How 'coaching' patients can deliver better health at reduced cost – Professor Peter A Mossey
The risk of death from an NCD increases based on lifestyle factors, including tobacco use, physical inactivity, diet, and the harmful use of alcohol, so ceasing such behaviours becomes of central concern.
Yet there remains little effort and expenditure put into preventive healthcare generally. Simply pushing out advice, campaigns and education programmes has been shown to be entirely ineffective.
By not being person-centred, these approaches usually are dismissed as something which happens to other people and fail to achieve changes to individuals’ behaviour.
A more scientific approach to behavioural change is required. Research has evidenced the link between effective clinician-patient communication and the adoption of better behaviours/lifestyles by patients, resulting in improved health outcomes.
Health literacy (the ability to access, understand, and apply health knowledge) is a crucial part of effective communication. For the best results, the patient must be addressed at a level they can understand but which feels personally relevant to them.
Health coaching, also called motivational interviewing, is designed to provide this person-centred communication, and has proved to be effective in leading to more positive behaviours and health outcomes. It aims to empower and motivate individuals to make changes. By voluntarily committing to improve their health, patients can tailor changes to their own needs, circumstances, values and at their own pace.
This individualised, self-determined programme can be monitored and measured over time, with successes providing the reinforcement for continued motivation and commitment.
It targets modifiable common risk factors contributing to the causes of common diseases such as diet, smoking, stress, but these all require conscious behaviour change and internal motivation.
Since health coaching communication skills can be taught and adapted to target specific risk behaviours to control the development of NCDs, the technique is ‘cascadable’. The implications are potentially very powerful, providing a sustainable and cost-effective tool for use in primary prevention.
An area which could see large improvements using this approach is oral disease. That is due to behaviours like smoking and diet which increase risks of NCDs simultaneously increasing risks of dental decay and gum diseases.
This was the logic behind the World Health Assembly’s landmark resolution to add oral diseases to the list of NCDs in May 2021, a change that signalled a new way of thinking on this issue.
The challenge facing healthcare now is building on this new thinking. Achieving this means introducing measures through communication that effectively address both oral and general health issues.
In the spirit of cooperation, doctors, dentists and healthcare workers can move towards a new era of prevention where effective communication is key. With tools like heath coaching used in a coordinated, collaborative way, prevention and behaviour change can be fundamentally reimagined, creating better health at a reduced cost.
Peter A Mossey is a fellow of the Royal Society of Edinburgh, professor of craniofacial development and associate dean for internationalisation at the University of Dundee Dental School. The RSE is Scotland's National Academy, bringing great minds together to contribute to the social, cultural and economic well-being of Scotland. Find out more at rse.org.uk and @RoyalSocEd.
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