FOCUS  |  PROFESSIONAL

Health coaching as a
lifestyle medicine process
in primary care

Shivaun Conn, Sharon Curtain ONE IN TWO AUSTRALIANS has at least one What is health coaching?
chronic disease,1 with preventable
lifestyle factors (eg poor diet and Health coaching is the practice of health
Background
Lifestyle medicine is a relatively new
nutrition, physical inactivity, smoking education and health promotion within a
approach to managing lifestyle-related and alcohol overconsumption) known coaching context to enhance the well-being
disease. Health coaching is an integral to account for at least 70% of the of individuals and to facilitate the
part of lifestyle medicine that can be total healthcare burden.2 General achievement of their health-related goals.4
used to facilitate behaviour change in practitioners (GPs), as the first and
key lifestyle areas. most consistent point of contact with Health coaching incorporates evidence-
Objective patients, play a vital part in prevention, based health behaviour change
The aim of this article is to familiarise early intervention and management of interventions and techniques from
general practitioners with the emerging lifestyle-related disease. Traditionally, behavioural medicine research literature,
discipline of health coaching and show the health professional’s role in assisting positive psychology, health and coaching
its effectiveness in primary care. patients to change their unhealthy habits psychology, and athletic and performance
Discussion and adopt healthier lifelong behaviours coaching. It can be used in health
The recognition that the traditional has been to educate, persuade and promotion, prevention, early intervention,
healthcare approach is not fully effective prescribe actions to reduce ill health. treatment and management of chronic
at supporting health behaviour change The World Health Organization conditions such as in lifestyle medicine.
in an era of chronic diseases has led to
states that ‘simply giving information Using the Transtheoretical Model,5
the emergence and growth of a new
to patients is unlikely to change health coaching identifies the patient’s
approach to the prevention and
treatment of lifestyle-related diseases – behaviour; health care providers must stage of change, guiding clients to take
the practice of health coaching. understand the psychological principles stage-appropriate actions to increase
that underlie self-management confidence or importance and therefore
training and comprehend that moving clients towards readiness.
motivating patients requires more Health coaching supports patients to
than imparting brief information build self-determination – the process
to the patient’.3 Long-term health by which a person controls their own life
behaviour change requires a different – and self-efficacy – the belief that one
approach to acute disease management. has the capability to initiate and sustain a
To achieve sustainable health desired behaviour. Motivation is generated
behaviours and outcomes, patients by supporting patients to evoke their
need to be supported in behaviour own compelling reasons for change and
change techniques that promote articulate a clear vision of their health goals.
self-efficacy, self-determination and Deci and Ryan’s self-determination theory
self-responsibility. of motivation6 is applied through fostering

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FOCUS  |  PROFESSIONAL HEALTH COACHING AS A LIFESTYLE MEDICINE PROCESS IN PRIMARY CARE

autonomy, competence and relatedness, the chance of patients implementing and confident they feel about changing their
and linking clients to intrinsic motivators. maintaining health behaviour change. behaviour. Using rating questions is an
Once the patient is ready to change, The benefits of health coaching are not effective way to gauge confidence and
they are encouraged to have a curious and only limited to patient outcomes, but also importance.
flexible mindset of trial and correction, result in: Ask your patient, ‘Given everything
learning, growth and compassion as • enhanced practitioner job satisfaction going on in your life, how important is
they are guided towards their goals • enhanced patient satisfaction with it to you to lose weight?’ The patient is
while connecting to their values and services and outcomes asked to respond on a scale of 0–10,
vision. The health coaching process • improved consultation efficiency and with 0 meaning ‘not important’ and 10
encourages self-reflection, self-awareness, effectiveness meaning ‘very important’. If your patient
self-regulation and positivity. Patients are • decreased reliance on the medical gives you a low score, such as 4, they
supported to build confidence, focusing on system by patients who learn are not ready to change. Attempting to
strengths as they learn from past failures self-management skills educate or persuade them, such as by
and successes to overcome barriers and • enhanced multidisciplinary professional providing advice about how to lose weight
increase facilitators for change. Behaviour collaboration. or information about consequences, is an
change is more likely to be maintained ineffective strategy.
when goals are self-determined, as
patients are both motivated to take Integrating health coaching Find out the reasons they want
action and are invested in the result. into practice to change
Integrating health coaching into practice Ask, ‘Why did you choose 4 and not 2?’
requires an understanding of a patient’s (ie why not a lower number?). The patient
Evidence to support health coaching readiness to change and of the support will describe why change is important
Systematic reviews of health coaching in patients need to change (Figure 1). This to them, and you can reflect these
comparison to traditional care (Table 1) can be achieved by asking patient-centred motivational hooks back to the patient
have found health coaching to: questions. to strengthen their decision to change.
• significantly improve patients’ Patient-centred questions can help For example, they might say, ‘I chose a
physiological, behavioural, ascertain the importance of change to 4 because I know that losing weight can
psychological and social outcomes7 a patient, build confidence, generate help my diabetes’. That allows you to ask
• significantly improve one or more of insights and momentum, and ensure goals them to tell you more about how it would
the behaviours of nutrition, physical are determined by the patient. benefit them, and they will begin to talk
activity, weight management or Consider an overweight patient with themselves into change.
medication adherence8 pre-diabetes. Weight loss has been identified
• improve glycaemic control and reduce as an important goal for this patient. Find out about the barriers
glycated haemoglobin for patients with Asking, ‘Why did you choose a 4 and
type 2 diabetes9,10 First, assess readiness to change not an 8?’ can reveal the barriers and
• improve medication adherence11 Readiness is influenced by how important reasons why change is not a priority. The
• assist with weight loss and increase the behaviour is to the patient and how patient may have low confidence due to
the levels of motivation and personal
satisfaction12
• be an effective strategy to promote Table 1. Comparisons between a traditional clinical approach and coaching
reductions in energy intake, body approach in primary care
weight and body mass index13,14
Traditional approach Coaching approach
• improve physical activity.15
These findings are in addition to a Practitioner is the health expert Patient is respected as the expert in their
number of studies that show the efficacy own life
of motivational interviewing in smoking Practitioner provides advice and solutions Practitioner offers information on the basis of
cessation, alcohol reduction and other what the patient identifies as needed
behaviour change.16 Practitioner decides the health priority Patient chooses the health goals, strategies
and targets

Can primary care benefit from Practitioner focus is on why the patient has Practitioner looks for positives and
not made the required changes affirms client
the practice of health coaching?
Incorporation of the health coaching Practitioner assumes client is ready Practitioner identifies client readiness and
framework into primary care can improve to change offers strategies to increase confidence and
importance.
patient outcomes. Health coaching increases

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HEALTH COACHING AS A LIFESTYLE MEDICINE PROCESS IN PRIMARY CARE FOCUS  |  PROFESSIONAL

failed attempts to lose weight in the past, effectiveness and efficiency of an Australian diploma due to launch at
knowledge gaps or competing priorities. consultations. the beginning of 2020.
The practitioner can ask: Incorporating health coaching into primary The level of health coaching training
• ‘What information would you like care can be done in a number of ways: needed by an individual will depend on
to know?’ • GPs can incorporate health coaching pre-existing training, skills, knowledge
• ‘What skills and support do you need?’ into their consultations and experience. Practising health
• ‘If you were going to change, how would • GPs can refer patients to practice nurses coaching skills on an ongoing basis and
you do it?’ and/or allied health professionals who participating in continuing professional
• ‘What is already working and/or what are trained as health coaches development is also essential.
have you considered changing?’ • GPs may refer to a qualified/accredited
The practitioner can then provide missing health coach who may consult within
information, challenge beliefs or explore or outside a practice via face-to-face Summary
what is possible. delivery, telephone or Zoom/Skype. Prevention and management of chronic
health conditions is an area of growing
Patient-centred goal setting Health coaching training demand. Integrating health coaching into
Behaviour change is more likely The increasing popularity of health primary care can significantly improve
to be maintained when goals are coaching has resulted in the emergence patients’ physiological, behavioural,
self-determined. The practitioner can ask: of various training options. Choices psychological and social outcomes, as well
• ‘What are you willing to try?’ range from training in individual as lead to higher rates of satisfaction for
• ‘What feels achievable?’ behaviour change disciplines – such as both patient and clinician.
• ‘What do you want to achieve?’ cognitive behavioural therapy, positivity
While these strategies are just the tip psychology and motivational interviewing
of the behaviour-change iceberg, they – to short courses in health coaching, Key points
can begin to help patients build the a number of online-based courses and • Chronic diseases call for different
self-determination and self-efficacy that postgraduate qualifications in coaching approaches to management at the
leads to sustainable behaviour change. psychology. The need for credible clinical level.
training qualifications that focus on • Health coaching is a relatively new
Modes of delivery Australian guidelines and standards has approach to modifying behaviours
Health coaching may be integrated resulted in the options for health coach associated with the development of
into primary care practice to improve training expanding from short courses to ill health.

• Behaviour change theories

• Positive psychology
• Appreciative inquiry

Health psychology • Stages of change theory

and behaviour change • Cognitive behaviour therapy
principles, models and • Motivational interviewing
techniques • Mindful awareness

• Goal setting
• Health knowledge
• Communication
• Relationship-building skills Skills and techniques
Experience, • Effective questioning
• Empathy knowledge and skills from performance
• Overcoming setbacks
• Listening skills of health practitioner and development
• Awareness and
• Problem-solving skills coaching
self-responsibility
• Coaching models

Figure 1. A number of skills and models can be integrated into general practice to adopt a health coaching approach.

© The Royal Australian College of General Practitioners 2019 AJGP VOL. 48, NO. 10, OCTOBER 2019  | 679
FOCUS  |  PROFESSIONAL HEALTH COACHING AS A LIFESTYLE MEDICINE PROCESS IN PRIMARY CARE

• Health coaching uses health behaviour Sharon Curtain BSc, MDiet, Dietitian, Nutritionist,
Health Coach, Director, Campaign Healthy, Vic; author
9. Wayne N, Perez DF, Kaplan DM, Ritvo P. Health
coaching reduces HbA1c in type 2 diabetic
change theories to build motivation and co-creator, Diploma of Health Coaching, Vic patients from a lower-socioeconomic status
and promote self-determination and Competing interests: S Conn is a Board Member community: A randomized trial. J Med Internet Res
of the Australasian Society of Lifestyle Medicine 2015;17(10):e244. doi: 10.2196/jmir.4871.
self-efficacy. 10. Thom DH, Ghorob A, Hessler D, De Vore D,
(voluntary unpaid position). S Curtain is the co-author
• Health coaching acknowledges the and co-creator of the Victoria University Polytechnic’s Chen E, Bodenheimer TA. Impact of peer
health coaching on glycemic control in low-
patient’s stage of change, and increases Health Coaching Diploma course.
income patients with diabetes: A randomized
Funding: None.
importance and confidence to increase controlled trial. Ann Fam Med 2013;11(12):137–44.
Provenance and peer review: Commissioned, doi: 10.1370/afm.1443.
readiness to change. externally peer reviewed. 11. Thom DH, Willard-Grace R, Hessler D, et al.
The impact of health coaching on medication
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[email protected] LIT-101. correspondence [email protected]

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