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|Issue 128||June 2017|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Systematic Review: The Effectiveness of Health Coaching
Chronic medical conditions are common among VA healthcare system users, with nearly 75% of Veterans who use VA healthcare having two or more chronic conditions. Optimizing beneficial patient health behaviors can help improve outcomes associated with chronic medical conditions. Yet making any kind of healthy changes can be a daunting task for many patients, especially those with multiple chronic conditions. Health coaching may be an effective tool to facilitate the uptake of health behaviors among people with one or more chronic medical conditions. While there is no consensus on how to define health coaching or what elements constitute a health coaching intervention, several characteristics serve to define the approach. At its core, health coaching is a patient-centered, collaborative model grounded in theories of health behavior change in which a coach collaborates with the patient to identify goals and action plans that maximize personal well-being and overall health. Health coaching includes solution-focused techniques like motivational interviewing, goal-setting, and problem-solving and has a central feature of patient empowerment toward autonomy. It is a modality grounded in the belief that patients are experts in their own life situations and can draw on these experiences to promote personal change. As such, health coaches work with patients to enhance activation and motivation to change by aligning health-related goals with the patient's personal values.
This systematic review evaluated the effects of health coaching interventions among adults with chronic medical conditions on clinical, behavioral, and self-efficacy outcomes. Investigators with VA's Evidence-based Synthesis Program Center located in Durham, NC searched MEDLINE®, CINAHL, and PsycINFO for peer-reviewed, randomized controlled clinical trials (RCTs) of interventions that self-identified as health coaching. After reviewing more than 2,500 citations, they identified 41 RCTs, in addition to 4 companion studies, that met their eligibility criteria. Using data from these resources, investigators also explored whether or not the health coaching intervention effects varied by program elements, such as patient chronic disease status, intervention dose (i.e., number of coaching sessions), mode of coaching delivery, and individuals conducting health coaching (i.e., healthcare providers, peers, health coaches). In collaboration with key stakeholders, they also explored whether or not effects varied by concordance of health coaching intervention with an a priori list of key health coaching elements (i.e., patient-centeredness, patient-determined goals, and self-discovery process).
Summary of Findings
It is important to note that many pooled estimates exhibited moderate to high statistical heterogeneity (I2 >50%). Further, results did not hold for the above outcomes when compared with active comparators.
In qualitative syntheses, results were mixed or inconclusive for effects of health coaching on functional status, smoking cessation, and medication adherence. However, limited qualitative evidence in two trials suggests that coaching has a positive effect on total calorie reduction. This systematic literature review also explored potential sources of variability in treatment effects, including population characteristics, intervention dose and delivery mode, type of individual conducting health coaching, and concordance with key elements of health coaching. Findings show that none of these factors were robust predictors of variability in treatment effects.
This report identifies gaps in evidence that warrant further research, which may help the Office of Patient Centered Care and Cultural Transformation (OPCC&CT) and the National Center for Health Promotion and Disease Prevention (NCP) prioritize future research projects.
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ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Quality Enhancement Research Initiative's (QUERI) Evidence-Based Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers – and to disseminate these reports throughout VA.
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