Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Health coaching might be an effective and inexpensive way to help people manage their own health when they have long-term conditions such as diabetes, asthma, high blood pressure, or lung disease. Coaching might be especially helpful in low-income communities where people with long-term conditions are often sicker and may benefit from additional support services. Health coaches help people make everyday decisions about taking their medications, exercising, or eating healthier. Other researchers have looked at how patients work with their doctors to make those decisions. However, researchers do not yet know how health coaches support patients in making decisions.

Project Purpose

The research team wanted to understand how health coaches work with patients to make everyday health decisions. The researchers also wanted to identify ways to support patients in making choices for better health.

Methods

The researchers held three focus groups in Spanish and three in English; 25 patients and 5 friends or family members took part. The researchers then interviewed 42 patients, 17 family members, 17 health coaches, and 20 healthcare providers. Everyone who participated in the study worked or was a patient at one of six urban primary care clinics. These six clinics serve low-income patients and had used health coaches for at least one year.

The researchers asked patients to think about a health decision, like walking more or stopping smoking, and how they worked with a health coach to make that decision. Family members, coaches, and healthcare providers were asked similar questions about working with patients to help them make health decisions.

Findings

Participants in the interviews and focus groups said health coaching was successful when

  • Patients felt like the coach was a peer.
  • Patients could talk to the same coach each time and as often as they liked.
  • The patient and coach trusted each other.
  • The coach served as a bridge between the patients and their doctors when the patients felt intimidated by their doctors.

Providing education, personal support, and assistance with decision making were also identified as health coaching activities that support patients in making everyday health decisions and further strengthen the patient-coach relationship.

Limitations

This study only looked at clinics in low-income areas that used coaches with a specific kind of training. Results might not be the same in other kinds of healthcare clinics or with health coaches who were trained using other programs.

Conclusions

Successful coaching that helps patients to make everyday health decisions requires a strong patient–health coach relationship. This study helped to identify important features of a successful patient-coach relationship, such as patients seeing the coach as a peer. Understanding how to build that patient-coach relationship can help improve future training for health coaches.

Project Information

David H. Thom, MD, PhD, MPH
University of California, San Francisco
$671,478
Health Team Support for Patient Informed Decision Making

Key Dates

June 2012
December 2014
2012
2014

Study Registration Information

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Last updated: March 4, 2022