A practical guide for clinicians
The Challenge
1 in 4 adults in the UK lives with two or more long-term conditions (multimorbidity) (Barnett et al., 2012).
Co-morbidities are more common in areas of deprivation and occur 10–15 years earlier in these populations.
Managing multiple conditions increases complexity for both patients and clinicians: competing priorities, treatment burden, fragmented care.
Patients often struggle to prioritise, self-manage, and stay motivated leading to poor outcomes and avoidable service use.
Why Use a Health Coaching Approach?
Health coaching helps people:
- Clarify what matters most to them across multiple conditions
- Set realistic, meaningful goals
- Build skills, confidence, and resilience to self-manage
- Navigate complex healthcare advice and treatment regimens
Rather than managing each condition separately, coaching helps individuals manage their lives with their conditions.
How Health Coaching Can Support People with Co-Morbidities
| Key Issue | How a Health Coaching Approach Helps |
|---|---|
| Polypharmacy | Shared decision-making supports medicines optimisation and deprescribing conversations |
| Conflicting Advice | Helps individuals reconcile conflicting goals (e.g., diet for diabetes vs heart disease) |
| Motivation & Commitment | Focuses on small wins, intrinsic motivation, and what energises the individual |
| Care Fragmentation | Supports better navigation of services and self-advocacy |
| Emotional Burden | Acknowledges grief, frustration, fear and builds emotional coping skills |
Health Coaching and Reducing Health Inequalities
Health inequalities are often driven by barriers to engagement, health literacy, and trust in services.
Health coaching levels the playing field by:
- Meeting individuals where they are, focusing on their goals, not just service targets
- Building health literacy, so people better understand and manage their conditions
- Supporting self-efficacy in communities where disempowerment is common
- Tailoring interventions to cultural, social, and economic contexts
Evidence shows that person-centred approaches like health coaching are particularly effective at improving outcomes in deprived populations (NHS England, 2019).
Health Coaching is for All Clinicians
| Role | Application |
|---|---|
| GPs & Nurses | Agenda-setting in annual reviews, holistic and collaborative goal setting |
| Pharmacists | Medication adherence conversations, prioritising medication goals |
| Allied Health Professionals | Integrating coaching into rehab and lifestyle support programmes |
| Specialist Nurses | Developing personalised care and support plans and enabling self-management |
| Dedicated Health & Wellbeing Coach roles | Working in depth with individuals over time, complementing clinical input |
You don’t need to be a ‘health coach’ to utilise and coaching approach.
Practical Techniques for Co-Morbidities
These approaches can be used in routine appointments, reviews, and opportunistic encounters.
| Technique | How to Use It | Why It Matters |
|---|---|---|
| Technique | How to Use It | Why It Matters |
| Agenda-Setting | At the start of the consultation, ask: “What’s most important for you to get out of today’s appointment?” | Empowers the patient to lead with their concerns. Prevents missing hidden priorities (e.g., fear of exacerbation, not just HbA1c). |
| Open Questions | Use open rather than closed questions to explore: “What matters most to you about managing your health?” | Builds trust, allows the person to frame their own health goals, rather than being task driven. |
| Scaling Confidence | “On a scale of 0–10, how confident are you that you could make that change?” “What would help move you from a 4 to a 6?” | Quickly assesses readiness and identifies barriers/supports. Opens coaching dialogue about small steps. |
| Chunking and Prioritising | Help break complex issues down: “There’s a lot going on. Which part would you like to tackle first?” | Reduces overwhelm, respects patient autonomy, increases sense of control. |
| Exploring Ambivalence | If the patient is unsure about making changes: “What are the pros and cons of doing this?” “What would be the good things about it?” | Normalises uncertainty. Helps people clarify their own motivations for change without feeling judged. |
| Normalising Struggles | Acknowledge challenges: “Many people living with multiple conditions can find it tough. It’s understandable to feel overwhelmed.” | Reduces stigma, supports resilience by validating feelings and experiences. |
| Celebrating Success | Always notice and amplify small wins: “That’s a brilliant step forward. What helped you do that?” | Strengthens self-efficacy, builds positive momentum for behaviour change. |
| Planning for Small Steps | Help design tiny, realistic next actions: “What’s one small thing you could try between now and our next conversation?” | Emphasises actionability and reduces fear of failure. Supports sustainable change. |
| Using ‘Menu of Options’ | Offer a range of evidence-based options: “There are a few ways we can support you – would you like to hear about them?” | Facilitates shared decision-making, avoids one-size-fits-all solutions, supports empowerment. |
Tips for Using These Techniques
- Tone matters: stay curious, collaborative, and supportive, not directive or prescriptive.
- Language matters: avoid jargon; match the person’s own words when possible.
- Pace matters: slow down where needed to allow reflection, especially with complex or emotionally laden issues.
Example in Practice:
During a review for a patient with diabetes and heart failure:
“Managing both your diabetes and your heart can feel like a lot. What’s the biggest thing on your mind today?”
“It sounds like you’re already doing a lot around your diet. If you had to choose one small thing to work on next, what feels manageable?”
“You’re saying you’d like to walk more. On a scale of 0–10, how confident do you feel about fitting that in this week?”
Evidence
Barnett, K. et al. (2012). Epidemiology of multimorbidity and implications for healthcare, UK. The Lancet.
NICE (2016). Multimorbidity: Clinical assessment and management (NG56). https://www.nice.org.uk/guidance/ng56
NHS England (2019). Universal Personalised Care: Implementing the Comprehensive Model.
Stacey, D. et al. (2017). Decision aids for people facing health treatment or screening decisions. BMJ Open.
Summary
Supporting people with co-morbidities:
- Requires personalised, coordinated, and empowering care
- Benefits from health coaching approaches that build ownership, skills, and resilience
- Helps to reduce health inequalities by tailoring support to individual and community needs
- Can be integrated into everyday clinical practice through small but powerful changes in how we communicate
