Engaging Patients in their Health Care: Lessons From a Qualitative Study on the Processes Health Coaches Use to Support an Active Learning Paradigm.

BACKGROUND: While recent health-care trends rely on activated patients, few studies report direct observations of how to engage and activate patients to be full participants in their own health care. The interpersonal processes and communication strategies used in integrative health coaching (IHC) may offer important insight into how clinicians can help patients step into a more active learning model rather than more typical passive roles. OBJECTIVE: This study uses verbatim transcripts of medical patients' first few IHC sessions to identify the actual processes used to help patients embrace this more active learning role. METHODS: A thematic analysis was conducted of 72 verbatim transcripts from IHC sessions of 26 patients with severe dysfunction from tinnitus. The patients participated in 6 months of IHC as part of a larger integrative intervention in a randomized, controlled pilot designed to assess feasibility for a larger randomized, controlled trial on the clinical effectiveness of an integrative intervention. RESULTS: Four themes emerged: (1) Describing the Health Coaching Process to patients; (2) Using Key Procedures for Action Planning-optimal health future self-visualization, Wheel of Health, and exploration of the gap between current and desired states to help patients set goals for themselves; (3) Supporting Action and Building Momentum-the creation and support of action steps with frequent reinforcement of self-efficacy; and (4) Active Listening and Inviting the Patient to Articulate Learning-coaches' active listening process included reflection, clarifying questions, turning patient questions back to the patients, highlighting values, identifying potential barriers and resources, and inviting patients to articulate what they were learning. CONCLUSION: The processes identified in IHC incorporate key principles of adult learning theory and engage patients' innate resources of goal orientation, self-direction, and intrinsic motivation. These interpersonal processes help patients embrace a more active learning role, with implications for patient engagement in other clinical contexts.

Integrative Medicine Strategies for Changing Health Behaviors: Support for Primary Care.

Until system reforms allow adequate time and reimbursement for primary care providers to focus on lifestyle change to prevent and mitigate chronic disease, primary care providers need a manageable, defined role to support lifestyle change. The authors suggest this role is to serve as a catalyst, priming the patient for change; educating and pointing the patient to appropriate, evidence-based resources for additional guidance and hands-on support; and providing ongoing encouragement throughout the long journey of change while patients work more intensely with health coaches or allied health providers.

Effects of tai chi chuan on anxiety and sleep quality in young adults: lessons from a randomized controlled feasibility study.

OBJECTIVE: To determine feasibility and estimate the effect of a 10-week tai chi chuan (TCC) intervention on anxiety and sleep quality in young adults. PARTICIPANTS: Seventy-five adults (18-40 years) from a predominately undergraduate midsized university. METHODS: This was an assessor blinded, randomized feasibility trial, and participants were randomized into one of three groups: 10 weeks of TCC meeting 2 times per week, 10 weeks of TCC with a DVD of the curriculum, and control group receiving a handout on anxiety management. Anxiety and sleep quality were assessed 4 times: baseline, 4 weeks, 10 weeks (immediate post-intervention), and 2 months post-intervention. Retention was defined as a participant attending the baseline assessment and at least one other assessment. Adherence to the intervention was set a priori as attendance at 80% of the TCC classes. RESULTS: Eighty-five percent of participants were retained during the intervention and 70% completed the 2 month follow-up assessments. To increase statistical power, the two TCC groups were combined in the analyses of anxiety and sleep quality measures. No significant changes in anxiety were found in the control group, while levels of anxiety decreased significantly over time in the two TCC groups. Sleep quality scores improved across time for all three groups, but adherent TCC participants reported greater improvement than control participants. CONCLUSION: TCC may be an effective nonpharmaceutical means of improving anxiety and poor sleep quality in young adults.

The Process of Patient Empowerment in Integrative Health Coaching: How Does it Happen?

Emerging healthcare delivery models suggest that patients benefit from being engaged in their care. Integrative health coaching (IHC) is designed to be a systematic, collaborative, and solution-focused process that facilitates the enhancement of life experience and goal attainment regarding health, but little research is available to describe the mechanisms through which empowerment occurs in the health coaching process. The purpose of this qualitative study is to describe apparent key components of the empowerment process as it actually occurs in IHC. A sample of 69 recorded health coaching sessions was drawn from 12 participants enrolled in a randomized controlled study comparing two different methods of weight-loss maintenance. Two researchers coded the word-for-word transcripts of sessions focusing on the structure of the sessions and communication strategies used by the coaches. Three basic sections of a coaching session were identified, and two main themes emerged from the communication strategies used: Exploring Participant's Experience and Active Interventions. In IHC, health coaches do not direct with prefabricated education based on the patient's presenting problem; rather, they use a concordant style of communication. The major tenets of the health coaching process are patient-centeredness and patient control focused around patient-originated health goals that guide the work within a supportive coaching partnership. As the field of health coaching continues to define itself, an important ongoing question involves how the structure of the provider-patient interaction is informed by the role of the healthcare provider (eg, nurse, therapist, coach) and in turn shapes the empowerment process.

Los modelos emergentes en cuanto a la prestación de atención sanitaria indican que los pacientes se benefician de la participación en su propio cuidado. La formación sanitaria integral (FSI) está diseñada para ser un proceso sistemático, colaborativo y centrado en la búsqueda de soluciones que facilite la mejora de la experiencia vital y la consecución de objetivos relacionados con la salud, pero existen escasas investigaciones para describir los mecanismos a través de los cuales se produce la capacitación en el proceso de la formación sanitaria. La finalidad de este estudio cualitativo consiste en describir los componentes claves aparentes del proceso de capacitación tal como se produce realmente en la FSI. Se obtuvo una muestra de 69 sesiones grabadas de formación sanitaria de 12 participantes inscritos en un estudio controlado aleatorizado para comparar dos métodos distintos de mantenimiento de la pérdida de peso. Dos investigadores codificaron las transcripciones literales de las sesiones centrándose en la estructura de las sesiones y en las estrategias de comunicación empleadas por los monitores. Se detectaron tres secciones básicas dentro de una sesión de formación y surgieron dos temas a partir de las estrategias de comunicación empleadas: la exploración de la experiencia del paciente y las intervenciones activas. En la FSI, los monitores de formación no dirigen con una enseñanza prefabricada basada en el problema que presenta el paciente sino que adoptan un estilo de comunicación concordante. Los principios básicos del proceso de formación sanitaria consisten en centrarse en el paciente y en el control de este con la mirada puesta en las metas de la salud originadas en el paciente que guían el trabajo dentro de una alianza de formación de apoyo. A medida que se va definiendo cada vez más el campo de la formación sanitaria, existe una cuestión permanente importante que gira en torno a cómo la estructura de la interacción entre el profesional y el paciente se ve influida por el papel del profesional sanitario (p. ej., enfermero, terapeuta, monitor) y da forma a su vez al proceso de capacitación.

Integrative health coaching: an organizational case study.

OBJECTIVE: The aim of this study was to describe integrative health (IH) coaching as developed in three different interventions offered through a major medical center, as a step toward further defining the field of health coaching. STUDY DESIGN: An organizational case study was conducted with document analysis and interviews. SETTING/PARTICIPANTS: Interviewees were the first six IH coaches at Duke Integrative Medicine who provided 360 clients with individual and/or group coaching (two to 28 sessions) in a randomized clinical study and two work-site wellness programs. ANALYSIS: Qualitative analysis using the constant comparative method was conducted. RESULTS: Integrative health coaching is characterized by a process of self-discovery that informs goal setting and builds internal motivation by linking clients' goals to their values and sense of purpose. Time, commitment, and motivation are necessary in the IH coaching process. CONCLUSIONS: The underpinnings of IH coaching are distinct from the medical model, and the process is distinct from health education, executive coaching, and psychotherapy. Integrative health coaching fits well with the assumptions of integrative medicine and has a role in supporting behavior change.

The relationship between marriage and family therapists and complementary and alternative medicine approaches: a national survey.

Respondents to a mail survey of a random sample (N = 424) of Clinical Members of the American Association for Marriage and Family Therapy provided information about their contexts of practice, use of complementary and alternative medicine (CAM), and relationships with CAM providers. Consistent with both national trends and the experience of psychologists as reported in a similar survey, the results of this survey suggest that marriage and family therapists have been affected significantly by and have a growing awareness of CAM practices. Limitations of the study and implications for the field are discussed.

The relationship between marriage and family therapists and complementary and alternative medicine approaches: a qualitative study.

In this article, we delineate the qualitative phase of a mixed-method research study focused on understanding the relationship between Clinical Members of the American Association for Marriage and Family Therapy (MFT) and complementary alternative medicine (CAM). Based on an analysis of the data derived from telephone interviews with 54 respondents, we describe four themes: definitional issues, depth of awareness of CAM, fit with MFT, and ethical considerations. Our discussion focuses on the findings of this phase, considerations from the quantitative phase, and reflections on the research study as a whole. While acknowledging the limitations of the study, we conclude that the growing awareness of and involvement with CAM approaches and practitioners among MFTs suggest a need for further education for both professionals and clients. We also note the importance of additional research support for the use of CAM practices.