Research at Oregon Health and Science University in the U.S. revealed the most common reasons why people don’t change behavior.
Their values don’t support it.
They don’t think it’s important.
They don’t think they can.
They haven’t worked through their ambivalence.
They aren’t ready for it.
They don’t have a good plan.
They don’t have adequate social support.
Notice that “lack of knowledge” isn’t on this list. A few years ago, the motivation for me personally to change my exercise level and dietary habits to address my high cholesterol had more to do with the personal implications for my life than my knowledge about my condition or its potentially detrimental effects. After all, I’m a cardiovascular clinical nurse specialist. I enjoyed eating and didn’t want to give up the foods I love. Regular exercise only dropped my total cholesterol by nine points and barely budged my HDL/LDL. I was disappointed and torn between the two choices. Such is the difficulty with health behavior change.
The traditional approach to health teaching directs information “at” the patient/client, expecting compliance. In essence, a healthcare provider’s goal is to have the patient/client do the things we determine they need to do; most often as the result of the diagnosis, condition, or prescribed treatment plan. Our expectation is that if we impart this knowledge to the patient/client and family, they will and should comply. Generally, this “knowledge-only” based approach has little concern for how this affects the social context of the patient/client’s life.
Dr. William Miller, originator of Motivational Interviewing, suggests that people have difficulty with changing behavior, not because they don’t understand its downside, but because they have conflicting feelings about it. Consider these examples: “I would exercise, but I’m just too tired when I get home”. “I know that I should eat more fruits and vegetables, but I don’t have time to cook.” “I had my new prescription filled, but the more I thought about taking it, the more concerns I had. So, I haven’t started it.”
Dr. Miller goes to say that it’s the “but” in the middle that maintains the patient’s status quo or ambivalence about the change. As healthcare providers, we can “tell” individuals what to do and “teach” them how to do. However, guiding them to explore their ambivalence about their condition or situation is the key to tapping into their own motivation to do something about it.
Evidence-based Health Coaching (EBHC) is not counseling, but skilled conversation that engages individuals to discuss their health and health conditions within the social context of their lives, to identify their own values, beliefs, and concerns that support or hinder lifestyle change needed to improve health, wellness or recovery. EBHC replaces the traditional “Do as I tell you” model of healthcare with guidance that taps into the patient/client’s own personal motivation to change.
In health coaching, the clinician’s role changes dramatically. We become the patient’s partner and guide to achieve what the patient wants to achieve while integrating health teaching along the way.
It takes both the healthcare provider’s expertise in medicine and health to guide the patient/client safely to achieve health-related goals when chronic conditions and health risk(s) are present and the patient/client’s expertise about their own life to jointly established a 50/50 partnership in health achieving goals far beyond what can be achieved alone.
Note this example of traditional health teaching versus evidence-based health coaching in two patient/client scenarios:
Patient/Client: “I don’t think I can lose weight, but my doctor says I have too."
Traditional Provider: "He’s right! Your blood pressure can lead to stroke.”
Nurse Health Coach Response: (with empathy) “What are your thoughts about losing weight?”
Patient/Client: "I want to start exercising, but I get home so late after work. I’m just too tired.”
Traditional Response: “Everybody needs exercise. Maybe a different time of day?"
Nurse Health Response: “It’s hard to be in the mood for exercise when you're tired. What do you think might work for you?”
While the traditional method is well-intentioned, it misses the opportunity to engage in a conversation with the patient/client about what they think will work for them.
Meet the patient/client where they are!
Addressing the concern as the patient conveys it is only the beginning of a series of conversations that use scientific strategies to guide the patient/client to talk about the change(s) he/she wants to make and to help them move safely and knowledgeably toward it!