Health Coaching for Behavior Change: Motivational Interviewing Methods and Practice

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Health coaching for behavior change: Karen Lawson, Ruth Wolever]. Healthcare Intelligence Network, c Check copyright status Cite this Title Health coaching for behavior change: Other Authors Wolever, Ruth. Physical Description 35 leaves ; 28 cm. Summary "In this special report, health coaching experts describe MI skills to improve health coaching outcomes, ways for coaches to assess a client's readiness to change and apply an understanding from the stages of change, and how the MI skills provide a foundational framework for an appropriate health coaching interaction.

The experts also identify examples of MI in practice. Contents Four pillars of health coaching: U of M Health Coach Training Fitting health coaching into integrative medicine Self-perception theory Motivational interviewing in coaching Defining the wheel of health model Precontemplation stage of change Cotemplation: View online Borrow Buy Freely available Show 0 more links Set up My libraries How do I set up "My libraries"? This single location in All: This single location in New South Wales: None of your libraries hold this item. Found at these bookshops Searching - please wait Finally, both approaches include working with the client to develop a plan for behavior change.

Integrative health coaching and motivational interviewing: Venn diagram of synergistic and distinct elements.

IHC is a comprehensive intervention with a minimum of six sessions, while MI is designed to be brief, lasting only one or two sessions. Additionally, IHC is a standalone approach, whereas MI is used simply to increase motivation and commitment to change; once that is achieved, other approaches ensue.

IHC uses a model of whole-person health when considering change, whereas MI is focused on the primary behavioral issue. IHC helps clients to develop a vision and identify core values to sustain change over time, whereas MI brings in the issue of values only to develop discrepancy and move clients toward a commitment to change.

IHC also sees clients through the whole process of change, whereas MI ceases once a plan for change has been developed. Given these similarities and differences, it may be helpful to conceptualize IHC as incorporating MI and moving beyond it. A case example presents this possibility. A year-old woman presents for a primary care visit with her daughter, who is her primary caretaker. The patient is obese, has hypertension and type 2 diabetes, and is taking insulin.

She has limited mobility and remains primarily homebound. Her most recent HbA1C was Through the course of the visit, the provider learns from the patient's daughter that she consumes fullsugar soda daily, brought by the patient's friends. Medication reconciliation demonstrated that the patient is not adhering to daily medications.

The provider's primary concern is the patient's uncontrolled diabetes and associated behaviors, including poor medication adherence and a high sugar intake. If this patient were referred to IHC, the coach would begin by asking the patient to complete the current and desired states form to self-assess where she is and where she would like to be on each of the domains of the Wheel of Health. The coach then would lead the patient through a envisioning exercise so she could articulate her desired future vision of health and wellbeing session 1.

From this exercise, the coach would use open-ended questions to ask the patient to articulate what are important values associated with this vision. This process of self-discovery would help the patient to become clear about what is most important to her and where she ideally wants to be session 2. The vision and values would become an anchor for future coaching conversations.

The coach would ask the client what she understands about her most recent visit with the physician and how her current health might be getting in the way of achieving her vision or might be conflicting with her values. This conversation would lead to the coach asking the patient where she would like to focus. This focus area might be specific to diabetes care eg, improve medication adherence and might not eg, improve social relationships sessions Once the SMART goal is identified, the coach would ask the patient where she would like to begin—Which action could she take in the next week to move toward this goal?

The coach would continue to work with the client on action steps to achieve the goal sessions Once the goal is achieved and the client feels comfortable she can maintain it, the client would terminate coaching or select another area of focus session 9 and if a new goal, beyond. If the patient were terminating coaching, the coach would reinforce the work the patient has done to date and ensure that support systems are in place to sustain her changes over time. For each session, the coach would ask the client to complete a coaching preparation form so that she can articulate where she has been, what she learned, where she would like to go moving forward over the next week or two, and what she will need to do to make that happen, including accessing resources and support.

The final coaching preparation form would ask the client to highlight key learning about herself and how she will use this knowledge moving forward to maintain all she has accomplished. For this patient, MI sessions would occur once or twice to help her achieve better diabetes control. The focus of these sessions would be to increase the patient's motivation for and commitment to improving diabetes control. The mechanisms to achieve better diabetes control would be up to the patient.


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The provider would focus first on helping the patient to resolve any ambivalence over making changes to improve diabetes control, using OARS and identifying and eliciting change talk, while rolling with any resistance that may arise. Once the provider determines that the patient's motivation to change is high, the discussion would turn to developing a plan for change. The patient would establish her own goal for change and a plan to achieve it.

Once a plan was outlined, the provider would summarize the plan created and solicit a verbal commitment from the patient to that plan. The MI sessions would terminate; however, the patient may be referred for additional support services, especially depending on the specific components of the plan. IHC actually uses many of the MI processes, in addition to other interpersonal techniques, to help empower the client and support the client's ability to change. However, while both approaches use reflection, open-ended questions, and motivational language to support the patient to change behavior, the IHC approach is much more comprehensive and sees the patient through the entire change process.

Conversely, while MI still works with the patient to establish a plan for behavior change, once that plan is articulated, MI ceases. Additionally, the focus on whole person health in IHC means that patients may establish a goal that is not directly related to a chronic condition, although achieving this goal may be necessary before other goals may be addressed. IHC and MI are both useful approaches for helping patients to achieve behavior change in healthcare settings. IHC is a more comprehensive approach that considers patients holistically and supports them across the entire behavior change journey.

Conversely, MI is a communication method and interpersonal style that focuses specifically on helping patients to resolve ambivalence and make a commitment to change. Both approaches have origins in behavior change theories and use interpersonal skills that emphasize empathy and meeting patients where they are. With its focus on self-assessment, continued learning, and personal development, IHC has the capacity to teach patients lifelong skills that may be harnessed when addressing future health or other behavior changes.

However, it is a time-intensive process that requires significant personal investment to be most successful. MI is a useful communication method for healthcare providers to incorporate into routine clinical care because there is a limited amount of time to help move patients toward behavior change. Since it is not a stand-alone method, additional resources are generally necessary to help patients enact the change plans they commit to, such as support from a behavioral therapist. Finally, MI is a method that coaches can use successfully with patients as part of the comprehensive IHC approach.

With the ongoing challenge of reducing rates of preventable chronic disease through behavior change, both IHC and MI are valuable approaches to achieve this end. Dr Simmons also disclosed that she provides integrative health coaching to private clients. National Center for Biotechnology Information , U. Glob Adv Health Med. Published online Jul 1. Find articles by Leigh Ann Simmons. Find articles by Ruth Q. This article has been cited by other articles in PMC.

Abstract As rates of preventable chronic diseases and associated costs continue to rise, there has been increasing focus on strategies to support behavior change in healthcare. Integrative health coaching, motivational interviewing, behavior change, patient education. Process IHC is an intensive intervention eg, minimum sessions of 30 min—40 min duration that embodies core aspects of a supportive and creative relationship to elicit change.

Strategies IHC uses a number of strategies within a basic structure that enables personalization, optimal patient engagement, empowerment, and successful outcomes.

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Process Miller and Rollnick have clearly stated that MI is a brief method of communication sessions designed to move individuals in the direction of change. Strategies With the spirit of MI as a backdrop, the provider engages in phase 1 by helping the client to resolve ambivalence and increase motivation for change. Open in a separate window. Integrative Health Coaching If this patient were referred to IHC, the coach would begin by asking the patient to complete the current and desired states form to self-assess where she is and where she would like to be on each of the domains of the Wheel of Health.

Motivational Interviewing For this patient, MI sessions would occur once or twice to help her achieve better diabetes control. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. What is health coaching anyway? Standards needed to enable rigorous research: Integrative health coaching for patients with type 2 diabetes.

Effects of comprehensive lifestyle modification on blood pressure control: Evaluation of a behavior support intervention for patients with poorly controlled diabetes. A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med.

Integrating Health Behavior Change in a Busy Medical Practice

Modifiable disease risk, readiness to change, and psychosocial functioning improve with integrative medicine immersion model. Altern Ther Health Med. The impact of telephone health coaching on health outcomes in a high-risk population. Global Adv Health Med. Innovative education and clinical programs emerging.

The wisdom of the whole: Create Space Press; California Institute of Integral Studies Career preparation in integrative health studies. Evidence based coaching handbook: An integrative goal-focused approach to executive coaching. The impact of life coaching on goal attainment, metacognition and mental health. The handbook of coaching. Hedonia, eudaimonia, and well-being: Goal striving, need satisfaction, and longitudinal wellbeing: J Pers Soc Psychol. The self-concordance model of healthy goal striving: Handbook of self-determination research.

University of Rochester Press, Williams P, Davis DC. Therapist as life coach: Kauffman C, Moore M. Adult development theory and executive coaching practice. Integrative health coach training: A model for shifting the paradigm toward patient-centricity and meeting new national prevention goals.

Global Adv Health Medicine. London; New York, NY: Goal setting as a strategy for health behavior change. Miller WR, Rollnick S.


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