There are different aspects of the evidence base:
- Supported self-management
- Patient activation
- Coaching skills, models and frameworks
Supported Self-Management
People who self-manage effectively have better health and wellbeing outcomes and make lower and more effective use of clinical services.
Therefore the aim of supporting people to self-manage effectively is to enable people with long term conditions to achieve these outcomes.
There are different ways to support self-management, the main ones being:
- Supporting people individually to build their confidence to self-manage effectively (through individual ‘Health & Wellbeing Coaching’)
- Self-management groups to help people to build their knowledge and skills to manage their conditions or common issues associated with managing long term health conditions
- Peer support
Patient Activation
'Patient activation' is often used to describe people’s levels of knowledge, skills and confidence to self-manage.
As increasing people’s levels of knowledge skills and confidence to self-manage is the aim of supporting self-management, using a patient activation measures, such as the PAM® is one way of assessing the effectiveness of an intervention on a person’s ability to self-manage effectively. (See How can outcomes be measured?)
Coaching skills, models and frameworks
Skills
Coaching skills are used in a wide variety of contexts: e.g. life coaching, business coaching, health coaching. However, this doesn’t mean that all approaches are all the same. Broadly speaking:
“Coaching is the art of facilitating the performance, learning and development of another” – John Whitmore (2002)
The key word here is ‘facilitating’. A coach’s role is to facilitate, not fix.
In the context of the NHS Personalised Care agenda [ref], there are a set of core skills set out by the Personalised Care Institute. All those providing training in health coaching skills in this context are required to include these core skills in their PCI-accredited training courses.
Health coaching in this context shares many skills with Motivational Interviewing. The main difference is that Motivational Interviewing is generally focused on a particular outcome; whereas Health Coaching takes a broader approach.
Coaching models
As well as being able to use the core skills, there are different ways of structuring a coaching conversation. Probably the best know is the GROW, or TGROW, model developed by John Whitmore in 19.. [ref]. There are, however, others.
KYOH uses the StACC Model. This is a standalone intervention using as its base the Coaching Conversation Flow that came out of the Health Foundation’s Co-Creating Health Supported Self-Management Programme which ran from 2007-2012. We use the StACC model because it:
Frameworks
There are other frameworks through which the aims of supporting self-management and patient activation can be viewed.
COM-B
More effective self-management often includes an element of behaviour change on the part of the patient, especially around lifestyle issues. The COM-B framework is a way of understanding the principles of behaviour change and stands for Capability + Opportunity + Motivation = Behaviour Change. [Ref]. Health coaching and motivational interviewing are ways of supporting behaviour change in the same way as they support self-management, patient activation, and improved outcomes for patients.
Transtheoretical Model (TTM)
The Transtheoretical Model is a lens through which to understand human behaviour in the context of behaviour change. It consists of five stages: Precontemplation, Contemplation, Preparation, Action, and Maintenance. Although it’s a different model and framework from the concept of Patient Activation, the two map together fairly closely, i.e. the 4 levels of patient activation are described as: Disengaged and overwhelmed; becoming aware but still struggling; taking action and gaining control; maintaining behaviours and pushing further.