Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief
    • Past Issues in Brief
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
    • Associate Editor Opening
    • Current Opportunities
    • Job Board
  • COVID-19
    • Preprint Collection
    • Casenotes Blog

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief
    • Past Issues in Brief
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
    • Associate Editor Opening
    • Current Opportunities
    • Job Board
  • COVID-19
    • Preprint Collection
    • Casenotes Blog
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
Research ArticleOriginal Research

What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial

Anjana E. Sharma, Rachel Willard-Grace, Danielle Hessler, Thomas Bodenheimer and David H. Thom
The Annals of Family Medicine May 2016, 14 (3) 200-207; DOI: https://doi.org/10.1370/afm.1924
Anjana E. Sharma
Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: Anjana.sharma@ucsf.edu
Rachel Willard-Grace
Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Danielle Hessler
Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Thomas Bodenheimer
Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David H. Thom
Center for Excellence in Primary Care, UCSF Department of Family & Community Medicine, San Francisco, California
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 1

    CONSORT Diagram of study participants.

    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2

    Outcome measures at baseline, 12, and 24 months for patients in the health coaching arm of the 12-month randomized controlled trial.

    HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; SBP = systolic blood pressure

Tables

  • Figures
  • Additional Files
    • View popup
    Table 1

    Baseline Participant Characteristics From Original RCT and Current 24 Month Follow-Up, Overall and by Study Arm

    All Participants at Baseline (n = 441)All Participants in 12- and 24-Month Analysis (n = 290)Usual Care Arm Participants in 12- and 24-Month Analysis (n = 133)Health Coaching Arm Participants in 12- and 24-Month Analysis (n = 157)
    Demographic Characteristics
    Clinic site, % (No.)
     Clinic site A75.3 (332)76.2 (221)77.4 (103)75.2 (118)
     Clinic site B24.7 (109)23.8 (69)22.6 (30)24.8 (39)
    Age, mean (SD), y52.7 (11.1)53.2 (10.8)52.5 (11.5)53.7 (10.2)
    Female sex, % (No.)55.3 (244)56.6 (164)62.4 (83)51.6 (81)
    Married or in long-term relationship, % (No.)53.1 (234)51.97 (150)57.1 (76)47.1 (74)
    Born in United States, % (No.)25.6 (113)26.6 (77)25.6 (34)27.4 (43)
    Years in United States, mean (SD)a18.2 (11.2)18.6 (11.0)17.4 (11.6)19.6 (10.4)
    Primary language, % (No.)
     English27.7 (122)28.3 (82)27.1 (36)29.3 (46)
     Spanish68.7 (303)69.0 (200)70.7 (94)67.5 (106)
     Other3.6 (16)2.8 (8)2.3 (3)3.2 (5)
    Race/Ethnicity, % (No.)
     Asian/Pacific Islander4.1 (18)3.5 (10)4.5 (6)2.6 (4)
     African American19.0 (84)20.0 (58)19.6 (26)20.4 (32)
     Latino or Hispanic70.1 (309)69.7 (202)71.4 (95)68.2 (107)
     White2.5 (11)2.8 (8)3.0 (4)2.6 (4/)
     Other4.3 (19)4.1 (12)3.0 (4)6.4 (10)
    Working status, % (No.)
     Employed full time18.6 (82)18.3 (53)17.3 (23)19.1 (30)
     Employed part time25.6 (113)27.9 (81)29.6 (38)27.4 (43)
     Homemaker13.8 (61)13.5 (39)16.5 (22)10.8 (17)
     Unemployed16.1 (71)14.5 (42)16.5 (22)12.7 (20)
     Retired, Disabled, SSI, other25.9 (114)25.9 (75)21.1 (28)29.9 (47)
    Education, % (No.)
     <5th grade22.7 (100)23.1 (67)26.3 (35)20.4 (32)
     6th to 8th grade21.1 (93)21.0 (61)19.6 (26)22.3 (35)
     Some high school13.4 (59)13.1 (38)12.0 (16)14.0 (22)
     High school graduate or GED17.7 (78)16.9 (49)13.5 (18)19.8 (31)
     Some college15.6 (69)15.9 (46)19.6 (26)12.7 (20)
     College graduate9.5 (42)10.0 (29)9.0 (12)10.8 (17)
    Income, % (No.)
     <$5,00034.0 (150)33.5 (97)30.8 (41)35.7 (56)
     $5,000–$10,00024.3 (107)22.8 (66)21.8 (29)23.6 (37)
     $10,000–$20,00029.5 (130)33.5 (97)33.1 (44)33.8 (53)
     >$20,00012.2 (54)10.3 (30)14.3 (19)7.0 (11)
    No. primary care visits in year before study, mean (SD)5.4 (3.9)5.2 (3.9)5.2 (4.2)5.3 (3.6)
    Baseline Clinical Characteristics
    BMI, mean (SD), kg/m231.6 (6.6)31.7 (6.0)31.7 (5.7)31.8 (6.2)
    HbA1c, mean (SD), %b9.9 (1.5)9.8 (1.5)10.0 (1.5)9.6 (1.4)
    LDL, mean (SD), mg/dLb146.5 (34.9)143.1 (32.2)143.9 (32.5)142.6 (32.3)
    SBP, mean (SD), mm Hgb158.9 (15.1)159.3 (15.4)160.4 (16.6)158.3 (14.2)
    Uncontrolled at baseline, % (No.)
     For 1 condition72.6 (320)74.5 (216)75.9 (101)73.3 (115)
     For 2 conditions23.6 (104)22.1 (64)21.1 (28)22.9 (36)
     For 3 conditions3.9 (17)3.5 (10)3.0 (4)3.8 (6)
     For HbA1c35.8 (158)35.5 (103)33.1 (44)37.6 (59)
     For SBP43.5 (192)44.8 (130)46.6 (62)43.3 (68)
     For LDL51.9 (229)48.6 (141)47.4 (63)49.7 (78)
    • HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; SBP = systolic blood pressure; SSI = Supplemental Security Income

    • ↵a For participants born outside the United States.

    • ↵b Includes only patients eligible for the study on this measure (158 at baseline, and 103 at 24 months for HbA1c; 192 at baseline and 130 at 24 months for SBP; 218 at baseline, and 141 at 24 months for LDL).

    • Note: We found no significant differences between health coaching and usual care groups at 24 months.

    • View popup
    Table 2

    Changes in Outcomes for Health Coaching Arm at 12 and 24 Months

    Outcome12 months24 monthsDifference, 12–24 monthsP value
    Composite 1, Patients meeting at least 1 goal (n = 157), % (No.)47.1 (74)45.9 (72)−1.2.80
    Composite 2, Patients meeting all goals (n = 157), % (No.)35.7 (56)33 (53)−1.9.66
    HbA1c at goal (n = 58), % (No.)53.4 (31)36.2 (21)−17.2.03
    LDL at goal (n = 70), % (No)42.9 (30)47.1 (33)4.3.58
    SBP at goal (n = 68), % (No.)25.0 (17)32.4 (22)7.4.20
    HbA1c, (mean (SD), %8.3 (1.8)8.9 (2.1)0.6.02
    LDL, (mean (SD), mg/dL111.6 (35.9)115.2 (45.7)3.6.51
    SBP, (mean (SD), mm Hg148.4 (16.0)145.6 (16.1)−2.8.16
    • HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; SBP = systolic blood pressure.

    • Note: The proportions of participants reaching composite and condition-specific goals were evaluated using McNemar’s χ2 test for (paired) dichotomous outcomes and paired t-tests for continuous outcomes.

    • View popup
    Table 3

    Subgroup Analysis of Usual Care Arm, Comparing Those Who Received Post-RCT Coaching vs Those Not Coached

    OutcomeUsual Care Arm Participants Coached Post-RCTaUsual Care Arm Participants Not Coached Post-RCT
    Baseline12 months24 monthsBaseline12 months24 months
    Composite 1, meeting 1 goal, % (No.)010.4 (5)
    n = 48
    33.3 (16)
    n = 48
    045.9 (39)
    n = 85
    48.2 (41)
    n = 85
    Composite 2, meeting all goals, % (No.)04.2 (2)
    n = 48
    25.0 (12)
    n = 48
    035.3 (30)
    n = 85
    37.7 (32)
    n = 85
    HbA1c at goal, % (No.)04.0 (1)
    n = 25
    24.0 (6)
    n = 25
    055.6 (10)
    n = 18
    44.4 (8)
    n = 18
    LDL at goal, % (No.)014.3 (3)
    n = 21
    38.1 (8)
    n = 21
    043.2 (16)
    n = 37
    56.8 (21)
    n = 37
    SBP at goal, % (No.)06.3 (1)
    n = 16
    18.8 (3)
    n = 16
    037.0 (17)
    n = 46
    32.6 (15)
    n = 46
    HbA1c, mean (SD), %10.2 (1.3)
    n = 25
    10.2 (1.8)
    n = 25
    9.7 (1.8)
    n = 25
    9.6 (1.5)
    n = 18
    8.3 (1.6)
    n = 18
    8.9 (2.1)
    n = 18
    LDL, mean (SD), mg/dL136.7 (35.2)
    n = 21
    130.7 (37.2)
    n = 21
    116.0 (37.1)
    n = 21
    149.8 (30.1)
    n = 37
    119.3 (34.3)
    n = 37
    103.0 (34.8)
    n = 37
    SBP, mean (SD), mm Hg162.8 (14.5)
    n = 16
    158.8 (15.9)
    n = 16
    154.3 (25.8)
    n = 16
    159.6 (17.3)
    n = 46
    146.3 (17.8)
    n = 46
    148.8 (20.2)
    n = 46
    • HbA1c = hemoglobin A1c; LDL = low-density lipoprotein; RCT = randomized controlled trial; SBP = systolic blood pressure.

    • ↵a Includes only patients in usual care arm who were out of goal range at 12 months, were offered coaching and accepted, and had clinical measures available at 12 and 24 months.

Additional Files

  • Figures
  • Tables
  • Supplemental Tables

    Supplemental Table 1. Baseline Characteristics of RCT Health Coaching Patients.; Supplemental Table 2. Baseline Characteristics of RCT Usual Care Patients; Supplemental Table 3. Baseline Characteristics of Patients, RCT Health Coaching Arm Patients and Usual Care Subgroups; Supplemental Table 4. Baseline Characteristics Of Patients Without Both 12 Month and 24 Month Clinical Data

    Files in this Data Supplement:

    • Supplemental data: Tables - PDF file
  • The Article in Brief

    What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial

    Anjana E. Sharma , and colleagues

    Background Most health coaching research focuses on effects during the period of active intervention. As a result, little is known about whether positive effects persist after health coaching has ended. This study follows up on a 12-month randomized controlled trial of a health coaching intervention for patients with poorly controlled diabetes, hypertension, and/or high cholesterol.

    What This Study Found In the initial study, the health coaching intervention significantly improved achievement of clinical goals (systolic blood pressure, LDL cholesterol and hemoglobin A1c) at 12 months. In this follow-up, up to one year after health coaching patients in the study's intervention arm experienced only minimal declines in clinical goals, with the exception of hemoglobin A1c. Specifically, the proportion of patients in the coaching arm of the trial who achieved at least one clinical goal at 12 months dropped only slightly from 47 percent at 12 months to 46 percent at 24 months. Similarly, almost the same proportion achieved the secondary outcome of meeting all clinical goals for which they were eligible on study entry at 12 months (36 percent) and 24 months (34 percent).

    Implications

    • These findings suggest that most improved clinical effects are maintained up to one year after receiving health coaching.
PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 14 (3)
The Annals of Family Medicine
Vol. 14, Issue 3
May/June 2016
  • Table of Contents
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
11 + 0 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial
Anjana E. Sharma, Rachel Willard-Grace, Danielle Hessler, Thomas Bodenheimer, David H. Thom
The Annals of Family Medicine May 2016, 14 (3) 200-207; DOI: 10.1370/afm.1924

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
What Happens After Health Coaching? Observational Study 1 Year Following a Randomized Controlled Trial
Anjana E. Sharma, Rachel Willard-Grace, Danielle Hessler, Thomas Bodenheimer, David H. Thom
The Annals of Family Medicine May 2016, 14 (3) 200-207; DOI: 10.1370/afm.1924
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • Acknowledgments
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • Making Inroads in Addressing Population Health in Underserved Communities With Type 2 Diabetes
  • Primary Care Outcomes Questionnaire: psychometric testing of a new instrument
  • Health Coaching in Severe COPD After a Hospitalization: A Qualitative Analysis of a Large Randomized Study
  • Delivery of Health Coaching by Medical Assistants in Primary Care
  • The Challenges of Measuring, Improving, and Reporting Quality in Primary Care
  • Coaching and health
  • In This Issue: Decisions, Decisions
  • Google Scholar

More in this TOC Section

  • Medical Practice Variation Among Primary Care Physicians: 1 Decade, 14 Health Services, and 3,238,498 Patient-Years
  • Pregnancy Medicaid Improvements in a Nonexpansion State After the Affordable Care Act
  • Diagnostic Agreement Between Telemedicine on Social Networks and Teledermatology Centers
Show more Original Research

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other topics:
    • Quality improvement

Keywords

  • primary care
  • patient-centered care
  • chronic care
  • patient self-care support
  • health promotion
  • disease prevention
  • health behavior change
  • special population
  • underserved patients
  • minority health
  • practice-based research

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Articles by Type
  • Articles by Subject
  • Supplements
  • Online First

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2021 Annals of Family Medicine