In my last blog, I talked about the foundations of coaching practice (or indeed any form of person-centred practice)- trust, rapport and empathy. I neglected to mention kindness and compassion which have received a lot of attention over the last few years (1). Let me tell you why…

Whilst kindness and compassion are important elements of the delivery of healthcare, there are 2 reasons why I am not as yet convinced (though you may disagree with me!) that they should replace empathy as the starting point for developing reflective, evidence-based practice.

Firstly, there are significant conceptual overlaps between empathy, compassion and kindness; they are not highly specified states of mind or states of being with clarity re: their inter-relationships. Secondly, measurement of kindness and compassion is in its infancy. Though there are emerging measures of compassion (2), kindness measures are only in the earliest stages of development (3). So, without wanting to suggest we should be unkind, how do we know how kind we are being if we don’t know how to measure it? No, my view is, for now, let’s stick with empathy measures.

Let’s move on to the purpose of coaching and how to measure the impact of your coaching practice. Most of us would agree that the primary intention of coaching is to support coachees to recognise, engage with, and mobilise their own sense of resourcefulness, to bring to awareness what really matters to them, and to problem solve and make plans about how to move forward in their lives. My view then, is that it’s our job to primarily support people to develop self-efficacy.

Self-efficacy was first described by Albert Bandura in 1977 (4) and initially described as ‘a set of beliefs that determine how well we can execute a plan of action in specified situations’. The core definition has been tested and re-tested across multiple contexts (e.g. in education, sport, business and health settings) and shown to be highly reliable, though over time others have expanded the core concepts to also include determination, perseverance and psychological flexibility (etc etc).

No matter, self-efficacy appears to be a strong candidate to help us understand the impact of coaching. As described above, self-efficacy is situational- being confident in your ability to ski down a black run is not the same as being confident in your ability to cook a perfect roast dinner. Nevertheless there are well validated generic self-efficacy scales and perhaps the most widely used is the GES (5).

When it comes to health and well-being, there are multiple measures of health-related self-efficacy. Perhaps the most widely used generic, health-related scale is the Patient Activation Measure- the PAM (6). The measure has been used world-wide for 20 years (7) and is highly validated. Improvements in PAM lead to improvements in multiple ‘down-stream’ indicators such as clinical outcome measures, PROMs and quality of life (QOL) measures. More on these measures in the next blog.

There are also multiple condition specific health-related self-efficacy measures (eg 8). These measures often include quite detailed domains to do with the medical management of the underlying condition and are perhaps therefore not the right tools for you as a coach unless you work specifically in, for instance, a pain clinic or a diabetes service.

Our view in TPCH is that generic self-efficacy or generic health-related self-efficacy measures might be helpful for you to help demonstrate the impact of your coaching. However, the PAN is not free to use, so what should you use if you don’t have the PAM?

There are a number of tools to consider and I’m just going to outline them here, before considering them in more detail in my next blog.

Firstly, there are single item questions such as:

1. ‘How confident are you that you can manage any issues arising from your condition(s)?’ (4 item responses ranging from ‘very confident’ to ‘not at all confident’ plus a ‘don’t know’ response)
2. ‘How would you rate your ability to manage your own health and wellbeing?’ (4 item responses ranging from ‘not very’ to ‘very’)
3. ‘How good are you at taking care of yourself and staying healthy?’ (4 item responses ranging from ‘not very’ to ‘very’)
4. ‘How confident are you that you can control or manage your health problems?’ (0-10 scale)

There are a number of multi-item ‘health confidence’ questionnaires, including a 4-item questionnaire that has been developed by the R-Outcomes team (9).

Lastly, the ‘Patient Enablement Instrument’ (10) is a 6-item measure that has been used worldwide for over 20 years.

I’ll consider the pros and cons of these ‘fast and frugal’ measures in my next blog, as well as other measures you could consider, including quality of life measurement tools. Meantime, please give feedback on this blog. I’m bound to have missed important
questionnaires that you know about, so please let us know!