Health coaching for preventive care?

At the recent Malaysian Innovative Healthcare Symposium (MIHS), a forum on ‘The Leading Edge of Health Coaching: Empowering Patients in the Myriad of Daily Health Decisions’ took place with panelists Dr Tiffanie Ong, CEO of health coaching startup Naluri; Gina Koay Wan Lee, chairman of WomenBizSense; and Associate Professor Dr Rosmini Omar, Patients for Patient Safety (PfPSM) committee member, Malaysian Society for Quality in Health (MSQH) sharing their views. The following are excerpts from the ensuing dialogue, moderated by Lim Jack Shen, Malaysian Pharmaceutical Society (MPS) treasurer.

What is health coaching?

Tiffanie (T): Health coaching is a broad term that everyone can define in different ways. The way that I define it is specifically in terms of whether clinically significant health outcomes can be achieved through using it.

Gina (G): Just as coaches exist in business and sports, they do in health as well. Coaches are people who help a person to achieve their objectives. In the health sense, it means helping someone reach their health outcomes they want. A person with diabetes may want to improve their blood sugar levels; a person with obesity may want to move from a size XL to size M.

To me, anyone can be a health coach. There are many business models in the US and elsewhere; I took a 1-year certification programme in the US on health coaching itself. In the US, doctors, pharmacists, nurses, medical assistants, and anyone interested in the field can get trained. But in Malaysia, there is currently no specific model for health coaching.

In the health coaching that I do in my own setting, I’ve set up a framework you might be familiar with. [It addresses] things like: who’s going to be the coach? Are they trained? How is the coaching structured? Who is the target customer, and who do you get referrals from? Who are the people who really need help? What are the means of assessment, and how often will the coach see them? What are the improvements you can expect to see during that duration?

How about fees? In my case, at the moment, there’s no fee charging in a pharmacy setting. ... Health coaching comes as a complementary service in a way, as an addition to the tools involved—medicines, supplements, diet aids, etc—because I don’t think anyone wants to hear “I’m charging you RM100 per session” in a pharmacy setting at the moment.

Can health coaching happen in Malaysia today?

T: Is Malaysia ready to utilize health coaching on top of primary and secondary care? My short answer is yes, one hundred percent, because of increased awareness among Malaysians about becoming healthier.

G: I agree, but if we don’t have a national health scheme … the issue is public-private sector integration. I feel that both sectors are getting stronger and have their capable HCPs, but the roles of both sides in this aspect of care need to be worked out.

How valuable is health coaching from a patient perspective?

Rosmini (R): From the patient perspective, I think what we would gain is empowerment. Because the rest of the time … in several pocket populations of Malaysia, we have several classes of people in terms of economics, education, etc. The idea for most Malaysians, especially those in rural areas, is that they see doctors as God, or someone to be afraid of. What they normally do is go to a doctor when they’re sick, and in front of the doctor they’ll say “ya, ya, pak cik, faham, I will do that.” But when they go back home, it’s Christmas for them in terms of food and other things.

But I think health coaching will give us a different perspective; it will empower them through more awareness of our health, and therefore provide an inner motivation to improve our health, rather than waiting till we’ve gotten sick and in need of a cure. [Health coaching] is timely because our society today is becoming increasingly educated; but although patient groups may be saying, “Yes, we’re ready for health coaching,” there are things that the whole ecosystem—the policymakers, the ministry, the industry, and the overall public—must consider together.

How does health coaching fit into the larger national healthcare narrative?

T: It’s a fundamental shift from today’s disease-based model to a more wellness-based, preventive model. If you consider the word ‘health’, it refers to a state of physical and emotional well-being; but often when we think about being healthy, we think about curing a disease. There’s always been less of a focus on prevention.

And I think this is where health coaching comes in. It’s a difficult journey because prevention isn’t something you can see, so it’s almost like playing a risk game. We might say to patients: “We are here to coach you because we want to prevent you from getting sick in 5 years.” The most common things I end up hearing in reply are things like: “How do you know what’s going to happen to me in 5 years? Why do I need to start getting healthier today? If you look at the probability of smokers getting lung cancer, maybe I’m in the percentage that won’t get it.”

That’s the constant battle we face in the health coaching space. Nonetheless, it needs to happen so that we’re serving the true purpose of health, which is to take care of an individual’s complete state of physical and emotional well-being.

Who should be a health coach?

G: I think the ideal health coach would be a HCP. But the thing about the current health model we have is that doctors may not have time to spend with patients. Let’s say you go to a specialist clinic; you might have paid between RM60 and RM100 or more just to see them. But when you go in, the specialist may spend no more than a few minutes with you and just ask a few questions … sometimes HCPs may not have time to spend on engaging patients.

From my own experience as a community pharmacist, I can spend time with patients. CPs can be health coaches. In other [healthcare] models … I have a friend who’s a health coach in Hong Kong. She’s actually a psychologist with an interest in that area, and she collaborates with doctors. And there’s a setting where before you even go in to see the doctor, you have to see a nurse first. You’ll check your weight, temperature, and so on, and then you also have a health coach waiting for you who asks certain assessment questions to get you ready physically and mentally before seeing the doctor.

I would say that a HCP who is fluent in the language of health is the ideal health coach, but I have seen nurses and medical assistants who are also health advisors, as they have an interest in that field.

What role would health coaches play in changing patient behavior?

R: In my view, coaching is about facilitation. The traditional approach to medicine, whether preventive or curative, is more dictating about medicines and other instructions. But from what I understand from the fields of business and education, the coach should help facilitate the learning process; in this case, learning to understand one’s own body. And later, the coach could move their guidance from the individual [patient] to the group of peers around them, the closest being the family, so each family member could help support each other’s lifestyle as well.

The patient can be the best champion of their own health. But on the patient’s side, we also need someone we can trust, and therefore we would like to have those that coach us as those who have the knowledge to do so, to help inform us on the most effective way of caring for our health. That’s why certification matters, because that builds up trust.