Health coaching and motivational interviewing: evaluating the chronic disease self-management toolbox as a tool for person-centered healthcare

Abstract

Objective: Many tools have been developed to assist patients in the self-management of chronic disease. Despite the role of clinicians in guiding patients to positive health outcomes, there has been little investigation of the tools from their perspective. The aim of this study was to investigate the preferences and motivations with which health professionals use chronic disease self-management (CDSM) tools as vehicles to improve the person-centeredness of clinical care. Method: Data collection was conducted in three phases comprising key informant interviews, piloting of data collection materials and interviews with CDSM practitioners. Findings: Key informant interviews established a need to explore clinicians’ use of health coaching and motivational interviewing in CDSM. While all participants used multiple tools for CDSM, there was a strong preference for health coaching for its effectiveness, adaptability and strong applicability to CDSM. There was widespread use of motivational interviewing, yet it was the least preferred tool. A third tool, Acceptance and Commitment Therapy (ACT), was considered to produce positive outcomes by reducing patient barriers. However, it was of limited applicability to CDSM. Four themes emerged as determinants of clinicians’ tool preferences and use: (i) strengths and weaknesses; (ii) flexibility; (iii) skills and (iv) barriers to implementation. Conclusion: Beyond descriptions of individual tools, this study shows how health professionals adopt a ‘toolbox’ approach to tailor CDSM to their patients. Adaptable and flexible tools such as health coaching and motivational interviewing empower clinicians to meet the complex needs of people living with chronic disease and to increase the person-centeredness of clinical care. However, workplace and patient barriers continue to impact on the acquisition of patients’ self-management skills and the satisfaction of health professionals working to achieve better patient outcomes.