What is health coaching?
Health coaching is a supported self-management intervention. It focuses on supporting people to make more informed and conscious choices about their health. It enables people to develop the knowledge, skills, and confidence to take opportunities to become active participants in their care.
Health coaching focuses on empowering people to engage in goal setting to reach solutions, playing a more active role in their healthcare and enabling them to make decisions about their future health.
It can be particularly effective in supporting self-management of conditions where there are behavioural/lifestyle risk factors, for example, conditions such as muscoskeletal (MSK) issues, managing pain, hypertension, metabolic syndrome and stress/anxiety.
Health coaching can be delivered using a standalone service or embedded as an approach across a service or pathway – there are examples in the section about how health coaching is delivered. Health coaches can have a dedicated role, for example, a health and wellbeing coach in primary care. They can also be a clinician or non-clinical person, who is trained and skilled in health coaching.
Evidence for health coaching
There is compelling evidence that demonstrates health coaching has a positive impact on the outcomes of patients with chronic diseases such as, diabetes, hypertension, obesity and heart disease . Health coaching is associated with high practitioner and patient satisfaction, increased patient motivation to self-manage and adopt healthy behaviours and improved patient outcomes.
It has also been found to reduce the demand on healthcare services. In Sweden a large-scale randomised control trial demonstrated that the implementation of health coaching reduced hospitalisation rates by 12 per cent . Another study of a health coaching on a rehabilitation ward in Hampshire estimated an indicative cost saving of £3 million .
 A case management intervention targeted to reduce healthcare consumption for frequent Emergency Department visitors. European Journal of Emergency Medicine, 23(5), pp.344-350.
 Recovery coaching in an acute older people rehabilitation ward. BMJ Quality Improvement Reports, 3(1), pp.u205646.w2316
Evidence outcomes recorded for heath coaching include:
- increased patient motivation to self-manage and adopt healthy behaviours
- increased adherence to medication
- improved self-efficacy and patient activation
- improved clinical outcomes such as HbA1c (blood glucose/sugar) levels
- reduced need for readmissions, residential home placements – after rehabilitation and physiotherapy follow up appointments.
Who can benefit from health coaching?
Health coaching is particularly beneficial to people with, or at risk of, one or more long-term condition(s), where behaviour and lifestyle are a risk factor. Especially where people would benefit from increasing their knowledge, skills and confidence to manage their condition.
It can be used to support particular groups of people who might be more at risk of developing long-term conditions, or who are most at risk of disease progression. Health services can proactively target specific people for health coaching support, using population health management and risk stratification tools to identify those who could most benefit most. This could include those who face health inequalities and/or groups where there is an increased prevalence of long-term conditions.
Example of proactive and targeted health coaching
- In Coastal Fareham and Gosport Primary Care Network, in Hampshire, health coaching is being offered to support people at risk of, or with a diagnosis of, Type 2 diabetes. Diane, the health and wellbeing coach in the primary care network uses reporting data to identify people who are pre-diabetic or have Type 2 diabetes and contacts them to invite them to a coaching programme. She gives people dedicated time to build their knowledge, skills and confidence to take control of their health. One client, who has taken part in the programme and has had Type 2 diabetes for 20 years, said he has learnt more about his condition, felt more supported and confident about making the right choices in the last six months than ever before. He’s put his self-management skills into practice and has already lost weight and seen his blood sugar levels drop.
- In Derbyshire health coaches proactively targeted people experiencing chronic pain to support them to live well with pain. People living with chronic pain such as fibromyalgia, chronic fatigue syndrome and osteoarthritis joined the programme, which covered topics such as acceptance, goal setting, physical activity, and pacing. This short film explains more about the programme and the impact it has had.
The benefits of health coaching
In addition to the evidence outlined above, there are other benefits of health coaching:
- It is adaptable and can be embedded into different pathways and services to meet the needs of different populations.
- It supports people to make healthier lifestyle choices, and encourages prevention of new conditions, as well as addressing existing issues.
- With the right training anyone can learn health coaching skills and apply them to different professions, settings and groups of patients.
- It is non-judgemental and helps people to explore the consequences of decisions, risk taking, and to make informed choices.
An example of the personal benefits of health coaching
- Elaine, from Sheffield, had health coaching from a health and wellbeing coach in her GP practice to improve her mental health. She also lives with a number of other long-term conditions. Elaine found health coaching beneficial and it helped her to self-manage her mental health. She said: “Health coaching, with a health and wellbeing coach, gave me the space to reflect and become more aware of my behaviour and how it was impacting on my mental health. My coach was very skilled in helping me understand my behaviour better, whilst giving me the gentle nudges I needed to move forward and self-manage my mental health.”
How is health coaching delivered?
Health coaching can be delivered in different ways. It could be through a dedicated service or workforce. For example, employing health coaches or commissioning a service from a provider, such as a voluntary, community and social enterprise sector organisation.
It can also be embedded into the delivery of services across a team, condition pathway, department, or organisation by developing and using health coaching skills in daily practice to shift relationships with people. For example, training people from different professions in health coaching to make every conversation and consultation a health coaching one.
Whichever of these approaches is used health coaching is adaptable to people’s needs. It can be delivered face to face, online, on a one-to-one basis or in groups. Standalone health coaching sessions usually last around 45 to 50 minutes, with frequency of sessions decided between the coach and person being coached.
An example of a dedicated health coaching service
Many primary care networks provide access to health coaching support from teams of health and wellbeing coaches. This short film shows how Tasmyn, a health and wellbeing coach in London, works with her colleagues in primary care to support people with health coaching.
An example of embedding health coaching into an existing pathway/service
University College London Hospitals NHS Foundation Trust is piloting a health coaching approach in its rheumatology services for adolescents. The team at the trust want to empower young people to take ownership of their own health and wellbeing and to have conversations, focused on what matters to the young person. It has brought young people who use the service together to listen to what is important to them and build their feedback into the service.
The team believe that by focusing on life goals and building trust and rapport they can increase young people’s ability to solves problems. It is tracking progress over time to see how coaching is supporting young people with issues like medicine adherence and pain management.
Everyone in the multidisciplinary team has undergone accredited health coaching training, including physiotherapists, junior doctors, nurses, consultants and administration staff. They hope to create a sustainable coaching model by building skills and capability across the team.
Health coaching training
Health coaching training provides clinicians and non-clinicians with an opportunity to develop the skills needed to share responsibility with patients and empower them to self-care. The Personalised Care Institute (PCI) quality assures and accredits health coaching training providers. Details of accredited health coaching training courses can be found on the PCI website.
A two-day PCI accredited training programme with opportunities for reflection and follow up activities is recommended for those looking to develop health coaching skills. This training would be relevant to health and social care staff, voluntary sector representatives, and peer leaders and carers who want to use health coaching skills as part of consultations or conversations.
A four-day, more in depth, PCI accredited training programme is the minimum standard for health and wellbeing coaches in the NHS, whose key role is providing health coaching. Further information on training and supervision standards for health and wellbeing coaches is available in the workforce development framework for the role.
Key principles of an effective system-wide approach to health coaching
If you are establishing or commissioning health coaching or embedding health coaching as an approach, there are a number of key principles that underpin effective evidence-based health coaching. These include:
- The purpose of health coaching and evidence for it is clearly articulated and understood across the system, in the context of personalised care.
- Health coaching is linked to the vision, values and strategy of the system, including the benefits of a personalised care approach in addressing system pressures and health inequalities.
- Everyone is committed to health coaching and recognises its importance as a supported self-management intervention, including patients, clinicians and system leaders.
- Evaluation is undertaken and outcomes are measured, including those relating to health inequalities and the wider determinants of health. Further information is available on measurement and evaluation in supported self-management, on the NHS England website.
- Adequate resources are allocated to health coaching, for example, time, funding, training etc.
- The infrastructure is in place to support the ongoing training, development and supervision of those delivering health coaching to facilitate the sharing of learning and enhance skills, including peer support for health coaches.
- Services are coproduced to ensure they are flexible and responsive to people’s needs.
- Minimum training and supervision standards are met for all health coaches employed in the system.
You can find more information about health and wellbeing coaches and support available to them on the NHS England website.
For more information about health coaching, or is you have any questions, please email email@example.com
Publication reference: PRN00827