Does Health Coaching Work?
This rapid review summarises evidence on: what health coaching is; its impact on people's attitudes, behaviour, health status and service utilisation; the groups most likely to benefit from coaching; and how to recruit and train health coaches. It provides an excellent introduction to health coaching for anyone with an interest in introducing it locally.
The term ‘health coaching’ is described as referring to a diverse set of interventions, but all with a shared aim of helping people set goals and take action to improve their health or lifestyle. It may be facilitated by people with long-term conditions (peers), nurses, doctors, pharmacists, therapists or other allied health professionals. It can take place in person, by telephone, by email or online, or using a combination of approaches. It may be a one-off occurrence or occur regularly, such as every week or month for several months. Health coaching can be used to support people with long-term conditions or those who wish to make changes to their lifestyle.
In terms of its impact, the authors conclude that the evidence base shows that there are many benefits likely associated with health coaching, but in order to be effective health coaching may need to be implemented as part of a wider programme supporting education and behaviour change. The report found that
- There is some evidence that health coaching can support people’s motivation to self-manage or to change their behaviours, and their confidence in their ability to do so.
- There is some evidence that health coaching can support people to adopt healthy behaviours and lifestyle choices. Research has most commonly cited benefits in increasing physical activity, eating more healthily and reducing smoking.
- There is mixed evidence about the impact of health coaching on physical outcomes such as cholesterol, blood pressure, blood sugar control and weight loss. This may be because it takes time to demonstrate changes in clinical indicators and many studies do not include long follow-up periods or large sample sizes.
- There is insufficient evidence to conclude whether health coaching reduces healthcare use or costs. Most studies are from outside the UK, making generalisation difficult.
The report explores different kinds of health coaching and concludes that it is difficult to suggest that one form is more effective than others because studies do not tend to compare. Specifically:
- Face-to-face and telephone approaches may be more interactive than online or virtual health coaching, but it would be premature to conclude that this is associated with better outcomes. Both one-to-one and group sessions have been found to have benefits.
- Health coaching can be provided as part of routine consultations or as a standalone initiative. Most research considers health coaching as a specific initiative rather than exploring incorporating health coaching skills into usual consultations.
- One clear message is that the more health coaching sessions people take part in, the more likely they may be to change.
In terms of who benefits, studies have found that health coaching can be effective in younger and older people, in men and women and in people from a wide range of ethnic groups. There is no evidence that health coaching is more effective for people with some conditions than others. However, the overall trends are that health coaching has been found to work best for:
- people with low levels of self-efficacy prior to health coaching
- people with high readiness / motivation to change
- people at highest risk
- people with the most severe symptoms
- people with low levels of self-management or medication adherence
- young people (for telephone or virtual health coaching) or much older people
- minority ethnic groups
- vulnerable groups
- people with the lowest levels of education
There is research about nurses, doctors, pharmacist, allied health professionals, peers and lay people providing health coaching. Studies do not tend to compare one type of coach with another so it is not possible to say that certain professionals are more likely to engage with or be effective at using health coaching skills. Although professionals sometimes express doubts about the feasibility of using health coaching skills within routine practice or their ability to motivate people towards behaviour change, there is evidence that a wide range of professionals and peers can successfully apply health coaching skills.
There is some research to suggest that the context in which health coaching is implemented is important. In other words, professionals need to be supported to provide health coaching practically and emotionally and there needs to be a receptive organisational context.