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Dansk Coaching Institut - Patient focused Health Coaching - English


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The latest research on Health Coaching from the pioneering project of Assistant Professor Ms. Ayse Basak Cinar in partnership with Danish Institute of Coaching. Our first article for magazines in english. Academic articles for journals can be requested:

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Dansk Coaching Institut - Patient focused Health Coaching - English

  1. 1. PATIENT FOCU COACHING T A N D P L E J E R E N J U N I 2 0 1 438 GROW New Insight, consiousness about Myself, my goals, values & beliefs KNOW Recieve knowledge about what you want to improve, change and learns ACT Optimizing skills & capabilities by doing, learning and experience Figure 1. Schematic representation of coaching for behavioral change. Modified from the Learning Model by Danish Coaching Institute, 2011. OW ACT ou Op Figure 1. Schematic representation of coaching for behavioral change. Modified from the Learning Model by Danish Coaching Institute, 2011. Transition & Development Action learning, recieving feed- back. Building skills and competence Transformation & New behavior Relearning into new personal & social Competencies This process is ongoing for us all throughout our lives. You can call it a universe of learning. This is important in order for a patient to learn, unlearn and relearn new skills, competencies and habits to secure an in- creased positive level of orral health and quality of life. The dental team is in the coaching role creating a space and fram for learning in order to secure a greater level of rap- port, compliance and self efficacy. Understand & Learn from exercising, observation, trial and error The Development and Learning Triangle is based on DavidKolbLearningTheories.Thismodelillustratethe theory of experience based learning - action learning. This way of learning and growing take you through an iterative proces of learning, we know this as transition. - A Proces of experience leading into self reflection and thoughtfulness for then to exchange perspectives and recieve feedback. When you have reached a level of self recognition and conceptualization, you are able to engage in activities and experiement and gain new experience. Unlocking the Human PotentialUnlocking the Human Potential Danish Coaching Institute Danish Coaching Institute
  2. 2. ›› USED HEALTH Health Coaching (HC) is a new patient-centered behavi- oral/lifestyle intervention. It facilitates individuals in establishing and a aining health promoting goals in order to change lifestyle-related behaviors. The intent is to reduce health risks, improve self-management of chro- nic-conditions and in- crease health-related quality of life1 . HC, in principal, focuses on transformation and maintenance of positi- ve health behaviors by empowerment of patients. HC, one of the most effective behavioral techniques, is directly associated with positive lifestyle outcomes (smoking cessation, management of obesity and diabetes)2-6 . An assessment of the effect of HC on multiple chronic disease management as a common approach has been a neglected issue. Ayse Basak Cinar and Lone Schou and the research group, the first to their knowledge, run an international project that aims to evaluate the impact of a HC on oral health and diabetes management among patients with diabetes type 2 (DM2), by comparing HC intervention to health education. DM2 and oral diseases Promoting good oral health is essential to prevent and reduce the negative consequences of DM2 and to maintain good health, as proposed by the WHO 7 . Periodontal disea- se may significantly contribute to the risk of dying from DM8 . Periodontal inflammation in early old age tends to be associated with mortality in older age8 and DM2 patients are more likely to have periodontal disease than people In the last issue of the Dental Hygienist Magazine (May 2014), Dental Hygi- enist Ms. Azita Negahban explains her contribution to the research project headed by assistant professor Ms. Ayse Basak Cinar at the Faculty of Odon- tology at Copenhagen University.The research focuses on the benefits and impact of empowerment and coaching on diabetes patients. It is vital that patients learn to connect their health goals and lifestyle to a vision of health in a greater picture (...) without DM29 . DM2 and oral diseases, so called lifestyle diseases, share common bio- logical mechanisms10, 11 and the same lifesty- le related risk factors (poor dietary habits, smoking)12, 13 . Be er management of these diseases requires good self-care practices and adherence to regular daily regimes. Howe- ver, many patients find themselves unable to follow recommended lifestyles (a healthy diet, regular physical exercise, no smoking, tooth brushing twi- ce daily), which makes them more prone to DM2-related complications and poor oral health, leading to a poor quality of life. Therefore, a common-risk factor approach to promote be er oral health and successful DM2 management are proposed as an urgent need by WHO14 and IDF15 . Behavioral inter- ventions are highly recommended to meet this need16 . In line with this recommenda- tion, studies by Cinar and colleagues (2013, 2014), has found that HC, compared to tra- ditional health education, significantly im- proves HbA1c (clinical parameter reflecting the average blood glucose level over the past three months time), periodontal health and psychosocial measures (self-efficacy, diabe- tes coping skills) among DM2 patients17, 18 . By Ms. Ayse Basak Cinar, assistant professor, and Ms. Lone Skou, head of section, Faculty of Odontology at Copenhagen University J U N I 2 0 1 4 T A N D P L E J E R E N 39
  3. 3. What makes HC different from other health promotion approaches? The HC approach in the present study: 1. originally stems from coaching that is international- ly accredited and uses specific psychological tech- niques19 including motivational interviewing 20 , neu- ro-linguistic programming (NLP)21 and self-efficacy22 . Health Education and promotion is integrated to the HC,withacontinuousfocusonpatientempowerment. 2. tackles health-related psychological blocks to change by empowering and motivating the patient. 3. is a collaborative process between medical professio- nal and patients/people. It is not a communication between an expert and an obeying patient. It is desig- ned to motivate people to a ain specific goals which can improve their performance and enhance their quality of life. 4. may work for promotion of multiple health behaviors based on patient-centered choice. 5. functions in terms of empowering, applauding, sup- porting, motivating, providing feedback, and helping the patient to remain commi ed to achieving goals and accountable for choices he/ she makes. 6. explores multiple interaction, not unilateral, pathways between emotional and cognitive compo- nents of patient’s health behavior, and differentiates from health education (table 1). 7. targets the continuous personal growth of the patient to adopt and maintain healthy lifestyles and to improve quality of life. The initial point is to createawarenessofowncapacityandvalues-beliefsand therea er to set up a health-related goal based on these. HC as an interventional method in the clinical settings The primary method is that patients themselves set up the goal and an action plan, focusing on improvement of lifestyle and clinical measures, under the supervision of the coach. Each coaching session is used for subsequent monitoring of patients’ progress towards the achieve- ment of the target goal. The time frame for face to face coaching sessions is 20-60 minutes, determined by needs, expectations, hindrances, and progress of patient. Figure 1 on page 14 is a schematic representation of coa- ching for behavioral change, modified from the Learning Model by Danish Coaching Institute, 2011. A Wheel of Health (figure 2) is administered during the initial HC session visits to explore values, establish priorities, and set goals: Participants define their prio- rity areas in health to improve, on the wheel of health where each pie represents an health area such as diet, physical activity etc (figure 2). Then they rate how sa- tisfied they are in each area ranging from 0% to 100% A erwards they define how satisfied they would like to be in each area. Wheel of Health is specific for participant identifying his/her priorities, needs and expectations COMPARISON OF HEALTH EDUCATION MODEL AND PATIENT FOCUSED APPROACH-HEALTH COACHING T A N D P L E J E R E N J U N I 2 0 1 440 Traditional Care Model • Health professional as expert • Client told what to do • One size fits all solutions • Extrinsic motivators • Client required to facilitate change • Ignores barriers to change • Resistance to change • Goal setting overload Health Coaching Model • Client as expert in own life • Client offered information but chooses own solutions • Individually tailored solutions • Intrinsic motivators • Collaboration and assistance in facilitation change • Adresses barriers to change • Magnitude of goals to suit client Tabel 1. Comparison of Health Education Model and Patient Focused Approach-Health Coaching modified from Health Coaching Australia,
  4. 4. referring to health (figure 2). Participants choose one do- main and set up a specific goal and action plan during each face-face session. The progress of the patient is sup- ported by telephone calls. HC as a new effective dental professional-patient commu- nication tool can be used at daily clinical practice. HC has seven master bones structure an effective and successful communication: 1. Building Trust and Rapport (1+1=3, asking permis- sion, empathy, being in the moment) 2. Unconditional Positive Regard (acceptance and re- spect) 3. Patient-Focused Approach 4. Empathy 5. Active Listening and Empowerment (words and tone of voice, body language and behavior) 6. ASK, Don`t Tell 7 Feedback and summarising (mirroring). Figure 2. The wheel of health is a great tool to create ovierview, clarity and conciousness for the patient. This assessment for a focused dialogue support the HP and the patient in moving in on what is most important, what create most value for the patient and reflect where the inner drive of the fokusperson is. The fokusperson always leave with a task defined by the fokusperson itself in order to motivate for continous and future compliance and most importantly building ressources and skills for self efficacy. ›› WHEEL OF HEALTH Assessment of the patients own level of statisfaction with state of health Level of statisfaction – present state on a level from 0% to 100% in this area Level of satifaction – future state on a level from 0% to 100% in this area Oral health behaviour, (mostly brushing twice a day) Sleeping habits Stress & emotional Management Physical activity Self & Life Management Diet Mindfulness & meditation Weight (BMI) Oral health behaviour, (mostly brushing twice a day) Sleeping habits Stress & emotional Management Physical activity Self & Life Management Diet Mindfulness & meditation Weight (BMI) Goal setting for Focus Points: What action to take in order to close the gap bewteen present and fu- ture state of statisfaction and then reach goal for excellent oral health and quality of life: I will... I want to...(positive formulated, specific, concrete, measurable, attractive and timed). Focus Points: Patient choose the areas (max. 3) to work with right now in order to close a gap in a wheel of health area of great importance and value. 0% J U N I 2 0 1 4 T A N D P L E J E R E N 41
  5. 5. T A N D P L E J E R E N J U N I 2 0 1 442 1. Butterworth SW, Linden A, McClay W (2007) Health coaching as an intervention in health management programs. Dis Manage Health Outcomes 15: 299-307. 2. Lancaster T, Stead LF (2005) Individual behavioural counselling for smoking cessation. Cochrane Database Syst Rev 2. 3. Stevens VJ, Glasgow RE, Toobert DJ, Karanja N, Smith KS (2003) One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consump- tion of fruits and vegetables. Prev Med 3: 594-600. 4. Sarvestani RS, Jamalfard MH, Kargar M, Kaveh MH, Tabatabaee HR (2009) Effect of dietary behaviour modification on ant- hropometric indices and eating behaviour in obese adolescent girls. J Adv Nurs 65: 1670-1675. 5. Whittemore R, D’Eramo Melkus G, Grey M (2005) Metabolic control, self-manage- ment and psychosocial adjustment in women with type 2 diabetes. Clin Nurs 14: 195-203. 6. Whittemore R, Melkus GD, Sullivan A, Grey M (2004) A nurse-coaching intervention for women with type 2 diabetes. Diabetes Educ 30: 795-804. 7. WHO European Region (1999) Health21: the health for all policy framework for the WHO European Region. WHO, Denmark. 8. Avlund K, Schultz-Larsen K, Krustrup U, Christiansen N, Holm-Pedersen P (2009) Effect of inflammation in the periodontium in early old age on mortality at 21-year follow-up. J Am Geriatr Soc 57: 1206-1212 9. Sandberg GE, Sundberg HE, Fjellstrom CA, Wikblad KF (2000). Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects. Diabetes Res Clin Pract 50: 27-34. 10. Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y (2005) A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 76 (11 Suppl):2075-2084. 11. Nishimura F, Kono T, Fujimoto C, Iwamoto Y, Murayama Y (2000) Negative effects of chronic inflammatory periodontal disease on diabetes mellitus. J Int Acad Periodontol 2:49-55. 12. Santacroce L, Carlaio RG, Bottalico L (2010) Does it Make Sense that Diabetes is Reciprocally Associated with Periodontal Disease? Endocr Metab Immune Disord Drug Targets 10:57-70. 13. The Australian Institute of Health and Welfare (2012) Risk factors contributing to chronic disease 2012. http://www. aspx?id=10737421546. Accessed April 29, 2013 14. Petersen PE (2003) The World Oral Health Report 2003: continuous improvement of oral health in the 21st century-the approach of the WHO Global Oral Health Programme. Community Dent Oral Epide- miol 31 Suppl 1:3-23. 15. IDF. Diabetes and oral health (2009) http:// vital-component-wellbeing. Accessed March 2014. 16. WHO (2013) Non-communicable diseases. ets/fs355/en/. Accessed March 2014. 17. Cinar AB, Oktay I, Schou L (2013 Dec). "Smile healthy to your diabetes": health coaching- based intervention for oral health and diabetes management. Clin Oral Investig. [Epub ahead of print] 18. Cinar AB, Schou L (2014). Health Promotion for Patients with Diabetes: Health Coaching or Health Education? Int Dent J 64(1):20-8. doi: 10.1111/idj.12058. [Epub ahead of print] 19. O’Connor J, Lages A (2004). Coaching with NLP: How to be a Master Coach. London: Element. 20. Miller R, Rollnick S (2002) Motivational Interviewing – Preparing People for Chan- ge. New York: The Guilford Press, pp. 428. 21. Tosey P, Mathison J. Introducing Neu- ro-Linguistic Programming Surrey., UK: Centre for Management Learning and Development, School of Management, University of Surrey, 2006. Available from: http://www.som.surrey. IntroducingNLP.pdf. [Accessed April 29 2013]. 22. Bandura A. Self-Efficacy: The Exercise of Control. New York: W.H. Freeman and Company; 1997. p. 604. 22. Wolever RQ, Dreusicke M, Fikkan J et al (2010) Integrative health coaching for pa- tients with type 2 diabetes: a randomized clinical trial. Diabetes Educ 36:629-639. 23. Astrøm AN, Rise J (2001) Socio-economic differences in patterns of health and oral health behavior in 25 year old Norwegians. Clin Oral Investig 5: 122-128. 24. Donovan JE, Jessor R, Costa FM (1993) Structure of health-enhancing behavior in adolescence: a latent-variable approach. J Health Soc Behav 34: 346-362. 25. SW Butterworth, et al. Health Coaching as an Intervention in Health Management Programs. Dis Manage Health Outcomes 2007; 15: 299-307. 26. Cinar AB, Schou L. Impact of Empowerment on Toothbrushing and Diabetes Manage- ment. Accepted for publication to Oral Health Prev Dent April 2014. While dentists, physicians and diabetes educators un- dergo extensive education and training to learn ’what is best’ for patients, the education/training mostly misses ’how’ to achieve that best. ’How’ is implied in the patient’s motivation and patient’s needs to find out his/her moti- vators with support and encouragement of health care providers who can put on HC ’shoes’ . It is vital that patients learn to connect their health goals and lifestyle to a vision of health in a greater picture, which is a critical step in developing the best strategies for lasting behaviour change22 , thereby to maintain be er oral health and diabetes management. Therefore, dentists, physicians and diabetes educators need to en- gage patients under the ’umbrella’ of health behaviours considering that health behaviors including oral health co-occur as separate clusters as either health-enhancing or health-detrimental behaviors in the same individual23 . Engagement either in health-enhancing or in health- detrimental behaviors is proposed to represent an individual’s health-related lifestyle24 . HC provides a holistic communication approach to motivating and supporting patients for se ing up health goals connected to each other. HC is being increasingly incorporated into health management programs, implemented in a variety of se ings, from individual health behavioral change to disease management/health at population se ings25 .HC in dentistry can take a lead role at management of be er oral health and diabetes management considering dental professionals have more time to communicate with/treat their patients compared to other medical health care pro- fessionals. Besides, toothbrushing can be a practical start point for empowerment of other healthy behaviors, in line with earlier publication26 .Dental professional-patient communication, from simple consultations to complex treatment, can be more effective by integration of HC ’bones’. Acknowledgements We express our deepest thanks to Christian Dinesen, Danish Coaching Institute for his collaboration. Many thanks are due to our patients for their participation and cooperation.