Becoming more evidence based as a health coach
We all try to do our best for the clients/patients we see. But what does ‘doing our best’ really mean? To my mind it’s about ensuring that our daily work is informed by evidence (which usually comes from studies on populations of people) and that it is tailored to the assets, values, goals and preferences of individuals.
Evidence based healthcare `(cf evidenced based medicine) has deep roots but only really began to gain widespread acceptance in the 1980s and 90s thanks to the pioneering work of a few people in a handful of centres worldwide (1). I was privileged to work in one of those centres (Oxford) and to experience the movement growing around me; it was quite exhilarating. In just a short time-frame, evidence-based healthcare replaced ‘expert-based healthcare’ and is now an accepted philosophy for health services worldwide, though it is not without its critics (2).
But what does it mean as applied to health coaching?
For me, health coaching is primarily about supporting people to consider and bring about change in their lives. At a deeper level it’s about re-writing the story of who we are- see for instance (3) which is quite a ‘medical’ take on story telling but insightful nevertheless. Some might say that change is about setting goals and working towards them. I’m not sure I agree; I think it’s about learning and adaptation and whilst setting goals and action plans might be a way of supporting people to change, many believe that if people set goals and don’t attain them, the approach can lead to a feeling of failure and disengagement (4).
Whatever the overall purpose of health coaching is, the problem is that it is not like a pill. It doesn’t have a single active ingredient- it’s more of a toolbox of evidence informed ways of working that come from disparate sources. And to add another layer of complexity, many of the concepts are (to quote my great friend Alan Cribb) ‘volatile and contested’.
Digging into all of this, my starting point is that coaching is relational. It builds on a foundation of trust, rapport and empathy. None of the other ingredients work of we don’t have those foundations. And if you start to dig a little deeper into definitions of these foundations, everything becomes a little murky. There are, for instance, multiple ‘determinants’ of each of these principles, many of which overlap. My overview is this:
1. Trust is my experience of the other in terms of my perception of their honesty, integrity, dependability, confidentiality and competence (5). It is primarily (though not entirely) my appraisal of them (in the healthcare context) as a professional
2. Rapport is more relational and there isn’t an accepted definition of what ‘it’ is (6) though there appears to be agreement that it is a term applied to a ‘harmonious relationship’ between clients and professionals (7)
3. Empathy takes us to a different level. Again, the underpinning determinants are contested but most agree that it is the ability to understand and share another person’s feelings (8)
There is now a considerable literature on empathy (9) and a national centre in Leicester (10). My view is that this is the cornerstone of health coaching and if we want to practice evidence informed coaching, empathy is our starting point.
So how do we measure it? Well, there are numerous scales that attempt to measure health professional empathy – and these scales are either self-report, observer report or patient report. 2 to consider are the Jefferson scale (the JSE- a self-report measure) (11) or CARE which is a patient reported measure (12,13).
Whichever scale you use, think of it as an opportunity to learn. There are many ways of doing this, including setting up a small group of peers where you can learn from each other, perhaps in a facilitated conversation.
I used CARE in my own practice – surveying 30 patients every 6 months – and found it really helpful to discuss the reports with a psychologist with whom I had regular supervision (yes, I was that lucky). It’s a foundation of coaching but it is only one of the core ingredients. In my next blog, I’ll talk about other ingredients that are important and that can be measured.
Please give me feedback on this article. You may agree – you may not. You’ll almost certainly have a different perspective, so I welcome your views.
1. https://www.bmj.com/content/348/bmj.g371
2. https://www.bmj.com/content/348/bmj.g3725
3. https://www.researchgate.net/publication/317336502_Acceptance_and_Commitme
nt_Therapy_and_the_Cognitive_Behavioral_Tradition
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851389/
5. https://journals.sagepub.com/doi/full/10.1177/2050312116664224
6. https://pubmed.ncbi.nlm.nih.gov/34154861/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8806294/
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151200/
9. https://postgraduateeducation.hms.harvard.edu/trends-medicine/building-
empathy-structure-health-care
10. https://le.ac.uk/empathy
11. https://link.springer.com/article/10.1007/s44250-023-00020-2
12. http://www.sspc.ac.uk/media/Media_705350_smxx.pdf
13. https://caremeasure.stir.ac.uk