the trainees appeared to have a reasonable grasp of behavior-change action plans, though there was some discomfort that the behavior change was too small to make a difference. So all of a sudden this was thrown at me, and I didn’t know anything about how the action plan worked. I learned the living-with-diabetes [part] a whole lot more. So let’s go for the long-term goal, with short-term goals in the meantime.… But if that long-term goal isn’t understood, it isn’t going to stick for people. It’s sort of like, the little accomplishment is a good goal, and I get a star, and everybody’s happy with me, but once you get the star, it goes away. Training methods The trainees generally appreciated the interactive nature of the training and the tests at the end of the training, but questioned whether they were truly prepared to coach patients. The role-playing was one of the better things. You know, everybody hates role-playing. But it actually worked. Because they make you go home and say, well, I know we’re going to roleplay tomorrow.…They did this really great thing, when they would have questions—we used to play games at the end of the sessions—and people would be broken into teams. And then we would go through all kinds of questions about the material that was covered that day.
They did have some times where they did role-playing. But that isn’t anything like when you’re dealing with a real patient. It doesn’t give you a clue what to say and do with a real patient.
We really have to know the information so well, or know where to get it…but on the final test, it wasn’t there. And that final test should have been nasty. It should have been really hard. Because we knew it was coming. It’s like, you’ve got to study for it, you’ve got to know it, because the next person you’re going to talk to is a patient.Scope of practice The trainees took seriously that they had a responsibility to do right by their patients and provide accurate information. We don’t know everything, so there’s a limitation as a peer coach. We cannot just tell them, “Oh, don’t take this medicine.” We can only say what we know. And in the training that we have, they told us…if you don’t know anything, just tell no instead of saying something that you don’t know and it will hurt your patient. Maintenance of knowledge The monthly mentoring sessions were generally felt to be important to refresh their knowledge and solve problems. Our coach group meetings, it kind of helps to reinforce, and we learn, I think, a little more each time, because of discussions with different things, so I think that helps a lot.…And the meetings help, because then, like I said, it’s an exchange of different things and possible solutions to anything we might run into.
