Health Coaching Intervention Research Articles

Health coaching: the node of health literacy & health promotion

Abstract Introduction To achieve sustainable health behaviors and outcomes to move from a precarious health situation to good health, people need to be supported in health literacy in behavior change that ensure interventions’ success. As a non-clinical approach, health coaching aims to increase a person’s levels of self-efficacy, confidence and resilience, by promoting the sense of coherence. This communication aims to identify the benefits that health coaching as a salutogenic approach can trigger. Methods The work is structured in a narrative review of literature and the lived experience of the authors in health coaching. Results The published research on health coaching and the systematic professional experience of the authors highlight: (1) the anchoring of health coaching in the salutogenic model and in the person-centered approach focused on individual characteristics and needs in driving healthy behaviors; (2) health coaching as a collaborative relationship with chronically ill people and people at risk of developing illness; (3) the role of health coaching as a sense of coherence (SOC) promoter; (4) health coaching as a new profession in the healthcare ecosystem (e.g. NHS, UK), cooperating with multidisciplinary teams. Discussion From A.Antonovsky’s model approach to health, the SOC stands out and constitutes one of the basic theories in health coaching interventions, by strengthening the person’s capabilities of comprehensibility, manageability, and meaningfulness. As an emerging profession, with ethical and a growing research foundation, it is facilitated by trained professionals in managing and monitoring health behavior change. Conclusions Health coaching aims to bring relevance, meaning and strategy to a person’s behavioral change. Health coaching demonstrates positive effects on several health parameters by supporting the implementation of health literacy development and empowering people to trigger sustainable changes that lead to healthier lifestyles.

Goal Setting Moderates Behavior Change Outcomes in College Students After an Online Health Coaching Intervention

ABSTRACT Background Health coaching sessions that incorporate goal setting may help improve college students' health behaviors. Purpose This study examined whether specific goal-setting practices moderated changes in health behaviors during an online wellness intervention in college students. Methods Participants were 90 college students recruited from one US university. The intervention was a one-hour virtual one-on-one health coaching session where participants set two goals for either physical activity (Metabolic Equivalent Task (MET)-minutes or MET-minutes), nutrition, sleep, or stress management. Self-reported baseline behaviors were collected, and follow-up surveys were completed at 6- and 12-weeks. Mixed effects models examined behavior change outcomes across the follow-up timepoints while testing the moderating effect of goal setting using interactions. Results The Goal×Time interaction was significant for moderate MET-minutes at 1st follow-up (b = 443, p = .003), and for total MET-minutes at the 2nd follow-up (b = 717, p = .047). The Goal×Time interaction was also significant for stress management at 1st follow-up (Odds Ratio = 7.3, p = .042). Discussion Participants who set physical activity and stress management goals had significantly higher physical activity and utilized more stress management techniques. Translation to Health Education Practice The use of specific goal-setting strategies for physical activity and stress management is recommended during online health coaching sessions. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars.

Initial Perspectives From Rural-Residing Adults on a Digital Cognitive Health Coaching Intervention: Exploratory Qualitative Analysis.

A growing body of research has examined lifestyle-based interventions for dementia prevention. Specifically, health coaching interventions have been linked to decreased risk of Alzheimer disease (AD) comorbidities, such as diabetes. Despite the association, there is a lack of research examining the efficacy and perception of digital health coaching on reducing AD risk. Understanding the perceived benefits of participating in a digital health coach program is critical to ensure long-term use, including participant adherence and engagement. The purpose of this study is to examine the initial attitudes toward a digital health coaching intervention aimed at preventing cognitive decline among at-risk, rural participants. This exploratory qualitative study is part of the ongoing Digital Cognitive Multidomain Alzheimer Risk Velocity Study (DC-MARVel; ClinicalTrials.gov NCT04559789), a 2-year randomized control trial examining the effects of a digital health coaching intervention on dementia risk, cognitive decline, and general health outcomes. Participants were recruited from the northwest region of Arkansas via word of mouth, email, local radio, and social media. At the time of the analysis, 103 participants randomly assigned to the health coaching group completed an average of 4 coaching sessions over a 4-month period. The intervention included asynchronous messages 1-2 times per week from their health coach that contained health education articles based on the participant's goals (eg, increase physical activity), unlimited access to their coach for questions and recommendations, and monthly meetings with their coach via videoconference or phone to discuss their goals. Participants were asked 2 open-ended questions, "What were your top 1 or 2 takeaways from your recent Health Coaching session?" and "Is there anything you would change about our Health Coaching sessions?" A thematic analysis was conducted using feedback responses from 80 participants (mean age, SD 7.6 years). The following four themes emerged from participants' feedback: (1) healthy lifestyle and behavioral changes, (2) a sense of self-awareness through introspection, (3) value in coach support, and (4) a desire for a change in program format (eg, frequency). In total, 93% (n=74) of participants expressed that the intervention needed no changes. Initial participation in the digital cognitive health coaching intervention was well received, as evidenced by participants reporting value in goal setting and strategies for healthy lifestyle and behavioral changes as well as self-reflection on their personal lifestyle choices. Feedback about their assigned coach also offers insight into the importance of the coach-participant relationship and may serve as a significant factor in overall participant success. Given the exploratory nature of this study, more robust research is needed to elicit more information from participants about their experiences to fully understand the acceptability of the digital health coaching intervention. ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/show/NCT04559789. RR2-10.2196/31841.

Health Coaching Improves Outcomes of Informal Caregivers of Adults With Chronic Heart Failure: A Randomized Controlled Trial.

Caring for someone with heart failure takes an emotional and physical toll. Engaging in self-care may decrease stress and improve the health of informal caregivers. We conducted a randomized controlled trial testing the efficacy of a virtual health coaching intervention, compared with health information alone, on the self-care, stress, coping, and health status of heart failure caregivers. We enrolled 250 caregivers providing care at least 8 hours/week, reporting poor self-care, and able to use technology. All received a tablet device programmed with websites providing vetted information on heart failure and caregiving. Half were randomized to also receive 10 synchronous support sessions virtually with a health coach over 6 months. Data on self-care, stress, coping, and health status were collected at baseline and 3 and 6 months. Linear mixed-effects models were used to assess the interaction between time and treatment group. The sample was majority female (85.2%), White (62.2%), spouses (59.8%), and aged 55±13.6 years. Many were employed full time (41.8%). They had been caring for the patient 8 hours/day for a median of 3.25 years. In the intention-to-treat analysis, caregivers who received the health coach intervention had statistically and clinically greater improvement across 6 months compared with the control group in the primary outcome of self-care maintenance (5.05±1.99; P=0.01) and stress (-4.50±1.00; P<0.0001). Self-care neglect declined significantly (-0.65±0.32; P=0.04), but the difference between the treatment arms disappeared when the results were adjusted for multiple comparisons. Mental health status improved statistically but not clinically (3.35±1.61; P=0.04). Active coping improved in both groups but not significantly more in the intervention group (P=0.10). Physical health status was unchanged (P=0.27). This virtual health coaching intervention was effective in improving self-care and stress in heart failure caregivers.

Goal Setting, Movement Behaviors, and Perceived Health during an Online Health Coaching Intervention

The purpose of this study was to examine the associations of goal setting, movement behaviors, and health perceptions in young adults after an online health coaching intervention. Participants were young adults from a university within the western United States (N=257; 57.2% female). Participants met with health coaches in an online setting for one hour and goals were set for two behavior areas. Physical activity (PA), sitting time, sleep, and perceptions of general health and emotional wellbeing (health perceptions) were collected at baseline and at 2- and 4-weeks after the coaching session. Mediation analyses determined the associations of the health coaching session with goal setting on self-reported general health and emotional wellbeing and the indirect associations of each movement behavior. No movement behavior positively mediated the associations between the health coaching session and any of the health perception outcomes, although PA, sitting time, and weeknight sleep at 2-weeks associated with general health at 4-weeks (b=0.17–0.39, p&lt;0.01) and associated with emotional wellbeing at 4-weeks (b=0.16–0.21, p&lt;0.01). Emotional wellbeing mediated the associations of the health coaching session on general health (IE=0.19, p&lt;0.001) and general health mediated the association of the health coaching session on emotional wellbeing (IE=0.09, p&lt;0.001). Movement behaviors correlated with self-reported general health and emotional wellbeing, but no positive mediating associations were observed. Emotional wellbeing mediated the associations of the health coaching session on general health and vice-versa, suggesting a bidirectional association between the two health perceptions.

Effect of Digital Health Coaching on Self-Efficacy and Patient-Reported Outcomes in Individuals with Acute Myeloid and Chronic Lymphocytic Leukemia: A Pilot Randomized Controlled Trial.

Promotion of self-efficacy can enhance engagement with health care and treatment adherence in patients with cancer. We report the outcomes of a pilot trial of a digital health coach intervention in patients with leukemia with the aim of improving self-efficacy. Adult patients with newly diagnosed acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) were randomized 1:1 to a digital health coach intervention or standard of care. The primary outcome of self-efficacy was measured by the Cancer Behavior Inventory (CBI) score. A total of 147 patients (37 AML, 110 CLL) were enrolled from July 2020 to December 2022. In the AML cohort, there was a mean increase in CBI score of 7.03 in the digital health coaching arm compared to a mean decrease of -3.57 in the control arm at 30 days (p = 0.219). There were no significant associations between the intervention and other patient-reported outcomes for patients with CLL. There were numerical, but not statistically significant increases in self-efficacy metrics in AML patients who received digital health coaching. Although this trial was underpowered due to enrollment limitations during a pandemic, digital health coaching may provide benefit to patients with hematologic malignancy and warrants further investigation.

Health Coaching Intervention to Improve Self-Care Management of Hypertension Among Older People in Indonesia: A Randomized Controlled Study Protocol.

One-third of the global population is predicted to be diagnosed with hypertension (HTN) in 2025, with the percentage highest among older people. Without proper self-care management, uncontrolled HTN causes negative health consequences and decreases the quality of life. The previous scoping review identified various challenges that older adults may face in dealing with HTN and that effective approaches should consider each individual's circumstances and attributes. This study aims to investigate the efficacy and sustainable impact of an Indonesian adaptation of an 8-week nurse health coaching intervention on self-care management and self-efficacy among older people with HTN. The coaching sessions will last for 30 min weekly for 8 weeks. The data will be measured at three points: baseline (initial), 1 week after the eighth health coaching session, and 3 months after concluding the intervention. This study will be the first health coaching intervention research based on motivational interviewing and cognitive behavioral therapy approach with Indonesian background adjustment. The study result will help develop a guideline for nurses and other health workers providing health coaching for older people in Indonesia and other countries with similar characteristics in terms of sociodemographics or lifestyle. thaiclinicaltrials.org Identifier: TCTR20230410001 (Date of registration: April 9, 2023).

Health coaching intervention with or without the support of an exercise buddy to increase physical activity of people with chronic low back pain compared to usual care: a feasibility and pilot randomised controlled trial

BackgroundExercise buddies (people to exercise together with) might support people with low back pain (LBP) to become active. However, involving buddies in randomised controlled trials (RCT) might challenge recruitment, data collection and follow-up. ObjectivesTo explore the feasibility of the intervention, recruitment and data collection approaches and potential effects of a health coaching intervention (focused on physical activity) with or without exercise buddies’ support on physical activity of people with chronic LBP versus usual discharge care. DesignFeasibility and pilot RCT. MethodsAdults (n = 30) discharged from LBP treatment were randomised to the Buddy-Assisted (health coaching intervention with exercise buddy's support), Individual-Only (health coaching only), or usual care groups. Data were collected at baseline, three and six months. The feasibility of trial's procedures was assessed through recruitment rate (acceptable if >70%), data completion rate (acceptable if ≤ 20% missing data), and follow-up rate (successful if ≥ 85%). The intervention's acceptability was assessed via feedback questionnaires. Preliminary effects on physical activity and other outcomes were also explored. ResultsRecruitment and baseline data completion were acceptable. However, data collection and follow-up rates post-randomisation were not. 85% of the Buddy-Assisted Group believed the buddies helped them to increase physical activity and would recommend the intervention. 70% of the Individual-Only and Control groups believed exercise buddies would help them to become further active. ConclusionThe data collection and follow-up approaches were not successful and need amending before a large-scale RCT. Nonetheless, the buddy-assisted intervention was well-accepted. A future RCT will focus on differences in clinical outcomes. Trial registrationThe study was registered at the Australian New Zealand Clinical Trial Registry (ACTRN12620001118998).

Effects Of 1-Year Of Health Coaching and Health Education Interventions on Physical Function of Middle Aged and Older Adults

Effects Of 1-Year Of Health Coaching and Health Education Interventions on Physical Function of Middle Aged and Older Adults

Technology-Enabled Collaborative Care for Type-2 Diabetes and Mental Health (TECC-D): Findings From a Mixed Methods Feasibility Trial of a Responsive Co-Designed Virtual Health Coaching Intervention.

Type-2 diabetes (T2D) is a complex chronic condition associated with a lower quality of life due to disease specific distress. While there is growing support for personalized diabetes programs, care for mental health challenges is often fragmented and limited by access to psychiatry, and integration of care. The use of communication technology to improve team based collaborative care to bridge these gaps is promising but untested. We conducted an explanatory sequential mixed methods study to assess the feasibility and acceptability of the co-designed Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D) program. Participants included adults aged ≥18 years who had a clinical diagnosis of T2D, and self-reported mental health concerns. 31 participants completed the 8-week virtual TECC-D program. Findings indicate that the program is feasible and acceptable and indicate that there is a role for virtual diabetes and mental health care. The TECC-D program, designed through an iterative co-design process and supported by innovative, responsive adaptations led to good uptake and satisfaction. The TECC-D model is a feasible and scalable care solution that empowers individuals living with T2D and mental health concerns to take an active role in their care.

HEALTH COACHING IMPROVES EVERYDAY COGNITION AMONG INDIVIDUALS AT RISK FOR ALZHEIMER’S DISEASE

Abstract Alzheimer’s disease (AD) is the 7th leading cause of death and 6th most burdensome disease among US older adults. With pharmacological treatments for AD being predominantly ill-effective, alternative, non-pharmacological prevention and treatment strategies warrant exploration. Personal health coaching provides individualized strategies designed to improve physical, social, and emotional health leading to positive behavior changes that may improve cognitive ability. The purpose of the present investigation was to examine the effects of a Health Coaching (HC) intervention on cognitive outcomes. Adults (n=182) over 45 years of age were randomly assigned to HC or control arm of a 12-month intervention. Participants (age = 61.9 + 8.4 years) had their cognition (ECog-12) tested at baseline, 16, and 52 weeks. Participants assigned to the HC intervention met with a health coach once per month to establish healthful goals and implementation strategies improving the health and well-being of the participants. The control group received bi-weekly emails including similar information presented during the health coaching sessions. Results revealed a main effect for time for improved ECog-12 scores (p=.04) with a 3.2% improvement in ECog-12 after 52 weeks. Upon further analysis, HC had a significant improvement in cognitive performance after both 16 and 52 weeks, while the control group remained unchanged. Improvement in self-reported cognition was 4.0% (p=.03) and 5.5% (p=.01) in the HC group after 16 and 52 weeks, respectively. These results suggest HC is an effective non-pharmacological prevention strategy for cognitive decline among a group of adults at-risk for developing AD.

Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study.

Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=-112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=-101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=-.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=-1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=-4.78; P=.02). This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors.

Perception of a Peer Health Coaching Intervention Among College Students: Client Experience

ABSTRACT Background As health coaching is becoming more popular as a health promotion intervention tool, there is a lack of empirical evidence to understand the clients’ experience in the peer health coaching program among college students. Purpose This qualitative study explored the experiences and perceptions of the health coaching clients following an 8-week peer health coaching intervention in college. Method A total of 14 student clients (female, n = 9, 57% White) from the health coaching program participated in the focus group, following an 8-week peer health coaching program. The semi-structured focus group guide was developed to understand their experience. Results Clients’ positive experience in the health coaching program contributed to transformative outcomes, including behavioral outcomes and goal achievement, well-being and personal growth, and self-empowerment, with the coaching relationship mediating the relationship and the coaching modality moderating the relationship. Discussion The health coaching experience facilitated lifestyle changes, helped clients gain self-efficacy and confidence to manage their health and wellbeing and provided an overall caring, enjoyable, supportive experience. The bonding with the peer health coaches provided important social support for the student clients. Translation to Health Education Practice A peer health coaching program can be a cost-effective option for health promotion on college campuses. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars

Electronic Health Record-Driven Approaches in Primary Care to Strengthen Hypertension Management Among Racial and Ethnic Minoritized Groups in the United States: Systematic Review.

Managing hypertension in racial and ethnic minoritized groups (eg, African American/Black patients) in primary care is highly relevant. However, evidence on whether or how electronic health record (EHR)-driven approaches in primary care can help improve hypertension management for patients of racial and ethnic minoritized groups in the United States remains scarce. This review aims to examine the role of the EHR in supporting interventions in primary care to strengthen the hypertension management of racial and ethnic minoritized groups in the United States. A search strategy based on the PICO (Population, Intervention, Comparison, and Outcome) guidelines was utilized to query and identify peer-reviewed articles on the Web of Science and PubMed databases. The search strategy was based on terms related to racial and ethnic minoritized groups, hypertension, primary care, and EHR-driven interventions. Articles were excluded if the focus was not hypertension management in racial and ethnic minoritized groups or if there was no mention of health record data utilization. A total of 29 articles were included in this review. Regarding populations, Black/African American patients represented the largest population (26/29, 90%) followed by Hispanic/Latino (18/29, 62%), Asian American (7/29, 24%), and American Indian/Alaskan Native (2/29, 7%) patients. No study included patients who identified as Native Hawaiian/Pacific Islander. The EHR was used to identify patients (25/29, 86%), drive the intervention (21/29, 72%), and monitor results and outcomes (7/29, 59%). Most often, EHR-driven approaches were used for health coaching interventions, disease management programs, clinical decision support (CDS) systems, and best practice alerts (BPAs). Regarding outcomes, out of 8 EHR-driven health coaching interventions, only 3 (38%) reported significant results. In contrast, all the included studies related to CDS and BPA applications reported some significant results with respect to improving hypertension management. This review identified several use cases for the integration of the EHR in supporting primary care interventions to strengthen hypertension management in racial and ethnic minoritized patients in the United States. Some clinical-based interventions implementing CDS and BPA applications showed promising results. However, more research is needed on community-based interventions, particularly those focusing on patients who are Asian American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander. The developed taxonomy comprising "identifying patients," "driving intervention," and "monitoring results" to classify EHR-driven approaches can be a helpful tool to facilitate this.

Supporting Youth Mental Health Through a Health Coaching Intervention with a Mindfulness Component: A Pilot Randomized Controlled Trial During COVID-19

Supporting Youth Mental Health Through a Health Coaching Intervention with a Mindfulness Component: A Pilot Randomized Controlled Trial During COVID-19

Preliminary Efficacy of a Multi-Behavioral Zoom-Based Peer Health Coaching Intervention in Young Adults: A Stepped Wedge Randomized Controlled Trial.

The purpose of this study was to test the preliminary efficacy of a Zoom-based peer coaching intervention on health and risk behaviors in young adults. A convenience sample of young adults was recruited from one U.S. university (N = 89; 73.0 percent female). Participants were randomized to one of two coaching session sequences within the framework of a stepped wedge randomized controlled trial. One experimental sequence received a control condition and a single coaching session, and the second sequence received two sessions. The intervention was a 1-hour program delivered by peer health coaches in a one-on-one setting on Zoom. The program consisted of a behavior image screen, a consultation, and goal planning. Behavioral assessments were completed after each condition. Mixed-effects models were employed to test for behavior differences after coaching sessions compared with the control condition (no coaching session) adjusting for baseline scores. Participants reported significantly higher levels of vigorous physical activity (b = 750 metabolic equivalent of task minutes, p < 0.001), a lower frequency of e-cigarette use (b = -2.1 days; p < 0.001), and a lower risk of e-cigarette susceptibility after two sessions (relative risk = 0.04, p = 0.05), and higher odds of using stress reduction techniques after one session (odds ratio = 1.4, p = 0.04). A nonsignificant trend was observed for longer weekday sleep (b = 0.4 h/night, p = 0.11) after two coaching sessions. The Zoom-based peer health coaching intervention may be an efficient way to improve vigorous physical activity, lower e-cigarette use and susceptibility, and facilitate the use of stress reduction techniques in young adults. The results observed from this preliminary study warrants further investigation using powered effectiveness trials.

P31-027-23 Self-Efficacy as a Predictor of Weight Loss in Patients With Obesity or Elevated BMI Using a Health Coaching Intervention for Weight Management in Primary Care: The GEM Study

P31-027-23 Self-Efficacy as a Predictor of Weight Loss in Patients With Obesity or Elevated BMI Using a Health Coaching Intervention for Weight Management in Primary Care: The GEM Study

Theoretical Derivation of a Telephone-Based Health Coaching Intervention for Promoting Physical Activity and Healthy Nutrition.

Present research regarding interventions to change behavior suffers from insufficient communication of their theoretical derivation. This insufficient communication is caused by the restrictions imposed by most of the relevant scientific journals. This impedes further intervention development. In this article, a telephone-based health coaching (TBHC) intervention is introduced using a format outside these restrictions. This intervention is seen as a combination of (1) the activities performed with the target persons, i.e., its core, and (2) measures to ensure the quality of the intervention. The theoretical derivation of the core is presented. The core is seen to consist of (1) the style of coach-patient interaction and (2) the contents of this interaction. The style of coach-patient interaction was derived from self-determination theory and was concretized using motivational interviewing techniques. The contents of the coach-patient interaction were derived from the health action process approach and were concretized using behavior-change techniques. The derivation led to (1) a set of 16 coaching tools referring to the different states in which a patient might be and containing state-specific recommendations for performing the coaching session, and (2) guidelines for selecting the appropriate coaching tool for each session. To ensure the quality of the intervention, a coach-training program before and supervision sessions during the TBHC were added.

Effect of a Peer Health Coaching Intervention on Clinical Outcomes Among US Veterans With Cardiovascular Risks

Although cardiovascular disease (CVD) is the leading cause of death in the US, CVD risk factors remain suboptimally controlled. To test the effectiveness of a home-visit, peer health coaching intervention to improve health outcomes for veterans with multiple CVD risks. This 2-group, unblinded randomized clinical trial, called Vet-COACH (Veteran Peer Coaches Optimizing and Advancing Cardiac Health), used a novel geographic-based method to recruit a racially diverse population of veterans with low income. These veterans were enrolled at the Seattle or American Lake Veterans Health Affairs primary care clinics in Washington state. Veterans with a diagnosis of hypertension with at least 1 blood pressure reading of 150/90 mm Hg or higher in the past year, and 1 other CVD risk factor (current smoker, overweight or obesity, and/or hyperlipidemia), who resided in Census tracts with the highest prevalence of hypertension were eligible to participate. Participants were randomized to the intervention group (n = 134) or control group (n = 130). An intention-to-treat analysis was performed from May 2017 to October 2021. Participants in the intervention group received peer health coaching for 12 months with mandatory and optional educational materials, an automatic blood pressure monitor, a scale, a pill organizer, and healthy nutrition tools. Participants in the control group received usual care plus educational materials. The primary outcome was a change in systolic blood pressure (SBP) from baseline to 12-month follow-up. Secondary outcomes included change in health-related quality of life (HRQOL; measured using the 12-item Short Form survey's Mental Component Summary and Physical Component Summary scores), Framingham Risk Score, and overall CVD risk and health care use (hospitalizations, emergency department visits, and outpatient visits). The 264 participants who were randomized (mean [SD] age of 60.6 [9.7] years) were predominantly male (229 [87%]) and 73 (28%) were Black individuals and 103 (44%) reported low annual income (<$40 000 per year). Seven peer health coaches were recruited. No difference was found in change in SBP between the intervention and control groups (-3.32 [95% CI, -6.88 to 0.23] mm Hg vs -0.40 [95% CI, -4.20 to 3.39] mm Hg; adjusted difference in differences, -2.05 [95% CI, -7.00 to 2.55] mm Hg; P = .40). Participants in the intervention vs control group reported greater improvements in mental HRQOL scores (2.19 [95% CI, 0.26-4.12] points vs -1.01 [95% CI, -2.91 to 0.88] points; adjusted difference in differences, 3.64 [95% CI, 0.66-6.63] points; P = .02). No difference was found in physical HRQOL scores, Framingham Risk Scores, and overall CVD risk or health care use. This trial found that, although the peer health coaching program did not significantly decrease SBP, participants who received the intervention reported better mental HRQOL compared with the control group. The results suggest that a peer-support model that is integrated into primary care can create opportunities for well-being improvements beyond blood pressure control. ClinicalTrials.gov Identifier: NCT02697422.

High health coaching adherence increases Alzheimer’s protection in at‐risk inviduals following a 4‐month intervention

AbstractBackgroundAlzheimer’s disease and related dementias (ADRD) imposed an estimated financial cost to Americans of $355 billion in 2021 and is projected to rise to $1.1 trillion by 2050. ADRD affects more than 6 million Americans and is expected to rise to more than 13 million by 2050. Health coaching (HC) interventions improve many lifestyle factors also known to be protective against ADRD; however, their ability to provide protection in individuals at‐risk for developing cognitive decline is unknown. The purpose of the present investigation was to examine the effect of HC intervention adherence on ADRD protective factor score after 4 months.MethodAdults aged 45‐75 years (n = 104) with at least two ADRD risk factors and a maximum of one protective factor participated in this study. Participants completed the Australian National University Alzheimer’s Disease Risk Index (ANU‐ADRI) both before and after a 4‐month HC protocol focusing on reducing modifiable risk factors for ADRD in six domains (diet, exercise, sleep, stress, social engagement, and cognitive activity). Participants who completed a number of check‐ins with the health coach greater than the group mean (5.6 check‐ins) were placed in the high adherence (HA) group, and individuals with fewer were placed in the low adherence (LA) group. A mixed factorial ANOVA was conducted to determine if there was a difference in pre‐ and post‐ANU‐ADRI overall protective factor score.ResultAfter the 4‐month HC intervention, ANU‐ADRI scores did not change overall in the pooled sample (F(1,102) = 1.45, p = .23). However, a significant adherence*time interaction effect indicated that HA improved overall protective factor score significantly more than LA (F(1,102) = 4.85, p = .03), and pairwise comparisons revealed that protective factor scores improved only in the HA group (p = .02 for HA versus p = .47 for LA).ConclusionThese results indicate an HC intervention may effect behaviors and emotional states understood to be ADRD protective factors when adherence with the protocol is high. This has the potential to improve the quality of life for individuals at‐risk for ADRD. Further investigation will shed light on whether the ADRD protection derived from HC is iterative and durable.