New challenges need new approaches – and this is certainly true in health care! While there have been remarkable successes in treating acute diseases, the flip side is that there has been a surge in the prevalence of chronic conditions. In addition, the incidence of musculoskeletal conditions like chronic low back pain has surged – in fact, low back pain has become the most common reason for consulting a family physician!
People living with chronic conditions require a different approach to care than that used in acute care. For example, in acute care, health care professionals provide their patients with education that is disease-specific and then prescribe treatment, while in chronic care the educational focus is on understanding the condition, and teaching patients the skills they will need for self-management.
But while the patient may understand what is needed, and want to comply, they may not know how to do it. Some call this the ‘intention-behaviour gap” – the intention to change is not followed by action (Sniehotta et al 2005). Many factors may contribute to the gap – for example, the patient’s personal situation, their understanding of their condition, or conflicting priorities.
Health coaching is one strategy that may help bridge that gap – health care professionals work in partnership with patients to identify and begin making the changes that will take them toward better health. The partnership recognizes that the patient is the expert on their life, and the health professional is the expert on health-related recommendations.
Health coaching is a tool physiotherapists can incorporate within their practice – it is a positive approach to care for individuals with chronic conditions that is effective, teaches them concrete strategies for self-management and fosters their sense of personal responsibility.
There are three key principles in health coaching:
- The patient drives the process. They set the priority for what change looks like, and what the challenges are. Behaviour change is most likely to occur when it is linked to something a person values, and is perceived as worth the risk associated with the change – what will improve, what will be different.
- The coach guides the patient. This will include recognizing the patient’s motivation to make a change and the factors involved – and tailoring the coaching strategy appropriately. For each patient, the coach provides targeted, specific information that the patient can either consider and gain more understanding, or can apply in carrying out the plan they have made for change. The health coach and the patient work collaboratively on the action plan to break it down into manageable steps and/or to set a workable timeline.
- The patient is accountable. Bridging the “intention - behaviour gap” requires action. The patient tracks and records their progress towards their goal, with each success building a sense of self-efficacy, or confidence in completing a task. Self-monitoring can also help the patient recognize when a goal needs revision, and how to problem-solve if an unexpected event becomes a barrier. The coach provides feedback for the patient, reviewing their progress or discussing how a plan may be modified.
To learn more, read Physiotherapy Alberta’s Introduction to Health Coaching for Physiotherapists. It provides clinicians with a new tool to use in the promotion of self-management for patients with chronic conditions.
In addition, register for the Physiotherapy Alberta webinar on November 21, 2019: Embracing Health Coaching in Clinical Practice, with Zachary Rethorn, a physiotherapist who has incorporated health coaching within his practice. Zachary is currently conducting research on how health professionals promote physical activity with their patients for his PhD thesis.
Bridging the intention–behaviour gap: Planning, self-efficacy, and action control in the adoption and maintenance of physical exercise, Psychology & Health. 2005; 20:2, 143-160,