Research ArticleOriginal Research

A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

David H. Thom, Jessica Wolf, Heather Gardner, Denise DeVore, Michael Lin, Andy Ma, Ana Ibarra-Castro and George Saba
The Annals of Family Medicine November 2016, 14 (6) 509-516; DOI: https://doi.org/10.1370/afm.1988

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  • Table 1

    Participant Characteristics (N = 118)

    CharacteristicFocus Groups (n = 30)aInterviews
    Patients (n = 42)Family/Friends (n = 17)Health Coaches (n = 17)Clinicians (n = 20)
    Age, mean (SD), y55.5 (9.9)53.8 (8.0)48.9 (14.8)29.0 (5.0)42.7 (12.4)
    Female, No. (%)20 (66.7)26 (61.9)12 (70.6)10 (58.8)12 (60.0)
    English primary language, No. (%)17 (56.7)22 (52.4)9 (52.9)17 (100)20 (100)
    Race/ethnicity, No (%)
     Latino/Hispanic14 (46.7)20 (48)8 (47.1)10 (58.8)3 (15.0)
     Black/African American9 (30.0)12 (28.5)6 (35.3)0 (0)1 (5.0)
     White, non-Hispanic3 (10.0)4 (9.5)1 (5.9)1 (5.9)12 (60.0)
     Asian/Pacific Islander1 (3.3)4 (9.5)2 (11.8)5 (29.4)3 (15.0)
     Other3 (10.0)2 (4.8)0 (0.0)1 (5.9)1 (5.0)
    Education, No. (%)b
     Less than high school9 (30.0)8 (19.0)3 (17.6)0 (0)NA
     Some high school5 (16.7)8 (19.0)3 (17.6)0 (0)NA
     High school graduate5 (16.7)9 (21.4)4 (23.5)0 (0)NA
     Some college6 (20.0)5 (11.9)3 (17.6)6 (35.3)NA
     College graduate4 (13.3)12 (28.5)4 (23.5)11 (64.7)NA
    Employment, No. (%)
     Disabled10 (33.3)18 (42.9)1 (5.9)NANA
     Retired4 (13.3)4 (9.5)3 (17.6)NANA
     Homemaker4 (13.3)2 (4.8)2 (11.8)NANA
     Employed full or part time4 (13.3)18 (42.9)10 (58.8)NANA
     Unemployed5 (16.7)0 (0)1 (5.9)NANA
     Other or missing3 (10.0)0 (0)0 (0)NANA
    Born outside United States, No. (%)16 (53.3)24 (57.1)8 (47.1)NANA

    • NA = not asked.

    • ↵a Composed of 25 patients, 5 family members.

    • ↵b One missing response from focus group participants.

    • Note: 8 patients who participated in the focus groups were also interviewed.

  • Table 2

    Description of Themes for Patient Decision Making With Health Coaches

    ThemeDescriptionComponentsRelationship to Patient’s Decision MakingParticipants (No.) Sharing Experiences Identified for Themea
    Shared characteristicsDemographic characteristics and life experiences shared by patient and health coachShared language, culture, and sex
    Similar social status, experiences, and values    		Shared characteristics may help the patient feel more comfortable with and understood by health coach and therefore more likely to work with coach to make health decisionsPatients (6)
    Family/friends (1)
    Health coaches (13)
    Clinicians (11)
    AvailabilityHealth coach being available to the patientFrequency of contacts
    Duration of contacts
    Continuity over time
    Being accessible to patient
    Proactively contacting patient    		Health coach’s ongoing contact with patient helps build the relationship and allows for reinforcement and support of patient’s decisionsPatients (32)
    Family/friends (5)
    Health coaches (16)
    Clinicians (14)
    Trusting relationshipPositive, trusting relationship between health coach and patientPatient trust in health coach
    Health coach trust in patient
    Factors that create or reinforce trust
    Consequences of trust    		Trust makes patient more willing to confide in and accept support from health coach around health decisionsPatients (29)
    Family/friends (5)
    Health coaches (17)
    Clinicians (9)
    EducationHealth coach educates patient in person and through written materialsProviding patients with basic information about his/her condition and explaining how his/her behaviors affect it
    Describing options and possible consequences
    Explaining purpose of medication    		Education provides a foundation to effective decision making; patients need to understand their options and how their choices affect their healthPatients (28)
    Family/friends (4)
    Health coaches (14)
    Clinicians (6)
    Personal supportHealth coach provides emotional support, engages with patient, makes personal commitment to help patientCaring about and valuing patient
    Listening to and understanding patient
    Allaying patients’ fears
    Providing hope and confidence
    Encouraging and empowering patient
    Motivating patient using encouragement, reminders, connecting actions to outcomes    		Providing a supportive relationship allows patient to disclose more, be more honest about goals, barriers, and decisions; active listening helps the patient process information, express needs and emotions; patient may be more likely to care for self when feels cared for by health coach; motivated patients more likely to make and carry out decisionsPatients (33)
    Family/friends (6)
    Health coaches (17)
    Clinicians (8)
    Decision supportPragmatic support for patient to make and carry out health decisionHelping patient identify goals
    Helping create action plans
    Checking back with patient
    Identifying barriers and problem solving
    Encouraging small steps
    Helping patient get prescription filled
    Helping patient make and keep appointments    		Using specific methods and techniques from coach training to help patient identify their goals and choose an action plan to move toward those goals; makes it easier for patients to get what they need to carry out their decision, thereby increasing range of optionsPatients (28)
    Family/friends (5)
    Health coaches (16)
    Clinicians (10)
    Bridging as part of the themeHealth coach acts as a liaison or bridge between patient and primary care clinicianHelping patient communicate with clinician
    Providing clinician with information about patient
    Clarifying clinician’s communication to patient
    Checking with patient between visits about treatment plan
    Helping patient to disclose to clinician
    Reducing patient’s fear of physician    		Health coach can help strengthen the patient-clinician relationship and improve patient-clinician communication leading to more informed and shared decision making between patient and clinicianPatients (18)
    Family/friends (4)
    Health coaches (15)
    Clinicians (16)

    • ↵a Counts are of the number of participants in each group who contributed at least 1 experience during their interview that was coded.

Additional Files

  • The Article in Brief

    A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes

    David H. Thom , and colleagues

    Background Despite the growing use of coaches to help patients make health-related decisions and behavioral changes, there is little research about the ways in which health coaches support patients.

    What This Study Found Analyzing focus group and individual interviews with patients, family members, health coaches and clinicians, this study identifies several core features of successful coaching and develops a model to describe how health coaches and patients work together. Themes identified by respondents include shared characteristics between health coaches and patients, availability of health coaches to patients, development of a strong relationship based on trust, educational role of the health coach, providing personal support for patients, providing support for decision making, and bridging between the patient and clinician.

    Implications

    • The resulting model, which attempts to characterize how health coaches and patients can work together, can be used in training and supporting health coaches in practice.

  • Supplemental Appendix

    Supplemental Appendix

    Files in this Data Supplement:
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