Australian Journal of Primary Health — Vol. 9, No. 2&3, 2003 1 Coaching for Behaviour Change in Chronic Disease: A Review of the Literature and the Implications for Coaching as a Self-management Intervention Helen Lindner 1 , David Menzies 2 , Jill Kelly 2 , Sonya Taylor 2 , and Marianne Shearer 2 La Trobe University 1 and Whitehorse Division of General Practice 2 Self-management is a necessary aim in the treatment of chronic illnesses, such as diabetes, heart disease, arthritis, lupus, and chronic obstructive pulmonary disease. Although the effective treatments are available for these serious conditions, the rate of adherence to medication, dietary changes, physical activity, blood monitoring, or attendance to regular medical screenings is reported to be approximately only 50%. The role of health professional support in effective self-management of chronic illness has been recently acknowledged. Furthermore, numerous studies on professional support for self-management of chronic illness have focused on the health professional as a “coach”. Coaching has been defined as an interactive role undertaken by a peer or professional individual to support a patient to be an active participant in the self- management of a chronic illness. A review of the literature revealed a limited number of empirical studies on coaching, with these focusing on one of three areas: disease-related education; behaviour change strategies; or, psychosocial support. Due to the small number of research investigations, only tentative support can be given to the efficacy of the different coaching approaches. However, it was apparent that education-based interventions have a significant role in self-management, but that these were not sufficient by themselves. The role of behaviour change-focused coaching was also shown to be an important factor. However, not all patients are ready for change, and therefore the need for coach interactions that move a patient to a stage of action were evident, as was the need to consider the emotional state of the patient. The challenges for future research is to investigate the relative strengths of these coaching approaches for the support of patient self-management of chronic illness, and the means to effectively integrate these approaches into routine health care, through a wide range of health professional groups. Key words: Health coaching, Health professional patient support, Chronic illness, Self-management, Adherence Chronic diseases, such as heart disease and diabetes, pose significant concerns for western societies (Sabate, 2002). Cardiovascular disease has been identified as a major cause of death in the western world (Mathers, Vos, Stevenson, & Begg, 2000; National Heart Foundation, 1999; Rich- Edwards, Manson, Hennekens, & Buring, 1995), and diabetes has been reported to affect approximately 150 million people world-wide (King, 1999). Positive health outcomes for chronic illness require both effective treatments and adherence to these treatments (Haynes, 2001). In fact, Dunbar- Jacob et al. (2000) reported that adherence was a major factor in treatment effectiveness. However, a review by Haynes found that adherence to treatment for a chronic medical condition was generally only 50%. Furthermore, adherence to health-related lifestyle changes has also been found to be less than satisfactory (Myers & Midence, 1998). Research has suggested that interventions aimed to improve adherence to medical treatment of chronic illness, based on self-management strategies, have been found to improve the health status of the patient and reduce the costs and usage of health services (e.g., Massanari, 2000; Valenti, 2001; Wahl & Nowak, 2000). The role of professional support in the self- management of chronic illness has more recently been investigated (e.g., Doherty, Hall, James, Roberts, & Simpson, 2000; Reda & Makhoul, 2003). Numerous studies on professional support for self- management of chronic illness have focused on the health professional as a “coach” (e.g., Axelrod, Zimbro, Chetney, Sabol, & Ainsworth, 2001; Samarel & Fawcett, 1992). Wilkie, Williams, Grevstad, and Mekwa (1995) defined coaching “as a method of patient education that guides and prompts a patient to be an active participant in