The Potential Contribution of Current Health Care Zeitgeists to the Success of Health and Wellness Coaches

Abstract

Chronic disease is challenging to treat because treatment often requires lifestyle behavior changes. In recent years the use of health and wellness coaches (HWC) has emerged as a way to support patients making behavioral changes. The use of HWCs has resulted in improved management of chronic disease for many patients. The success of HWCs is often thought to be due to the extended care they provide and the behavioral modification techniques they promote such as goal setting and self-monitoring. This article describes how HWC’s conformity to the current health care zeitgeist of personalized, holistic care may be another reason for their success.

‘The addition of health and wellness coaches to patients’ medical team has resulted in the improved management of many chronic conditions.’

The current health care system was established to treat illness and disease. As medical science has advanced, society has experienced a vast number of clinical and public health successes. Illnesses that used to result in immense human suffering or death have been eradicated with a vaccine or can now be cured with a pill. Failing organs can be transplanted, pacemakers can beat people’s heart, and cancers that used to kill can now be treated. ¹ Advances in treatment have resulted in increased life expectancy and have enabled a switch in focus from solely survival to improvements in quality of life.^1,2 Today, chronic disease presents the greatest health threat to society and greatest challenge to the health care system. ³ As the term implies, chronic diseases are lifelong and are intimately connected with daily health behaviors. As such, much of the work of preventing and managing chronic disease occurs in patients’ daily lives, not in a health care provider’s office. As discussed by Sforzo and colleagues ⁴ in this issue, health and wellness coaching has emerged as a strategy to overcome this challenge to support patients with behavior change. The addition of health and wellness coaches (HWCs) to patients’ medical team has resulted in the improved management of many chronic conditions, including obesity, diabetes, hypertension, heart disease, cancer, high cholesterol, and overall wellness. ⁴

The success of health and wellness coaching is likely due to many factors. Not dissimilar to other health care professionals, HWCs practice a few key strategies to help patients implement behavior change including goal setting, resetting expectations, establishing patient rapport, monitoring progress, and requiring accountability. ⁵ In particular, this article examines the role of HWCs in extending patient care and providing personalized, holistic care.

Extending Patient Care

It is well established that the greater number of contact hours, the better patient outcomes.^6,7 Appointment time constraints often prevent health care providers from spending substantial time with patients to support behavior change, and frequent medical appointments are unrealistic for both providers and patients. Intended to supplement treatment provided by health professionals, HWCs are uniquely poised to address this gap in care because they can reach patients in a nonclinical setting. HWCs monitor progress and adjust goals on a schedule and with a modality most convenient for the patient. This flexibility and departure from traditional health care enables HWCs to take advantage of other emerging strategies to extend patient care such as telehealth.^8,9

Personalization of Care

Years ago personally customized items were rare, a notion adequately depicted by the famous quote from Henry Ford, “You can have any color you want as long as it is black.” Today advances in technology have made mass customization more possible and businesses are eager to customize products and services to create unique value for their consumer. Mobile phones, for example, are incredibly customizable (eg, ringtone, background picture, phone color, case design, GPS and personal assistant voice, etc). Consistent with the societal zeitgeist of customization, medicine is moving toward a more personalized approach. For example, nutrigenomics research holds promise that patients’ response to particular dietary treatment will one day be able to be predicted based on an individual’s genetic makeup. ¹⁰ HWCs play an integral role in the transition toward more personalized medicine.

Personalization of care inherently facilitates a patient-centered approach, which is likely a reason for the success of HWCs at improving patient outcomes. Cognitive behavioral therapy, the gold standard care for behavior change treatment, is a patient-centered approach. In fact, the mark of a good session is when a patient speaks for the majority of the appointment. ¹¹ Many lifestyle behaviors are culturally bound and differ from person to person. Theoretically, the more tailored an intervention is, the more likely it will be relevant to the individual, and the more likely the individual will be able to make the necessary changes. ¹² As respected members of the community in which they serve, community health workers have been trained to help bridge the gap between medical professionals and individuals from underserved communities. ¹³ It is thought that improvements in chronic disease observed with community health workers are due to their ability to effectively communicate medical recommendations to underserved populations in a more relatable way than medical professionals. This is similar to the tailored coaching provided by HWC.

Coaching in psychology has been around for some time and has become widely accepted into all areas of life. ¹⁴ However, in the past, the act of trying to “improve” oneself might have been viewed as an admission of dysfunction. Today, the increase in availability of health information has contributed to patients becoming more active consumers of health care who seek ways to improve their own health. ¹⁵ This shift is illustrated by the popularity of self-help books. ¹⁶ In addition to personalizing care, HWCs are likely well accepted by patients because they facilitate self-improvement, something that is now societally desirable.

Providing Holistic Care

Patients are likely also receptive to HWCs because of HWCs’ conformation to another current zeitgeist of medicine to treat the whole person instead of each aspect separately. Although this holistic approach can contrast to the specialized manner in which medical professionals are traditionally trained, holistic-based medicine is growing in popularity. This zeitgeist is best demonstrated by the dramatic increase in functional and integrative medicine practices, which are grounded in holistic, whole-person care. ¹⁷ The Academy of Nutrition and Dietetics has established standards of practice for dietitians practicing in this area, ¹⁸ and has included coaching as part of the registered dietitian nutritionist’s scope of practice. ¹⁹ Similarly, the American Nurses Association has recently sanctioned the role of Health and Wellness Nurse Coaches. ²⁰ Due to the extended care provided by HWCs and the HWC-patient relationship, HWCs are able to gather a more global assessment of a patient’s lifestyle and values from which behavior change can be informed. The holistic approach of health and wellness coaching includes mental, emotional, spiritual, and physical aspects to promote overall wellness. ²¹ Health and wellness coaching can incorporate established behavior change techniques to improve health for each aspect. For example, stress in any aspect of life may influence other areas of life. Associated with poor health itself, stress can prohibit individuals from being able to make lifestyle changes. ²² Whereas it is difficult for health care providers to adequately help patients manage stress during a medical appointment, due to their frequent contact with patients, HWCs can address stressors as they arise for patients. Once stress has been reduced, the focus may return to accomplishing health behavior changes more directly related to the management of the patients’ disease state.

Conclusion

Practitioners of lifestyle medicine are well aware of how difficult a task it is for patients to make health behavior changes. Ultimately, the most notable behavioral take-away from the success of health and wellness coaching, however, is that they have been successful. In terms of physical activity, the best activity is the one a patient will do. When it comes to dietary advice for weight loss, the best diet is the one to which the patient will adhere. Behaviorally, when a strategy is not working for a patient, health care providers change their approach. Equally as important, though, when a strategy is working, health care providers should encourage the patient to keep doing it. Given their popularity and success, HWCs should clearly be encouraged for patients.

The success of health and wellness coaching at improving patient management of chronic disease is impressive, and further investigation into how HWCs can be utilized most effectively is warranted. Importantly, in addition to the many behavioral principles practiced by HWCs, the health and wellness coaching strategy meets current zeitgeists for personalized, holistic care. It will be interesting to see if the efficacy of health and wellness coaching remains as current zeitgeists are replaced with new zeitgeists over time. Right now, though, patient demand for HWC should not be overlooked. If patients want a HWC, health care providers should try to find a way to include health and wellness coaching into their patient’s care.