How Can Registered Dietitian Nutritionists Use Health Coaching Techniques?

Abstract

The concept of coaching has become fairly common today in the health care arena. There are people with various credentials who coach others on the benefits of eating healthy, exercising, losing weight, managing stress, or quitting the use of tobacco. Coaching may be provided on an individual basis or for a group, occur face-to-face or with the use of technology, and involve delayed or real-time communication with the use of phone, Internet, email, fax, video conferencing, or social media.1The Academy of Nutrition and Dietetics Practice Tips: Telehealth Challenges and Opportunities. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442476737&libID=6442476714. Accessed December 20, 2013.Google Scholar It was predicted in the March 2012 issue of the Journal of the Academy of Nutrition and Dietetics that “technology [would] transform nutrition counseling,”2Rhea M. Bettles C. Future changes driving dietetics workforce supply and demand: Future Scan 2012-2022.J Acad Nutr and Diet. 2012; 112 (Accessed December 20, 2013): S10-S24Abstract Full Text PDF PubMed Scopus (43) Google Scholar allowing more personalized nutrition information to be received, and this trend is likely to continue. “Telehealth” and “telemedicine” have been used by various organizations to describe the delivery of health-related information across a distance with the use of technology, regardless of its form.1The Academy of Nutrition and Dietetics Practice Tips: Telehealth Challenges and Opportunities. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442476737&libID=6442476714. Accessed December 20, 2013.Google Scholar, 3Institute of Medicine Workshop Summary: The Role of Telehealth in an Evolving Health Care Environment (2012). http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442476842&libID=6442476819. Accessed December 20, 2013.Google Scholar Telenutrition, which “involves the interactive use of electronic information and telecommunications technologies,” as defined by the Academy of Nutrition and Dietetics, is specific to registered dietitian nutritionists (RDNs), because it involves the use of the Nutrition Care Process (NCP) and is subject to state licensure laws.1The Academy of Nutrition and Dietetics Practice Tips: Telehealth Challenges and Opportunities. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442476737&libID=6442476714. Accessed December 20, 2013.Google Scholar Health coaching, which often involves some form of telehealth, is a way for RDNs to promote lifestyle change with the use of skills including behavior change models and communication techniques, such as motivational interviewing (MI). The use of the “social ecological model” as described in the Academy's Practice and Position Papers on “The Role of Nutrition in Health Promotion and Chronic Disease Prevention” explains how the RDN can conduct a nutrition assessment using this framework as a way to improve health outcomes.4Practice Paper of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442477004&libID=6442476981. Accessed December 20, 2013.Google Scholar, 5Position Paper of the Academy of Nutrition and Dietetics: The Role of Nutrition in Health Promotion and Chronic Disease Prevention. http://www.eatright.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=6442476998&libID=6442476975. Accessed December 20, 2013.Google Scholar This is especially important, since barriers to behavior change can exist at multiple levels (eg, individual, family, environment). Being a nutrition expert is important, but having the ability to communicate the information in such a way that people can apply it is even more critical—a proficiency RDNs possess. Rather than advising a specific way to eat, the coach works with the client to find out how the topic relates to him or her on a personal level. The delivery of this essential information requires a delicate balance between talking and listening. MI is a tool that can help with this process. It's defined as a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.”6Motivational Interviewing [Resources for Clinicians, Researchers, and Trainers]. http://www.motivationalinterview.net/. Accessed December 27, 2013.Google Scholar MI is a creative approach to conversation, allowing a person to find answers on his or her own, and is especially helpful if there is some reluctance to change or specific barriers have been identified. Coaching is a collaborative effort, which means the agenda for each session is developed along with the client. Since subsequent sessions are common with health coaching, personal goals are usually established and evaluated. This allows the client to apply the appropriate information and helps to reinforce the change in behavior. Time and again people will say they know what they need to do; however, their goals are either unrealistic or they haven't found a way to resolve the internal conflicts that have prevented them from making progress toward them. The coach can help them scale back their goals, if necessary, which helps to promote change that is sustained for a longer period of time, thereby increasing self-efficacy. Health coaching and the use of MI are both skills that require time for proficiency to develop. There are several organizations offering health coach certifications or training specific to MI. The Commission on Dietetic Registration offers a list of accredited providers for continuing professional education. The Academy also offers resources on health coaching and how RDNs can be leaders in this emerging field. Health coaching can be very rewarding as an RDN, because it integrates the art and science of nutrition and dietetics but allows the translation of information in such a way that elicits a change in behavior from the client without having to be told exactly what to do.