Characterizing Autonomy Supportiveness in Diabetes Peer Health Coaches

Abstract

BackgroundPrior studies have shown that peer health coaching improves outcomes among adults with chronic conditions such as diabetes. These studies have also suggested that higher ratings of their peer coach’s autonomy supportiveness, i.e., the degree to which a coach supports participant choice, is associated with improved outcomes. The types of actual behaviors and interactions that participants in these coaching relationships perceive as being more or less autonomy supportive are important to define. This investigation aims to more concretely characterize the ways in which participants perceive autonomy support and how important these perceptions are to their satisfaction with their peer coaches.MethodsThis article is a qualitative investigation of the US Department of Veterans Affairs–Technology Enhanced Coaching (VA-TEC) study, a parallel randomized controlled trial with diabetes patients with poor glycemic control at the Detroit VA Medical Center. Intervention arm participants work for 6 months with peer coaches who are also VA patients who now have good glycemic control. Researchers conducted semi-structured interviews with veterans who had recently completed their 6 months of coaching. Responses to Health Care Climate Questionnaire (HCCQ) items in the trial’s 6-month survey were used to identify veterans for interviews who rated their coaches either especially high or low in terms of autonomy supportiveness. Interview responses were then analyzed in order to elucidate veterans’ perceptions of autonomy support in their coaching relationships.ResultsSemi-structured interviews were conducted with 17 of the veterans who completed the VA-TEC program. Veterans who rated their coaches higher on HCCQ items tended to emphasize the positivity and non-judgmental nature of their coaches. They also described coaches who offered them choices and non-directive suggestions in identifying health behavior goals. Veterans who gave their coaches lower HCCQ ratings described coaches who tended to be less personally engaged and less focused on addressing veterans’ specific concerns about diabetes. Some veterans who rated their coaches lower on autonomy-supportiveness felt their coaches underestimated their existing knowledge of diabetes and were overly directive in providing advice. Overall, participants’ HCCQ ratings correlated well with expressed satisfaction with their coach in interviews. ConclusionsVA-TEC participant feedback outlines meaningful ways in which coaches can support autonomy. These include, among others, eliciting participants’ personal goals, remaining positive and non-judgmental, providing suggestions for behavior changes without being overly directive, and maintaining a balance between discussing diabetes and the types of personal conversations that are crucial to building trust. The effective behaviors described in this investigation can be used to train future coaches and other lay health workers.