Health Coaching (3)

Question 1

Describe the four principles of motivational interviewing

Answer 1

1. Engaging
   • Building connection + rapport
2. Focusing
   • Helping to identify a health behaviour-related goal
3. Evoking
   • Supporting patients to explore their situation further ‘change talk’
4. Planning
   • Supporting patients to identify possible options/opportunities/resources

Question 2

How can we use health coaching and motivational interviewing concepts to help focus and set effective goals

Answer 2

SMART goals
• Specific (well defined and clear)
• Measurable (measure progress towards goal)
• Achievable
• Realistic (relevant to context)
• Timely (clear timeline towards goal)

Effective goals also take into account
• How important goal is to the patient
• How motivated the patient is
• How the goal aligns with the patient’s values and situation
• The degree to which achieving the goal is under the patient’s control

identify both the overall goal that they would like to work towards, and also their goal for their conversation with you.

Question 3

useful questions to help set goals and explore motivation

Answer 3

What is the issue?
What makes this an issue now?
What is important to you about this issue?
How motivated are you to address this issue?
What part will be most useful to focus on in the next x minutes?
What do you want ideally? Often, people will come with an issue which they convert into what they think is a goal.

Question 4

Problem and alternative to statement “ I want to lead a healthy lifestyle”

Answer 4

It is too vague

Help the patient shape it into something more specific. You could ask: What does ‘healthy’ mean for you? What would it look like and feel like if you achieved this goal? What would other people notice?

Question 5

Problem and alternative to statement “I don’t want to eat junk food any more “

Answer 5

The goal is phrased in a way that is moving away from something (i.e. eating junk food) rather than towards something

Help the patient rephrase this into something they can work towards. This will help them to visualise it and develop motivation to achieve it. You could ask: What do you want instead?

Question 6

Problem and alternative to statement “I want my partner to cook healthier food for me “

Answer 6

The goal is about a third party-in this case the partner of the patient

It is worth reminding the patient that unfortunately we don’t have their partner in the room to work on and we can’t make them behave in a different way. You could ask: What part of this is within your control?

Question 7

Do Goals change?

Answer 7

yes - goals can evolve over time.

• can even happen during the coaching conversation itself, as the patient reflects more on their issues, motivators, values and context- which may also be changing and evolving over time.
• You may need to re-visit a patient’s goals more than once and perhaps several times in your conversations, as the patient continues to develop clarity about what they really want to achieve- which may be very different from their original goal.

Question 8

Which type of questions are used in health coaching?

Answer 8

• open, solution-oriented questions–> to help to explore the patient’s thoughts and feelings about their issue and to explore meaning, values and goals.

–> lead to overall ideal outcome and a more specific goal for the consultation

eg.

What do you want to be happening ideally with your diet?
If you did manage that, what would be happening instead?
What does eating better look like for you?
So with that in mind, what would be the most useful use of our time here?

Question 9

Which 3 factors allow us to shape a goal during a consultation

Answer 9

Questions
ideal outcome
patients foussed goal

Question 10

core skills of coaching

Answer 10

Open questions 
Affirmations 
Reflecting 
Summarising 
Pausing

fully present, listen actively and non-judgmentally

Question 11

What is “rolling with resistance”

Answer 11

if there is resistance during consultation use this approach:

• involves expressing empathy, emphasising the patient’s autonomy, avoiding arguing and advice-giving, and instead drawing on the core skills of coaching to create trust and work collaboratively with the patient, strengthening their belief in their capacity to change.

Question 12

Role of language in health coaching conversations

Answer 12

• immediate and powerful impact on mood and motivation.
• The language that patients themselves use is as important as the language of the practitioner.
• encourage and reinforce positive language (e.g. change talk) rather than negative language used by the patient, to maximise the motivation to change.
• ensuring your own wording is expressed positively and that your questions encourage the patient to express their reasons for wanting to make a change rather than focusing only on their reasons for maintaining the status quo.



Question 13

What are some useful questions to help explore the current situation (including perceived capability for behaviour change), begin to evoke ‘change talk’ and increase motivation?

Answer 13

What is stopping you from achieving your ideal outcome?
What needs to happen for this change to become possible?
What part of this do you have control over?
What would be different and better for you if you make this change?
How will you know when you are ready to make the change?
What is going right?
Imagine you are your own best friend. What do you say to yourself about this issue?

Question 14

How to use change talk in health coaching and its benefits

Answer 14

• listening actively,
• reinforces the patient’s own positive ‘change talk’.
• invite the patient to identify the areas they can influence and change.
• reflecting back their thoughts on what they have heard and affirming the patient’s motivation to change their health behaviour

skills of reflection, summarising and affirmations

• -> help reinforce any change talk
• -> support the patient to strengthen their motivation and confidence.
• -> helping the patient to identify possible options, opportunities and resources available to help them address their goal, including addressing what might get in the way.

Question 15

When should you contribute your ideas and how?

Answer 15

after patient starts using positive change talk

• capture verbally, write a list or spider diagram ect..

Question 16

What should you do once yours and patients ideas are generated/

Answer 16

• help the patient to evaluate them according to what the patient thinks is the most important to them, and to identify and plan next steps for action- including when these steps will be taken.



Question 17

What does self-monitoring of health behaviours allow

Answer 17

allow patient to track progress and get everything off their head

e.g. by keeping a regular written record, can increase the likelihood of achieving goals, and this can be useful to build into the planning process.

Question 18

Useful questions to help the patient plan next steps include:

Answer 18

What are your options?
How will you decide which option(s) to follow?
What are your next steps?
What might get n the way of your plans?
How could you adapt your plan if need be?
What resources can you access to help you?
Who can help support you in your plan of action?
What would really make a difference to achieve success?
When will you make a start?
How will you review your progress?

Question 19

how can we support patients to take steps to address the issue

Answer 19

• maintain rapport through verbal and non-verbal communication.
• ask questions inviting the patient to identify possible options
• makes effective use of pauses to create a space for the patient to generate new ideas.
• asks the patient which of the options seem possible.
• think about what might get in the way and what could help with the plan to maximise the likelihood of success.
• The question ‘So when will you start?’ puts a timeframe on the action plan to further increase the chance of success.

Question 20

What is the COM-B model of behaviour change

Answer 20

The model proposes that behaviour is a result of:

Capability (both physical, including the skills required, and psychological, including knowledge required to take steps towards behaviour change)
Opportunity (both physical, for example time and cost considerations, and social, for example the presence of a supportive companion or group)
Motivation (both reflective, through considering the long term benefits of the behaviour change, and automatic, through using this reflection to see the behaviour change as a ‘want’ and not just a ‘need’).

Question 21

How can we relate COM-B model to health coaching

Answer 21

COM-B (‘capability’, ‘opportunity’, ‘motivation’ and ‘behaviour’) model = behaviour is part of an interacting system involving all these components.

capability
-what part of this do you have control over?

opportunity
- what are your options here?

Motivation

• what do you want ideally?
• how motivated are you to carry out next step?

capability and opportunity
- which of these options seems the most feasible

capability and motivation
- whats stopped you achieving your ideal outcome

Motivation and opportunity
- Imagine you have achieve your goal, what does that look like for you

All
- imagine you are at your most resourceful. What do you say yourself about your issue

Question 22

Why is booking a review useful

Answer 22

• setting out next steps builds accountability
• book return appointment for review
• see relapses and avoidance as helpful learning rather than failure
• acknowledge successes
  facilitate a discussion about what what got in the way
  support the patient to identify what they have learned and help them make further plans

Question 23

How to deal with patients who have returned but have relapsed into bad habits

Answer 23

• begin to build trust and maintain rapport by asking an open, non-judgemental question
• non-judgemental and empathic
• invites the patient to reflect on the learning to inform future planning by saying: ‘Shall we think through what happened and let’s make a plan so you can move forward’.
• explore current motivation
• reinforces the positive ‘change talk’ language in the - summarising and acknowledging successes eg. ‘So what I’m hearing is the nutritious meals and planning all helped to make you feel healthier and help you have more energy overall.’
• supports the patient to further reflect on the experience by asking: ‘What got in the way?’ - This question generates new insights relating to the need to prioritise
• solution-oriented question: ‘And what could help you prioritise?’ This invites the patient to generate options and next steps
• supports the patient to identify a timeframe for the action plan through asking: ‘When will you start?’
• invite the patient to keep a regular written record of progress to self-monitor health behaviours as there is some evidence that this can increase the likelihood of achieving goals.

Question 24

Which of these is an example of ‘change talk’?

“I just don’t see this as a problem right now”

“I know I’d feel better if I started exercising more”

“I don’t understand why people are so bothered about it”

Answer 24

“I know I’d feel better if I started exercising more”

• -> The way in which we use language can have an immediate and powerful impact on mood and motivation.
• –> The language that patients themselves use is as important as the language of the practitioner. —> It is very valuable to encourage and reinforce positive language (e.g. change talk) rather than negative language used by the patient, to maximise the motivation to change.

Question 25

Brian describes wanting to build in more exercise into his busy life but is struggling to move forward with this and tells you he is also a carer for his wife which he finds exhausting and doesn’t feel he has the energy to exercise.

Which of these questions would be most useful to ask Brian?

“Why don’t you just make a start tomorrow by going for a walk after your evening meal? “
“Don’t you think it is important to prioritise your health by doing more exercise? “
“Imagine you are your own best friend. What would you tell yourself about this situation? “

Answer 25

“Imagine you are your own best friend. What would you tell yourself about this situation? “

—> useful question, especially where things feel stuck. It can help the patient explore their current situation (including their perceived capability for behaviour change) and begin to evoke ‘change talk’ and increase motivation.

Question 26

What can strengthen motivation in a conversation

Answer 26

Summarising the patient’s own ‘change talk’, e.g. about the benefits of exercising, can also help strengthen motivation.

Question 27

Why are open questions useful in between conversations

Answer 27

Open questions help to explore a patient’s thoughts and feelings about their issue and to explore meaning, values and goals. They invite the patient to provide more than just a simple one-word answer such as ‘yes’ or ‘no’.
–> invites to further reflect and summarise thinking, including own ‘change talk’.

Question 28

When a patient starts talking about change talk, what should you do?

Answer 28

When you hear a patient starting to use ‘change talk’, it can very useful to build on the momentum of this through supporting them to think through their next steps to move forward.

Talking about exercise is an example of ‘change talk’

Question 29

What are 10 useful questions to help the patient plan next steps?

Answer 29

1. What are your options?
2. How will you decide which option(s) to follow?
3. What are your next steps? 4. What might get in the way of your plans?
4. How could you adapt your plan if need be?
5. What resources can you access to help you?
6. Who can help support you in your plan of action? 8. What would really make a difference to achieve success?
7. When will you make a start?
8. How will you review your progress?

Question 30

Why should we ask “what went right “ if patient complains of failure

Answer 30

• to recognise and acknowledge any successes, no matter how small.
• see experience as learning rather than as failure —> helps reinforce Brian’s sense of his own capability and motivation which are key components of behaviour change according to the COM-B model.
• makes a new goal

Question 31

Key points

Answer 31

Several models and frameworks have been developed which are designed to help structure conversations in order to enable a person to move forward with their issue. Inherent in many of these approaches is what Motivational Interviewing (MI) terms as the ’Four Processes’: Engaging, Focusing, Evoking and Planning.


Ensuring goals are worded effectively and ‘SMART’ may take some time but it is time well spent and will help the rest of the conversation to flow more smoothly.


Goals can and do change and evolve over time as the patient continues to develop clarity about what they really want to achieve.


When patients are struggling to move forward with their issue, you may notice this as resistance during the conversation. ‘Rolling with resistance’ involves expressing empathy, emphasising the patient’s autonomy, avoiding arguing and advice-giving, and instead drawing on the skills above to create trust and work collaboratively with the patient, strengthening their belief in their capacity to change.


The way in which we use language can have an immediate and powerful impact on mood. It is very valuable to encourage and reinforce positive language (e.g. change talk) rather than negative language used by the patient, to maximise the motivation to change.


A key aspect of a health coaching conversation is for the patient to identify possible options, opportunities and resources available to help them achieve their goal, address what might get in the way and plan next steps for action.


Change is often not an easy process. If a person has relapsed, avoided the actions they set out to take or has only partially succeeded, you can facilitate a useful discussion about what got in the way, what did go right, even if partially and what they have learned from this when making plans for next time.


Remember the COM-B model and think about how you can use your coaching skills to further support the patient to build their Capability, Opportunity and Motivation to maximise positive Behaviour change.


The core principles and skills of health coaching approaches can be applied with a wide spectrum of patients and health-related situations. It can help patients to develop or consider new perspectives on their situation, informing how they feel about an issue and the decisions they make.