Lesley Evans (Diploma in Wellness Coaching Skills)
In this assignment I will discuss the impact of health/wellness coaching on the long term condition of diabetes. Firstly I will start by defining wellness coaching and outlining the condition of diabetes. This will then be followed by discussion of some of the evidence and research found around coaching and diabetes and what outcomes this may have for the individual and the wider implications for society. I will finish with some thoughts to consider for my own practice and development and briefly conclude.
Definitions for health and wellness coaching vary but is widely understood to be a process that facilitates healthy, sustainable behaviour change by challenging a client to develop their inner wisdom, identify their values, and transform their goals into action. Wellness coaching draws on the principles from positive psychology and appreciate inquiry and the practices of motivational interviewing and goal setting (Centre for Disease Control and Prevention).
As people are living longer, increasing numbers of people will have medical conditions that they will have to live with for the rest of their lives. The Department of Health (2005) reported that 17.5 million adults in the UK report chronic health problems, diabetes being just 1 of the 12 identified by the Australian Institute of Health and Welfare. In Wales the figures show a 30% increase in people living with at least one chronic condition between 2005-2015, however the biggest rise is in people living with multiple chronic conditions, which has increased by 56% over this 10 year period (www.health.org.uk) It is anticipated that diabetes will be the seventh leading cause of death by 2030.
In the UK Wales experiences the highest incidence of diabetes with 7.4% of adults over 17 years of age with a diagnosis. Treatment of this condition costs up to £500m each year, equating to 10% of the NHS’ annual budget. 80% of this is spent on managing complications, the majority of which could be prevented (Diabetes UK).
A diagnosis of diabetes can also have a devastating impact on an individual’s quality of life. Statistics report that people with a long term condition are 2-3 times more likely to experience mental health problems, the incidence increasing with multiple long term conditions.
As an Occupational Therapist it was interesting to note a study carried out by Atler et al (2018) which looked at the relationship between quality of life, activity and participation with people with diabetes, and how diabetes self management could be improved with engagement in meaningful and valued occupations.
Reviewing some of the evidence for the efficacy of health coaching for diabetes reports some favourable outcomes however there appears to be some considerations to be taken into account:
Some studies have focussed on the outcomes in terms of cost savings, which would have implications for organisations such as the NHS and the wider society. A review by Hale et al reported some improvements in compliance but noted no evidence for cost-effectiveness in the short term but project future savings over a longer period. A study by Sullivan et all report that health coaching increased self-efficacy and better self care management reducing the burden of unplanned hospital admissions.
Other studies looked into the impact that health coaching had for the individual. Sherifali et al examined the research evaluating health coaching for diabetes and found that it improved diabetes control and glycemic levels but also promoted increased self-care behaviours and quality of life. Delaney et al reported that health coaching improved levels of diabetes distress, knowledge, self reported health status, BMI and glycemic control. They also cite other studies which report improved satisfaction with life, decreased depression symptoms and also improved inadequately controlled blood glucose levels following coaching input. In another study comparing individuals who received health coaching -v- diabetes education reported improved patient activation, exercise frequency, stress and perceived health status for the coaching group. They advise that health coaching can be an effective intervention which focuses on accountability and lasting behaviour change.
The above study identified that patients who had poor knowledge and attitude towards diabetes directly affected self management, which in turn affected quality of life, and that these groups of patients demonstrated the greatest improvements in outcomes. It could also bring awareness to barriers for patients, which could already include age (vision, mobility, care-giving support), ethnicity, cognitive impairment and social deprivation and how this could assist with focussing on where health care services are used efficiently.
It is also interesting to note the differences in the approaches and definitions of health and wellness coaching which makes it difficult to compare evidence. Wolever et al (2013) reviewed literature to identify a definition of this new strategy used within healthcare. They found that there is a disparity between operational delivery of wellness coaching in terms of method of delivery, theories that intervention is based on, the person delivering the intervention (ie. a trained health professional) and also the timing/quantity of sessions. All of which made it difficult to come to a consensus and assess the efficacy of this intervention to provide an evidence base. However the literature did agree that health coaching is “a patient-centred process that is based upon behaviour change theory and is delivered by health professionals with diverse backgrounds”.
As a clinician this has highlighted several areas for my future development and to consider in my ongoing training. In my practice it is inevitable that I will encounter individual’s with one or multiple long term conditions and it is important that I always have an awareness of the barriers to participation in the forefront due to their condition/s, and to consider how health inequalities can affect an individual’s capacity to change behaviour. It is also interesting to consider the collaborative nature of self-management and how this relates to the relationship between the coach and their client, and potential outcomes.
To conclude, from the research it suggests that further in-depth studies will be required to determine what constitutes health coaching and also studies over a longer period of time to provide a greater evidence base for efficacy. However it is clear that positive outcomes such as improved self efficacy, activation, perceived health status and quality of life can be achieved for the individual with diabetes and the wider community with health coaching intervention, and that this can be a succesful strategy to consider.
- Department of Health (2005)
- Better Conversation Resource
- Diabetes Delivery Plan 2016-2020. Welsh Government
- The Health Foundation
- National Service Frameworks for Long Term Conditions (2005)
- Hale R & Giese J (2017) Cost effectiveness of health coaching, an integrative review, Professional Case Management, Vol 22 (5) pg 228-238
- Sullivan V, Hays M & Alexander S (2019) Health Coaching for Patients with Type 2 Diabetes Mellitus to Decrease 30-Day Hospital Readmissions. Professional Case Management, Vol 24(2) pg 76-82
- Atler, K, Schmid A, Klinedinst T, Grimm L, Marchant T & Marchant D (2018) The Relationship between Quality of Life, Activity and Participation among People with Type 2 Diabetes Mellitus Occupational Therapy in Health Care Vol 32 (4)
- Bruno B, Choi D, Thorpe K, Yu C (2019) Relationship among diabetes distress, decisional conflict, quality of life and patient perception of chronic illnes care in a cohort of patients with type 2 diabetes and other co-morbities. Diabetes Care 42 (7) pg 1170-1177
- Wolever R, Simmons L, Sforzo G, Dill D, Kaye M, Bechard E, Southard M, Kennedy M, Vosloo, J, Yang, N. A systematic Review of the Literature on Health and Wellness Coaching: Defining a Key Behavioural Intention in Healthcare (2013) Global Advances in Health and Medicine Vol 2 (4) Accessed at www.gahmj.com
- Wolever, Ruth & Dreusicke, Mark & Fikkan, J & Hawkins, T & Yeung, S & Wakefield, J & Duda, L & Flowers, P & Cook, C & Skinner, E. (2010). Integrative Health Coaching for Patients With Type 2 Diabetes A Randomized Clinical Trial. The Diabetes educator. 36. 629-39. 10.1177/0145721710371523.
- Delaney G, Newlyn N,Pamplona E, Hocking SL, Glastras SJ, McGrath RT, et al.
- Identification of Patients With Diabetes Who Benefit Most From a Health Coaching Program in Chronic Disease Management, Sydney, Australia, 2013. Prev Chronic Dis 2017;14:160504. DOI: https://doi.org/10.5888/pcd14.160504.
- Cinar A, Freeman R & Schou L (2018) A new complementary approach for oral health and diabetes management: health coaching. International Dental Joural 2018: 68 pg 54-64
- Sherifali D, Viscardi V, Bai JW & Ali R (2016). Evaluating the Effect of a Diabetes Health Coach in Individuals with Type 2 Diabetes. Canadian Journal of Diabetes 40 pg 84-94
- Turner J & Kelly B (2000) Emotional dimension of chronic disease. Western Journal of Medicine 172 pg 124-128
- Collins D, Thompson K, Atwood K, Abadi M, Rychener D & Simmons L (2018) Integration of Health Coaching Concepts and Skills into Clinical Practice Among VHA Providers: A Qualitative Study Glob Adv Health Med. 2018; 7: 2164957X18757463.
- Published online 2018 Feb 14. doi: 10.1177/2164957X18757463
- Sage, Sowden, Chorlton & Edeleanu (2008) CBT for Chronic Illness and Palliative Care
- White C A (2000) Cognitive Behaviour Therapy for Chronic Medical Problems
- Carrier J (2009) Managing Long-term Conditions and Chronic Illness in Primary Care