Health Coaching: America’s Overlooked Personalized Health Solution

Briar R. Miller¹, Arthur A. Klein¹, Joerg R. Leheste¹

1. Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine (NYITCOM), Old Westbury, New York, 11568, USA

OPEN ACCESS

PUBLISHED: 31 August 2024

CITATION: Miller, BR., Klein, AA., et al., 2024. Health Coaching: America’s Overlooked Personalized Health Solution. Medical Research Archives, [online] 12(8). https://doi.org/10.18103/mra.v12i8.5662

COPYRIGHT: © 2024 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI https://doi.org/10.18103/mra.v12i8.5662

ISSN 2375-1924

ABSTRACT

Chronic diseases are on the rise in the United States, particularly in rural and underserved areas, and they are often caused by preventable factors, accounting for a significant portion of healthcare costs. The short duration of routine medical visits does not give clinicians enough time to adequately address and support changes in patients’ behavior that are required to improve health outcomes. Health coaching, which focuses on holistic behavior modification, shows potential in preventing and controlling chronic diseases through individualized assistance and accountability. Motivational interviewing and continual patient involvement are critical components of health coaching, and they have proven to be highly beneficial. Despite the established success of existing programs, a more comprehensive implementation tailored to individual requirements is required. Health coaching is an underutilized but intriguing method for healthcare providers to address patient health concerns proactively and directly at the cause. This strategy focuses on those who neglect their health owing to stated time restrictions, financial worries, or a lack of health education, resulting in delayed treatment and the onset of preventable chronic disease. The adaptable design, as well as a combination of medical experts and volunteers, offers exciting possibilities for urban, suburban, and rural locations alike, and may be the answer to a long-standing problem to personalized medicine in a highly diverse healthcare environment.

Keywords:

• Health coaching
• Chronic diseases
• Preventive healthcare
• Behavioral modification
• Patient support
• Motivational interviewing
• Personalized healthcare

Introduction

In the last several years, the prevalence and severity of chronic diseases have skyrocketed across the US, especially in medically underserved areas which are often rural. Too often, avoidable issues relating to people’s way of life are to blame. In addition to lowering life expectancy by an average of fifteen years, chronic diseases are responsible for about 75% of healthcare expenditures. Adding to the problem, doctors are given less and less time to spend with the patient (15 min or less per visit), which is not enough time to make a big impact on the patient’s behavior.

While many other strategies have failed, the ingeniously simple and largely ignored health coaching is affordable and effective in providing a genuinely patient-centered experience. Health coaching is holistic and emphasizes behavior modification and long-term lifestyle adjustments to avoid or manage chronic disease. Health coaches help patients identify medically harmful behaviors and provide accountability, reward, and support. Health coaches can also help their clients with long-term dietary adjustments, exercise, stress management, and other health changes. What sets health coaching apart from the numerous other approaches that have been unsuccessful is the patient’s active participation and responsibility in creating goals that are based on their beliefs, strengths, and preferences.

Health coaches often employ motivational interviewing and ongoing patient engagement to check in with patients, address their problems, and make sure they are following through with their plan. A lot of individuals are aware of their position and want to live healthier lives, but they do not always have the resources, knowledge, or self-control to follow through. In these cases, people may need extra help or therapy to figure out what is best for their health.

This has led to numerous initiatives that have shown how health and wellness coaching can improve healthcare delivery by incorporating its many components. Yet, health care providers are hesitant and may feel overwhelmed by the variety of health and wellness coaching options available to their patients, as most of these programs cater to a particular age group, condition, or issue. Even though each of these programs has a purpose and is extremely beneficial, they have had little impact on the general population so far because of their limited scale. Health coaching can benefit everyone, and programs that provide coaches who cater to each person’s specific needs, goals, and desires should be considered for implementation everywhere. As a powerful and engaging method for health professionals to engage with patients, health coaching and counseling has great potential. In modern healthcare, which is more concerned with handling crises than preventing them, this option is, all too often, disregarded and undervalued.

Social pressures to perform and the ruthless approach many of us take to our own health are key contributors to the prevalence of chronic diseases. People often neglect their health and lead unhealthy lifestyles due to their overwhelming commitments to job, family, and other obligations. Because they believe they cannot afford or do not have the time, many people put off seeing a doctor as soon as they notice any symptoms of sickness or injury. It can be too late to stop additional harm or turn the situation around when health issues emerge due to this delay. Delaying medical care could lengthen the time it takes to detect an illness, reduce survival chances, and inflict unnecessary human suffering. To counteract these effects, health coaches educate their clients to reach their wellness objectives through the provision of individualized counsel, encouragement, and accountability.

Review Strategy

This scoping heath policy research review focuses on health coaching and includes a diverse range of validated sources and services including Medline/PubMed, The National Library of Medicine (NLM), Google Scholar, Scopus, The Centers for Disease Control and Prevention (CDC), Wellness Law, The Institute for Integrative Nutrition, The Kresser Institute, Med Care, Public Broadcasting System (PBS), The March of Dimes Foundation, The County Health Rankings and Reports, the American Heart Association; and the Arkansas Department of Health, Harvard Health, Hope for Healing, AFPA Fitness, The CMF Group, The American Medical Association (AMA), and Axios. Direct experiences with Lyon College in Batesville, Baxter Regional Medical Center in Mountain Home, AR, and the Arkansas Children’s Hospital in Little Rock, AR, inspired this effort. The health policy aspect of this work was inspired by a bill (H.R.4925) under consideration by the 116th U.S. Congress (2019-2020): The Community Multi-Share Coverage Program Act. Articles were selected based on their relevance to the topic. Search terms included, “health coaching, chronic disease, health statistics in Arkansas, chronic disease prevention, rural health, health coaching legislation, and telehealth”. Project research and analysis were conducted over a twelve-month period.

Review

LIFESTYLE AND CHRONIC DISEASE AT THE NATIONAL LEVEL

According to the CDC, roughly six out of every ten Americans suffer from a chronic illness. This includes cardiovascular disease, diabetes, strokes, cancer, obesity, and addiction. In fact, cardiovascular disease, cancer, and type 2 diabetes account for nearly two-thirds of all deaths in the United States. At the same time, lifestyle practices related to the prevention and treatment of these chronic diseases have improved minimally, if at all. Chronic diseases account for approximately 75% of current healthcare costs and come with a reduced life expectancy by an average of 15 years. They have also contributed to disabling conditions in approximately 10% of Americans. Smoking cessation, healthy eating, regular exercise, getting enough sleep, limiting alcohol consumption, attending regular wellness check-ups, and being aware of family history for certain risk factors are all examples of preventative health.

RECOMMENDATIONS FOR OPTIMAL HEALTH

Unfortunately, fewer than 1% of adult Americans meet the seven American Heart Association-defined metrics for optimal cardiovascular health behaviors and factors. These factors include: 1. Never smoked or was a former smoker. 2. BMI less than 23 kg/m2. 3. At least 150 minutes per week of moderate intensity exercise, at least 75 minutes of vigorous physical activity, or more than 150 minutes per week of moderate or vigorous intensity exercise. 4. Four or five dietary components, as listed below: 5. Cholesterol levels of less than 200 mg/dL; 6. Blood pressure levels of less than 120/80 mmHg; and 7. Glycemic levels of less than 100 mg/dL. As for the diet, recommendations are: 1. At least 450 grams of fruits and vegetables per day; 2. At least 198 grams of fish per week; 3. At least 85 grams of fiber-rich whole grains per day; 4. Less than 1500 milligrams of sodium per day; and 5. Less than one liter of sugary beverages per week.

THE STATE OF ARKANSAS – A CASE FOR HEALTH COACHING

Arkansas has one of the lowest levels of health quality and longevity in the United States with a life expectancy of only 75.7 years placing 46th in the country. Arkansas also has the highest rates of chronic respiratory diseases such as emphysema, as well as the third highest rates of heart disease, diabetes, and kidney disease. Most Arkansas counties are ranked in the bottom quartile for state health quality and are located in the Mississippi Delta region and in other rural areas. As a result, Arkansas should engage more money, time, energy, and manpower in health coaching activities, particularly in rural and underserved areas where patients may not have easy access to quality healthcare services. Nearly 36% of Arkansas’s adults are obese. Around 50.5% of Arkansas adults report eating fruit less than once a day, whereas approximately 28% eat more than one serving of veggies per day. Furthermore, less than half of Arkansas adults (41.2%) participate in at least 150 minutes of moderate intensity exercise every week. If health coaching was more widely implemented in Arkansas, it could help to reverse the trend of declining health and lead to improvements in physical activity, diet, physical, and mental health.

THE AMERICAN SICK-CARE SYSTEM

The American healthcare system prioritizes crisis management and treating symptoms over preventative medicine and treating the root causes of chronic illness. Pharmaceutical corporations, physicians, and health care providers benefit more when their approaches target symptoms and promise a rapid, simple cure. It is remarkably simple for pharmaceutical corporations and health institutions to inform individuals they are unwell and broaden the definition of preventable, treatable sickness in order to increase marketing for those who sell and deliver medicines. As a result, most patients have a poor relationship with their primary care physician and only schedule with them as a last resort or for routine check-ups. Research shows that a favorable patient experience with their physician leads to greater quality healthcare, including patient safety and clinical effectiveness. In addition, many patients who are seen for one chronic disease often have multiple, with one study noting that nearly 75% of patients in the Department of Veterans Affairs (VA) system have two or more chronic conditions. All of this argues for systemic failure and a more active role of patients in the prevention and management of their chronic conditions.

THE BENEFITS OF HEALTH COACHING

Some physicians and institutions have begun to employ health coaching as an alternative way for helping patients manage chronic diseases and symptoms. Even though most individuals are unaware of its benefits, health coaching programs and services have proven to be effective in motivating patients to alter their lives while also lowering their chance of getting or aggravating chronic conditions. Each primary care physician has a panel size (number of patients) of between 1,300 and 1,900 seeing an average of 20.2 patients per day. Implementing health coaching particularly in rural and underserved areas where the obesity epidemic is rampant, can help to alleviate a physician’s workload and free up time to increase access to high quality health care. When patients begin to improve their lifestyles and well-being with the assistance of a health coach, provider check-ups and follow-ups decrease, resulting in a ripple effect that allows providers to take on additional patients and provide better care. Reducing morbidity, also reduces the financial burden of patients, their families, physicians, insurance companies, employer healthcare plans, and entire healthcare systems.

The following saying: “Give a man a fish, and he will eat for a day; teach a man to fish, and he will eat for a lifetime.” highlights the effectiveness of health coaching by releasing a patient from the effects of their own poor lifestyle choices and assisting them in implementing and sticking to a healthier plan. Health coaching can assist health providers in providing a more integrated approach to patient-centered care, self-management, shared decision-making, education, and patient participation. In addition to coaching, health coaches can offer resources and connections to patients who need and request them. When asked, the coach can send the patient to another practitioner or recommend someone else for the patient’s therapy. Coaches must not only provide coaching, direction, and emotional support to their clients, but also teach and educate them on how to maintain their health. Coaches can also encourage patients to talk with their families and friends about their goals, as well as assist their loved ones in becoming healthy themselves! Coaches try to bridge the gap between clinicians and patients by giving patients someone to turn to for encouragement, guidance, and support as they work to attain their own health objectives.

HOW DOES HEALTH COACHING WORK

Health coaches come at all levels ranging from trained volunteers to paid medical professionals. Any volunteer, undergraduate, medical, or graduate student, or healthcare professional can train to be a health coach or participate in patient coaching. A health coach is often connected with a patient who has a chronic ailment or simply wants to live a healthier lifestyle. Health coaches frequently participate in training or classroom instruction that includes Health Insurance Portability and Accountability Act (HIPAA) compliance, learning about chronic disease, understanding socioeconomic factors that influence healthcare, and understanding that coaches serve as mentors to these patients, encouraging and guiding them. One study with patients who used health coaching to help them lose weight demonstrated how each of the three types of health coaches mentioned can be beneficial in eliciting patient behavior change. These types were Professional (a health interventionist with the requisite credentials), Peer (group members randomly matched coaching each other), and Mentor (a role model having previously lost weight). Coaches commonly employ motivational interviewing, positive psychology, establishing and comprehending stages of change, the building of good habits to replace bad ones, and accountability and goal setting to motivate patients to improve their health. A coach’s role is to educate and build a plan with their patient to improve their health, with the patient ultimately deciding how the plan is discussed and implemented. A health coach does not prescribe a specific course of action, but rather develops a plan that the patient can implement based on their unique circumstances and requirements. Coaches treat patients with compassion and understanding, rather than decision-making authority. Patients who participate in health coaching report high levels of satisfaction. Patients often say that working with a coach provides them with the confidence to take control of their health and lead their life in the way they want. Patients feel more understood and comfortable when working with their coach to enhance their health since the coach speaks their language, culture, and life experience. Patients who had this engagement and relationship with their provider were substantially more inclined to work with the coach on health decisions.

AN EXAMPLE OF HEALTH COACHING EDUCATION FOR STUDENTS – LYON COLLEGE

The most major difficulty is a lack of understanding about the benefits of health coaching. As a result, there are very few programs that train students or volunteers to become health coaches, but there are several examples of wellness coaching and its various applications in meeting the requirements of specific patients. Lyon College in Batesville, Arkansas, has a well-known health coaching program, which allows undergraduate upperclassmen interested in pursuing a career in medicine to actively mentor and coach a patient with chronic conditions in the second semester of the course, following a semester of classroom instruction in a group setting. Lyon College partners with White River Health System in Batesville to offer a yearlong health coaching program to students interested in medicine. The first semester of the course introduced students to distinct chronic diseases and the numerous problems that patients may confront in preserving their health. health, and how experienced coaches can bridge the gap between themselves and the patients, therefore enhancing patient-provider interaction. The second semester of the course allows each student to mentor a patient, apply what they have learned to coach that patient, and develop a long-term plan with them.

HEALTH COACHING OPPORTUNITIES FOR STUDENTS

Health coaching not only benefits patients, but it also serves as a good foundation for future medical students and those interested in a career in healthcare. In an interview, Hannah Wu, a former senior at Lyon College in Batesville, AR, and a current medical student at the University of Arkansas for Medical Sciences’ College of Medicine, said, “I can discuss things that others cannot in my applications. I learnt how socioeconomic issues influence patients, and I cannot comprehend how people without insurance deal with and manage chronic illnesses.” These experiences prepare students for patient encounters, provide them with a greater understanding of the consequences of limited access to high quality healthcare and fuel their desire to work in medicine or other healthcare-related fields.

Health coaching should be offered to volunteers of all levels who want to work with patients, not just undergraduate or medical students. Experiences could start as early as high school. Students interested in a specific expertise can be matched with patients who have requirements in that area. When done correctly, health coaching benefits everyone, but it is particularly suited for students interested in or pursuing specific fields such as nursing, medicine, occupational therapy, physical therapy, speech therapy, counseling, personal training, sports coaching, or social work. When applying to related programs, these students can highlight their job-relevant experiences. Their work as health coaches is not only indicative of their dedication to healthcare but also a reflection of their perseverance and focus.

MOTIVATIONAL INTERVIEWING

Motivational interviewing is a technique frequently used during health coaching sessions that is based on four guiding principles: To resist the righting reflex, to understand the patient’s own motivations, to listen with empathy, and to empower the patient. To be effective, the coach must listen and empathize with the patient, make a meaningful connection between the coaching and the patient’s short and long-term goals, assist in recognizing what can and cannot be changed, and allow the patient to control the dynamics of the coaching relationship. Motivational interviewing is patient-centered, which means that the patient has the final word in deciding whether a goal is right for them. Initially, it may be necessary to pre-contemplate and inform the patient of their harmful lifestyle. The patient may neither be aware of the origin of their health challenge nor that the power to make changes lies with them.

PERSONAL GROWTH OF THE COACH

When starting a new regimen, a patient may be hesitant or pessimistic. The coach may encounter a circumstance in which a patient is hostile or argumentative. When dealing with patients who are uncertain, troubled, or in need of comfort, the coach must maintain calm and reasonable behavior. These experiences will also allow the coach to improve his or her interpersonal skills, which will be useful when dealing with challenging patients in the future. Coaches frequently develop a high level of emotional intelligence over time, which benefits them professionally and personally. With every patient who follows through on the plan that they and the coach created together, the coach builds confidence in their ability to positively impact the lives of others. Coaches gain invaluable experience for their professional and personal development through their work with patients and encouragement of them.

TYPES OF HEALTH COACHING ACTIVITIES

Even though most people are unaware of what health coaching entails, there are several programs across the country that incorporate some of its core characteristics in different ways. Even if a program does not rely solely on one-on-one interviews and consultations, the use of health coaching can be beneficial in achieving the program’s objectives. Coaching, for example, does not have to take place one-on-one or in a meeting-like setting. Activities can be entertaining, engaging, and geared toward the patient’s interests. For example, Baxter Health in Mountain Home, AR, features a Rock Steady boxing program with classes for Parkinson’s disease (PD) patients. This program is based on non-contact boxing and fitness allowing individuals with PD to maintain cognitive health and improve their fitness, regardless of disease severity.

HEALTH COACHING WITH CHILDREN

Working together, coaches and parents can also help children who are battling health problems like obesity and type 2 diabetes. Arkansas Children’s Hospital in Little Rock, AR, offers a designated Center for Obesity and its Consequences in Health (COACH), which strives to assist children and teenagers who are battling with obesity through encouragement and lifestyle modifications. Patients ages four to seventeen who have a BMI larger than the 99th percentile (obesity), or a BMI greater than the 85th percentile with one or more risk factors, plus a parent willing to collaborate and engage with the program are eligible. One of the key observations is that it is easier to educate and motivate children to adopt healthy lifestyle habits at a young age. Furthermore, parents have a greater influence in a child’s life than any unconnected coach, so if parents set the example for their children to live and eat properly, the children are more likely to follow suit and maintain a healthy lifestyle throughout adulthood. Parents can also benefit from programs that teach parents how to foster healthy lives in their children and how to better interact with them.

TEEN AND SEXUAL COACHING

In 2017, the Children’s Hospital of Philadelphia established a program to urge teenage girls and young adults to utilize contraception or refrain from sexual engagement. This program is part of the American Health Association NCSHA’s Healthy Housing, Healthy Communities (H3C) Partnerships initiative, and in this case, two health coaches were invited to participate to learn how to better communicate with patients, incorporate new teaching strategies that tapped into a diverse range of learning styles, and practice motivational interviewing on teens to encourage them to use contraception and practice abstinence. Each of the 33 teenage participants were scheduled once per month for six months and received a new contraceptive at each visit. The primary goal of this program was to promote defined, appropriate, and consistent contraceptive use or abstinence throughout the six-month study period. This program was shown to be more cost-effective than traditional healthcare practices in preventing unwanted pregnancy and the related costs of counseling and abortion, allowing youth to make healthier sexual and reproductive health decisions.

DOULAS AND MATERNITY CARE

Another option for hospitals and institutions to consider is employing doulas as health coaches. A doula is usually a female who is hired to advise and support a birthing individual and their family throughout pregnancy and childbirth. Many European countries, including Sweden and Germany, have employed and demonstrated them to be highly useful. In Sweden, it is documented that women from various backgrounds have been used as doulas for foreign-born women. These women claim that doulas have given them information that has increased their faith and trust in Swedish health care, as well as made them feel more at ease and less alone. Childbirth is stressful enough for the family and everyone else involved, but it can be especially stressful for an individual who lives under less-than-ideal circumstances. Nonetheless, Americans could benefit from doulas who can provide comfort and guidance throughout birth, especially if they do not have a supportive family or other support structure. Doulas can also be highly valuable in specific areas of the United States known as “maternity care deserts”. These are areas with a lack of maternity care facilities, such as counties featuring no hospitals, birth centers, or obstetric physicians.

HEALTH COACHING SYSTEMS SHOULD BE IMPLEMENTED EVERYWHERE

The people who have used these services and initiatives have benefited greatly from them. Every regional health facility should establish a robust health coaching program for the area’s residents if they want to see positive and enduring changes to their health. Neither the term “health coaching” nor its benefits are well-known to the public. This means that hospitals should start offering health coaching to people whose conditions have avoidable causes.

HEALTH COACH SELECTION

It can also be difficult to approach the issue of each patient having their own health coach because every patient and family has a unique situation. Nonetheless, many patients would feel more at ease if the person coaching them was someone they knew and trusted. Even if a patient does not immediately know who they would like to be coached by questionnaires such as personality tests, compatibility assessments, and individual selection can help match a patient with a coach who they believe is the best fit for them. A patient may be invited to create a list or given the option of selecting three coaches depending on their preferences. This option can also assist patients in connecting with a coach who is more experienced in the field in which they wish or require coaching. For example, a patient who wants to lose weight and become more active can employ a diet and fitness expert rather than someone who wants to manage their mental health. Physician referral can be an effective path into health coaching. The outcomes of a large retrospective study show that patients who are referred by their physician to a health coach were more likely to enroll in a program that used a health coach. Furthermore, patient engagement in health coaching resulted in a significant reduction of health risk levels.

THE PROBLEM WITH FUNDING AWARENESS AND LEGISLATION

The main reasons why health coaching is still in its emerging stage are a lack of public awareness and inadequate government funding. Legislation has been reluctant to acknowledge and encourage health coaching, even though the average American life expectancy is 20 years behind that of equally wealthy countries, and the difference is rising. The causes include COVID-19-related deaths, drug overdoses, and accidental injuries, as well as lifestyle-related chronic diseases, which are an excellent target for health coaching. Despite the progression of chronic and mental illnesses, Congress in the United States has been slow to act. The Community Multi-Share Coverage Program Act (H.R. 4925; 116th U.S. Congress), introduced by Representative of Congress Bill Huizenga (R-MI-2) on October 30th, 2019, included a section on the use of health coaching for employees and in population health. Two resolutions (H.Res.481 and S.Res.272) were introduced in the 117th US Congress to show support for health and wellness coaches, but no new legislation has been introduced since.

THE COMMUNITY MULTI-SHARE COVERAGE PROGRAM ACT AND HEALTH COACHING

The purpose of House Resolution 4925 was to incentivize small businesses to offer better health insurance to their employees and the uninsured by providing them with grants. Educational and vocational programs for eligible individuals were also supposed to be funded by this money. If passed, this measure would have funded eight pilot initiatives supporting community-based coverage groups to offer qualifying coverage benefits. Its principal objectives were to assist individuals who are completely dependent on government-sponsored programs to make a smooth transition and to lower the number of uninsured through the formation of hospital-community partnerships that offer inexpensive health insurance options. It employs community and individual evaluation methodologies to investigate socioeconomic concerns and negative health effects. This allows doctors to better understand the environmental and social factors that influence their patients’ health and make better decisions. Health services provided included diagnostic laboratory tests and x-rays, ground-based emergency ambulance services, emergency services, inpatient and outpatient hospital services, mental health services, physician services, population health improvement services, preventative services, prescription drugs, and substance abuse services. It also provides educational and occupational training, as well as the opportunity to connect and establish long-term relationships among qualified persons. Individuals must meet specific criteria, such as earning between 100% and 400% of the federal poverty threshold based on their family size. They cannot enroll in a qualified health plan during the 180-day period before the date on which qualifying persons seek enrollment in the coverage scheme provided in this bill if their employer does not enroll them in a qualified healthcare plan.

This program employs health coaching as a “population health improvement service,” with the health coaching plan able to detect any social determinant of health that inhibits an eligible individual from reaching physical, mental, and financial wellness. This approach also generates a personalized plan to help improve a qualifying individual’s physical, mental, and financial health depending on their circumstances and health domain score. This plan assesses and evaluates each individual’s health domain score, provides health education classes, and establishes linkages with other organizations that support these patients. With inspiration by the recent COVID-19 pandemic, some legislation had begun to increase awareness about the effects of health coaching and why it’s inclusion would be timely in light of America’s chronic disease pandemic. Nevertheless, these endeavors have once again taken a back seat.

HEALTH COACHING AND INSURANCE

Another question about health coaching is whether a patient’s insurance will pay sessions with a coach. Many patients who might substantially benefit from health coaching believe they cannot afford health counseling, do not have the financial capacity to pay for quality coaching, or even feel worthy of being coached and encouraged to make beneficial lifestyle changes. Coaches must also have insurance because they frequently assume a high level of liability when dealing with individual patients. Coaches may be held accountable if patients follow their plans but do not get the intended outcomes. It is also important that the health coach has some type of liability insurance, especially if they are running a health coaching business or working as a professional. Liability insurance ensures that legal bills are met and that settlements or judgments obtained against the coach or company do not lead it to suffer a significant financial loss. Furthermore, insurance agents and organizations must manage both government restrictions and the coach’s preferences and requirements. All of these considerations must be taken into account when designing an insurance plan for a potential health coach. The plan should not only protect patient privacy, but also ensure that the patient has the financial resources to receive effective coaching. In addition, research on the impact of insurer or program involvement on the success of health and lifestyle changes made by patients participating in wellness or health coaching programs remains limited. One study, however, found that patients’ weight reduction success was significantly enhanced if they attended a minimum of six coaching sessions as part of a program that encouraged both weight control and weight loss.

PROTECTING SENSITIVE HEALTH INFORMATION

Counselors and coaches also need to be familiar with HIPAA rules and regulations, which require them to always keep patient information private or risk fines or other forms of prosecution. For example, if coaching is provided via telehealth, the meeting should be recorded and streamed in a room or location where others will be unable to hear the conversation between the coach and the patient. All phone coaching sessions must be held in a private or non-public setting as well. Alternatively, a patient can consent to having a family member or close acquaintance present during the sessions to assist the patient in implementing the plan developed with their coaches. Particularly young volunteers should think about several ethical and conflict-of-interest issues before participating in health coaching. Undergraduates who are interested in health coaching should be careful not to break any laws pertaining to protected health information. Unless the patient, coach, or main care provider gives permission for bystanders or other providers to be present or silent during sessions, it is crucial to consider that bystanders may overhear conversations during coaching sessions, increasing the possibility of HIPAA violations. This is an important consideration for all but especially less experienced student health coaching volunteers.

THE USE OF TELEHEALTH

Telehealth is an option for those who prefer not to make personal contact or who are too contagious to meet with the coach in person. Telehealth became popular during and after the COVID-19 outbreak, allowing clinicians to contact directly with patients using online technologies such as Zoom, Google Meet, or Skype. Prior to the pandemic, telehealth was not used very often and it was understudied as well. Telehealth has emerged as a convenient and sometimes necessary option for providers and patients who are unable to or who just prefer not to travel to a healthcare facility or a patient’s home. Telehealth visits allow for measurement recording, the use of online portals, and patient check-in via text messaging, FaceTime, Skype, or Zoom calls. However, telehealth has drawbacks, such as security concerns, transmission issues with personal health data, and a lack of insurance coverage from some companies, resulting in additional out-of-pocket costs. While the trend toward digital healthcare, including digital health coaching, is accelerating, there is a significant risk of excluding people who do not have the means, understanding, or skills required to use associated technology.

CLINICAL EVIDENCE SUPPORTING HEALTH COACHING

Current evidence in support of health coaching confirms that it can help people stick to new healthy living habits, including eating better and exercising more. Further research indicates that health coaching works particularly well for losing weight and the reduction of body fat controlling diabetes as well as common cardiovascular risk factors such as hypertension. Additional research points to possible advantages for specific types of chronic pain.

CONCLUSIONS

Health coaching has demonstrated to be a successful strategy for assisting patients in making significant life changes that lead to improved health outcomes by increasing awareness, trust, motivation, and accountability. Because there are a variety of health coaches, from volunteers to paid medical professionals, the concept is applicable everywhere and could be especially beneficial in rural, medically underserved areas of the country, which are also at the epicenter of the present chronic illness health crisis. Despite this, health coaching is widely underutilized and poorly publicized. Rising healthcare costs, the prevalence of chronic diseases, and the pervasive influence of mass media and advertisement driving bad lifestyle choices, innovative approaches to revolutionize patient relationships and health education are much needed. Furthermore, many people choose to disregard their health and poor nutritional habits, completely oblivious of the opportunity to enhance their well-being. Others may just lack the motivation to make the necessary changes. If widely introduced, health coaching may have a beneficial ripple effect, spreading from providers to patients and throughout society, resulting in a healthier, more confident, and productive population, eventually improving social value and success. Overall, health coaching is a verified strategy for improving public health and healthcare systems, with benefits outweighing possible hazards when combined with well-established high-quality coaching methodology. The incorporation of health coaching into hospitals and clinics, particularly in underprivileged areas, has the potential to greatly enhance population health and reverse the rise in chronic disease prevalence. However, policymakers, healthcare providers, educational institutions, allied health staff, and individual practitioners must collaborate to raise awareness and encourage the use of health coaching in their practices.

ACKNOWLEDGEMENTS

I would like to express my gratitude to the New York Institute of Technology College of Osteopathic Medicine’s Masters in Biomedical Sciences program for providing the opportunity and framework for this study.

Additional Information

DISCLOSURES OF CONFLICTS OF INTEREST

In compliance with the International Committee of Medical Journal Editors (ICMJE) uniform disclosure form, all authors declare the following:

PAYMENT/SERVICES INFO:

All authors have declared that no financial support was received from any organization for the submitted work.

FINANCIAL RELATIONSHIPS:

All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.

OTHER RELATIONSHIPS:

All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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