The evidence for health coaching comes predominantly from the USA. There are three health coaching delivery modes:
iii) Face to face
A combination of telephone and online health coaching services helps to eliminate problems with the scaling of effective health interventions.
Many NHS Trusts offer face to face health coaching. This is highly inefficient and unlikely to result in genuine behaviour change. If an NHS trust has an adult population of 250,000 people, approx 7.5% require support for lifestyle related Type II diabetes i.e. 18,750 people. Assuming each health coach can see 3 people / day (predominantly home visits) this equates to 45 / day. Assuming 220 work days this will mean 9,900 people will receive one visit from a health coach within the year (just over 50% population). Genuine behaviour change requires ongoing support, advice, encouragement and guidance – not one visit from a health coach.
A cost comparison for the three coaching modes:
1. Face to face
Face to face coaching support with 15 health coaches will cost the NHS trust ~£375,000 / year in staff alone (no on costs such as travel etc), delivering coaching support to 9,900 people/year (one coaching session per person).
Telephonic coaching support with 15 health coaches would cost the NHS trust ~ $670,000/year reaching 39,600 people (one coaching session per person) or 6,600 with a personalised 12 week program (6 coaching calls / person/ program).
A personalised online coaching support programme could be delivered to the entire population for somewhere in the range of $4- $8 / person / year. This modality is highly scalable and effective for large populations such as an NHS Trust or large corporate company.
Research published in 2011 (2011 Benchmarks in Population Health Management) reported that:
- More than half of respondents (58.3%) observed improved health status among participants as a result of health coaching.
- 41.7% reported reduced health risks identified by a health risk appraisal (HRA).
- Just over a third (34.4%) reported a decrease in overall healthcare claims cost.
With more than three-quarters of the burden of chronic disease attributed to lifestyle factors such as smoking, poor eating habits and physical inactivity we need to act quickly and with scale to try and reduce the financial and health impacts of our changing lifestyle.
Behaviour change is difficult, it requires ongoing support for people and we need to look at technology and the phone to reach more people.
Below is a specific paper that also supports the effectiveness of health coaching (telephonic) using motivational interviewing technique.
“Effect of motivational interviewing-based health coaching on employees’ physical and mental health status.”
By Butterworth, Susan; Linden, Ariel; McClay, Wende; Leo, Michael C.
Journal of Occupational Health Psychology, Vol 11(4), Oct 2006, 358-365.
Written by Dr. Noel Duncan