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The "Health Coaching" programme: a new patient-centred and visually supported approach for health behaviour change in primary care.

Neuner-Jehle S, Schmid M, Grüninger U - BMC Fam Pract (2013)

Bottom Line: In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%.The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high.Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of General Practice and Health Services Research, University of Zürich, Pestalozzistrasse 24, Zürich 8091, Switzerland. sneuner@bluewin.ch

ABSTRACT

Background: Health related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients.

Methods: Our new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques-such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors' communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the "Health Coaching" programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients' self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues.

Results: In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high.

Conclusions: Our innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

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Related in: MedlinePlus

Process steps, patient participation, and continuation rate from one step to the next step, and the times of data collection. Abbreviations: WS: work sheet (one worksheet per step): WS 1: Assessing awareness (self-rated health behaviour at baseline, using visual tool and visual analogue scales); WS 2: Exploring motivation (with extended questionnaire about health behaviour in the six areas and health-related attitudes); WS 3: choice of target behaviour and action plan; WS 4: evaluation of success (visual tool). I: importance. C: Confidence. R: Readiness. W: Weight. N: Nutrition PA: Physical Activity St:Stress Sm: Smoking A:Alcohol. TTM: Transtheoretical Model.
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Figure 3: Process steps, patient participation, and continuation rate from one step to the next step, and the times of data collection. Abbreviations: WS: work sheet (one worksheet per step): WS 1: Assessing awareness (self-rated health behaviour at baseline, using visual tool and visual analogue scales); WS 2: Exploring motivation (with extended questionnaire about health behaviour in the six areas and health-related attitudes); WS 3: choice of target behaviour and action plan; WS 4: evaluation of success (visual tool). I: importance. C: Confidence. R: Readiness. W: Weight. N: Nutrition PA: Physical Activity St:Stress Sm: Smoking A:Alcohol. TTM: Transtheoretical Model.

Mentions: In 2009–10, we conducted a feasibility and acceptance study with an extended evaluation to prove these concepts in a canton (Swiss state/district) in eastern Switzerland. After approval by the ethical committee of the Canton St Gallen, we enrolled 20 GPs (by postal invitation), who in turn recruited 1045 patients into the study during a 12-month period. Written, informed consent for participation in the study was obtained from participants. The mean age of patients was 50 (range 15–75) years, 53% were men. Participants’ health behaviours in the six areas and educational attainments were close to those of the average population in Switzerland. Figure 3 shows the workflow of counselling, rates of patient participation from one step to the next, and the times of data collection. We collected data from the patient-doctor worksheets used in the office consultations, patient questionnaires after counselling, office log books documenting the duration of counselling sessions, participants’ questionnaires at different times in the process, GPs’ questionnaires, semistructured interviews with GPs at the end of the 12 month study period, and GPs’ group interviews during the training courses and feedback meetings. We used SPSS (Statistical Software Package, Version 19, SPSS Inc., Chicago, Illinois) for our statistical analysis, and we calculated means, medians, standard deviations (SDs), and interquartile ranges (IQRs). The qualitative data were categorised based on thematic content analysis.


The "Health Coaching" programme: a new patient-centred and visually supported approach for health behaviour change in primary care.

Neuner-Jehle S, Schmid M, Grüninger U - BMC Fam Pract (2013)

Process steps, patient participation, and continuation rate from one step to the next step, and the times of data collection. Abbreviations: WS: work sheet (one worksheet per step): WS 1: Assessing awareness (self-rated health behaviour at baseline, using visual tool and visual analogue scales); WS 2: Exploring motivation (with extended questionnaire about health behaviour in the six areas and health-related attitudes); WS 3: choice of target behaviour and action plan; WS 4: evaluation of success (visual tool). I: importance. C: Confidence. R: Readiness. W: Weight. N: Nutrition PA: Physical Activity St:Stress Sm: Smoking A:Alcohol. TTM: Transtheoretical Model.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750840&req=5

Figure 3: Process steps, patient participation, and continuation rate from one step to the next step, and the times of data collection. Abbreviations: WS: work sheet (one worksheet per step): WS 1: Assessing awareness (self-rated health behaviour at baseline, using visual tool and visual analogue scales); WS 2: Exploring motivation (with extended questionnaire about health behaviour in the six areas and health-related attitudes); WS 3: choice of target behaviour and action plan; WS 4: evaluation of success (visual tool). I: importance. C: Confidence. R: Readiness. W: Weight. N: Nutrition PA: Physical Activity St:Stress Sm: Smoking A:Alcohol. TTM: Transtheoretical Model.
Mentions: In 2009–10, we conducted a feasibility and acceptance study with an extended evaluation to prove these concepts in a canton (Swiss state/district) in eastern Switzerland. After approval by the ethical committee of the Canton St Gallen, we enrolled 20 GPs (by postal invitation), who in turn recruited 1045 patients into the study during a 12-month period. Written, informed consent for participation in the study was obtained from participants. The mean age of patients was 50 (range 15–75) years, 53% were men. Participants’ health behaviours in the six areas and educational attainments were close to those of the average population in Switzerland. Figure 3 shows the workflow of counselling, rates of patient participation from one step to the next, and the times of data collection. We collected data from the patient-doctor worksheets used in the office consultations, patient questionnaires after counselling, office log books documenting the duration of counselling sessions, participants’ questionnaires at different times in the process, GPs’ questionnaires, semistructured interviews with GPs at the end of the 12 month study period, and GPs’ group interviews during the training courses and feedback meetings. We used SPSS (Statistical Software Package, Version 19, SPSS Inc., Chicago, Illinois) for our statistical analysis, and we calculated means, medians, standard deviations (SDs), and interquartile ranges (IQRs). The qualitative data were categorised based on thematic content analysis.

Bottom Line: In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%.The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high.Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of General Practice and Health Services Research, University of Zürich, Pestalozzistrasse 24, Zürich 8091, Switzerland. sneuner@bluewin.ch

ABSTRACT

Background: Health related behaviour is an important determinant of chronic disease, with a high impact on public health. Motivating and assisting people to change their unfavourable health behaviour is thus a major challenge for health professionals. The objective of the study was to develop a structured programme of counselling in primary care practice, and to test its feasibility and acceptance among general practitioners (GPs) and their patients.

Methods: Our new concept integrates change of roles, shared responsibility, patient-centredness, and modern communication techniques-such as motivational interviewing. A new colour-coded visual communication tool is used for the purpose of leading through the 4-step counselling process. As doctors' communication skills are crucial, communication training is a mandatory part of the programme. We tested the feasibility and acceptance of the "Health Coaching" programme with 20 GPs and 1045 patients, using questionnaires and semistructured interviewing techniques. The main outcomes were participation rates; the duration of counselling; patients' self-rated behavioural change in their areas of choice; and ratings of motivational, conceptual, acceptance, and feasibility issues.

Results: In total, 37% (n=350) of the patients enrolled in step 1 completed the entire 4-Step counselling process, with each step taking 8-22 minutes. 50% of ratings (n=303) improved by one or two categories in the three-colour circle, and the proportion of favourable health behaviour ratings increased from 9% to 39%. The ratings for motivation, concept, acceptance, and feasibility of the "Health Coaching" programme were consistently high.

Conclusions: Our innovative, patient-centred counselling programme for health behaviour change was well accepted and feasible among patients and physicians in a primary care setting. Randomised controlled studies will have to establish cost-effectiveness and promote dissemination.

Show MeSH
Related in: MedlinePlus