健康coaching is a way of helping people gain the knowledge, skills, tools and confidence they need to take an active part in their own health care. It helps them reach the health goals they want to achieve.
key points
如果您与持续的健康问题或复杂健康需求的人一起工作，那么健康教练将有用。
它的目标是改善他们的长期成果。
我t can include whānau members, so they can also support your client in achieving their health goals.
健康coaching is based on the saying that if you give a person a fish, they will eat for a day, but if you teach them to fish, they will eat for a lifetime.
just like sports coaches, the role of a health coach is to inspire confidence in you, share knowledge with you and find ways to motivate you to achieve your goals.
这y might help someone manage their appointments or medication, answer questions about their condition, or explain more fully why the doctor recommended they take certain actions. They will help them work out what they want to achieve and will help them find the support to do that.
健康coaches have five roles, which are to:
为客户自己管理自己的状况支持
bridge the gap between their client and their doctor
help their client find their way around the healthcare system
offer their client emotional support
如果他们有疑问，请成为他们的客户持续的第一个人。
(Image source: American Academy of Family Physicians, Fam Pract Mgt, 2010)
Anyone with the right aptitude, interest, person/whānau-centred approach, personality and compassion can potentially become a health coach. It is the mindset and approach that is more important for this role than how many qualifications you have.
As a result, health coaches can have very diverse backgrounds including:
临床培训的健康教练，例如护士，职业治疗师，药剂师，物理治疗师，社会工作者和医生
lay-leaders or peer support health coaches, such as receptionists, healthcare assistants, community workers, Stanford course leaders and more.
健康coaching is based on a collaborative approach rather than a directive one, so as well as requiring some technical skills that can be taught, a health coach needs certain personality traits.
我t therefore suits people who:
can match the cultural and language needs of the population being served
具有出色的沟通技巧，包括听力技巧
has an encouraging, supportive and motivating attitude and approach
can connect with a wide range of people
is empathetic, caring and nurturing.
Candidates for health coach training could include those who have these personal qualities and who currently work as a:
接待员
healthcare assistant
whānau ora worker
社区卫生工作者
同伴支持工作者
care coordinator
斯坦福课程负责人。
training options for health coaches
这re are several training options to become a health coach. Find out more on theSmstoolkit网站。为了支持实施健康教练和提供培训，您也可以contact us.
overseas experience of health coaching
two models of health coaching have been trialled overseas.
one widely used programme in the United States reports a 20–50% reduction in hospital re-admissions. Their programme focuses on these 4 pillars:
有一个可靠的计划定期服药。
overcoming barriers to follow-up appointments.
Having an acute plan and ensuring patients know how to recognise and respond to worsening signs and symptoms.
使用个人健康记录记录30天目标，健康信息和关键问题，将在下一次约会中与医生或护士共享。
健康教练的功效
几项研究表明，健康指导是有效的。
researchers have found promising clinical benefits from health coaching in diabetes and asthma management, while phone coaching improved attendance at colonoscopy clinics and better adherence to lipid-lowering drugs than usual care.
Clinics in the US have also reported productivity gains in delegating the work of health coaching away from primary care clinicians, with reports of physicians being able to see 2 to 3 more patients a day, and improvements in visit volumes and collections by 60%.
在冠心病的一项研究发现,patients in a coaching programme achieved a significantly greater change in total cholesterol of 14 mg/dl than the non-coached patients, with a considerable reduction in LDL-C. They also showed improvements in secondary outcomes such as weight loss, increased exercise, improved quality of life and less anxiety, as well as improvement in overall health and mood.
Another study found telephone coaching to be effective for assisting people with weight loss. The average body mass index of participants significantly decreased during the study, from an average baseline of 32.1% to 31.4% at 3 months, 31% at 6 months and 30.6% at 12 months.
在一项关于烟草戒烟12个月的研究中，教练的参与者的退出率为32％，而非参与者的戒烟率为18％。
And a study in 6 Minnesota primary care clinics found that adult patients with hypertension, diabetes or heart failure who were allocated ‘care guides’ (health coaches) achieved more goals, had a greater reduction in their unmet needs and improved more than the usual care patients in meeting several individual goals, including not using tobacco.
卫生专业人员的资源
健康教练工具和资源你niversity of California Centre for Excellence in Primary Care, US
这vision for SMILE is to normalise self-management support in ProCare-affiliated practices in the Manukau locality. As part of this project, in 2016, ProCare worked in collaboration with the Mt Wellington Family Health Centre to pilot the health coach model.
this pilot enabled the SMILE team to identify the skills and competencies for the health coaching role and develop a job description for use by other general practices. They also identified the issues that patients covered in their health conversation topics.
“the Health Coach helps me to communicate better” .... “I like the brainstorming and decision making techniques” ..... “I don’t like to waste peoples time, I like the fact that we can talk and listen to each other” .... “I can be a stubborn so and so. The coach has helped me get back on track.”
As part of its Kia Kaha project, Manage Better Together, Ko Awatea runs training in health coaching. The project is part of its Manaaki Hauora – Supporting Wellness campaign, which aims to help people with long-term conditions manage their own health for a better life.
this has led to running two-day health coaching workshops, which have been attended by primary and secondary care health workers, including diabetes specialists, pharmacists, nutritionists, psychologists, peer workers and volunteers.
组织者和健康心理学家Leona Didsbury说：“我们对健康教练技能的价值感到非常鼓舞，这是对与患者一起工作的任何人的实践的增强，因为它非常以患者为中心。我们尤其是excited about the possibilities of health coaching ‘teamlets’ working together in primary care. Our feedback to date indicates people find this training relevant and useful for their setting.”
东塔马基医疗保健（ETH）PHO健康教练计划
building on the success of their peer-led self-management education (SME) programme, Kia Kaha, ETH has initiated a health coaching programme. It has also expanded the original team to include options for self-management education, health psychology, peer support and care coordination.
to support the development of health coaches within their team, they have also been running two-day health coaching workshops as part of the Manaaki Hauora project. These workshops have been attended by primary and secondary care health workers, including diabetes specialists, pharmacists, nutritionists, psychologists, peer workers and volunteers.
organiser and health psychologist Leona Didsbury says, “We’re very encouraged about the value of health coaching skills as an enhancement of practice for anyone working with patients as it is very以患者为中心。我们尤其是excited about the possibilities of health coaching ‘teamlets’ working together in primary care. Our feedback to date indicates people find this training relevant and useful for their setting.”
All health coaches working in ETH have regular supervision as well as a weekly mentoring and support session. The health coaches reflect the cultural and linguistic makeup of the enrolled population.
Challenges have included getting the resources to do the training and quality control, the need to maintain and support the lay and volunteer workforce, and referral of patients to the programme.
为了克服这些挑战,Countie的支持s Manukau Health and Ko Awatea as part of the Manaaki Hauora campaign has made a big difference, as well as the seed funding that enabled it to happen. A validated and structured health coaching model has enabled role definition boundaries.
key lessons that may be useful for other teams who are interested in starting health coaching include to:
build on what works (lessons from the SME implementation informed the model)
应用改进科学方法，而不是依赖RCT的证据
给时间探索想法，改变和做不同的事情
使用结构化的健康教练计划，因为它使该想法更容易出售给组织中的其他人，尤其是临床人员
include information about the programme in in-house online publications
提供选项菜单。
这模型below shows how health coaching fits into the overall SME approach.
(Source: East Tamaki Healthcare (ETH) PHO – Health Coaching Programme)
references
Lansakara N.健康coaching inspires。ko Awatea: Health System Innovation and Improvement. 2017 Jan.
我started working with Bob in February. It was a very different interaction from the norm. From then until now we have not actually met in person. The beauty of this programme is that we can think outside the box and communicate in the best way possible to accommodate the busy lives of patients.
这constant contact has been via phone and internet. For example, I sent Bob a link for the Big Boys Club introduction. His response was very positive – he couldn’t wait to get started, so we organised him to meet a colleague, Edith Tatana. The 21st of March was set for Bob to meet up at the gym with Edith. The meeting went well. Bob met with Buck Stowers and was ready to sign up for the Big Boys Club.
这health coach sent an email to the GP, as Bob needed a referral or endorsement to attend the Big Boys Club programme. This sparked the team looking at him being able to take part and looking at the criteria for the programme. After the collaboration of the GP and the coordinators, Bob started the programme. He is thoroughly enjoying it.
After three months, I called Bob to catch up. He is doing very well. He has lost 17kg and feels great. He will attend the GP for a check in a month and then we will see the difference in his baseline results.”
*Name changed to protect privacy.
同伴支持案例研究
这resa's story
这resa's goal was simple. She wanted to take care of her health so that she could better look after her family. She not only achieved her goal, but she also lost 9kg over the 10-week programme.
这resa knows that she succeeded because of the support and practical help she got from the other programme participants.
Case study reported in Ko Awatea and Counties Manukau Health.sm我le: Self-Management is Life Enhancing。manaaki Hauora – Supporting Wellness Campaign. 2016 Aug; 20–21.
(Image source: American Academy of Family Physicians, Fam Pract Mgt, 2010)
这vision for SMILE is to normalise self-management support in ProCare-affiliated practices in the Manukau locality. As part of this project, in 2016, ProCare worked in collaboration with the Mt Wellington Family Health Centre to pilot the health coach model.