Psychosocial health coaching for chronically ill in a telehealth context: a pilot study
-
1
Philips Research, Netherlands
-
2
Philips Research, Acute Care Solutions, United States
-
3
Philips Research, Chronic Disease Management, Netherlands
Background
The prevalence of chronic illness has increased dramatically worldwide and will continue to grow. As such, one of the major challenges at present is to find ways to increase patients’ health and quality of life while at the same time keeping healthcare costs within bounds. As in-hospital healthcare is labor-intensive and costly as well as limited in reach and scalability, there is a growing need for remote health monitoring and care provision to patients at home, as is done in telehealth context. The effectiveness of these programs has been shown to depend for a large part on a patient’s self-management, making the provision of psychosocial care an essential element of a disease management program (cf. Lorig &Holman, 2003). However, technology-based solutions for providing psycho-social care for chronic patients are at present scarce, and if existent, limited in their scope. In the current study, the aim was to include psychosocial coaching in a telehealth program.
Psycho-social care covers a range of psychological and social factors which are important to chronically ill patients’ (ability to deal with) physical and mental health. It is important for healthcare providers to obtain an understanding of each individual patient’s needs to direct intervention efforts. To that end, we developed an online tool (More About You, henceforth MAY) which entails an assessment, leading to an enriched understanding of the patient (the profile) in an automated way and automatically suggests techniques for intervention. The pilot study described aimed to examine the feasibility and usability of the MAY for psychosocial care in a telehealth program; i.e. if structured care planning can be implemented in the regular work processes of the health coaches and if health coaches appreciate working with MAY.
Description
MAY provides a psychosocial profile of each patient, comprising factors that signify patients’ strengths and barriers related to disease management. The following factors are included: disease impact, comfort with technology, communication style preferences, coping style, patient activation (PAM; Hibbard 2004), ability for self-care, social support and well-being. The self-report questionnaire has 65 questions and is administered online. The resulting profile provides the starting point for health coaches (HCs) to choose and prioritize the needs of each individual patient in a structured and evidence-based manner. Furthermore, the MAY contains recommendations for intervention per psychosocial topic, so that communication and interventions can be tailored to specific needs. To embed MAY into a coaching process, we devised a structured psychosocial care planning approach. This structured approach includes a planning and review (PAR) form to support planning and tracking of coach visits.
First, HCs and patients fill out the MAY assessment together on a laptop, during a regular home visit. Next, the HCs discuss the outcomes with their supervisor, a social worker (SW). Together, they plan the first structured coaching meeting with the patient: from the MAY profile they identify the most urgent needs, and decide on the coaching actions. After the coaching sessions, HCs use this form to describe what has been done, the results, future plans, and a review of the meeting.
The study was designed as an experimental study with one intervention condition. Thirteen health coaches (HCs) participated; each implementing the MAY tool for structured psychosocial care with 2 patients. All patients were members of the Philips Intensive Ambulatory Care pilot telehealth program, and had at least 5 chronic illnesses. All HCs received training in MAY usage, like filling out the assessment and intervention techniques. At the end of the training and at the end of the study, HCs filled out the baseline survey on determinants of implementation, based on the MIDI (Fleuren, 2014). Descriptive statistics were used for analysis as to increase insight in determinants of usability. All the PAR forms were sent to the research team anonymously and consequently analyzed in a qualitative way in order to gain insight in the planning and reviewing process and thus feasibility.
Results: The surveys showed that coaches had positive attitudes towards working with MAY. Improvements between pre- and post survey were seen in aspects related to perceived knowledge and confidence about providing psychosocial care. HCs appreciated the structure and the insights that the protocol provided, and how it helped them reach their goals. They were however critical of the additional workload and did not always see the added benefit of the PAR form.
From the HC PAR forms, it became clear that the HCs are using the MAY recommendations to plan their coaching sessions. Noticeably, the language use suggests that it was difficult to translate the recommendations from MAY into concrete actions. The forms revealed that often goals were not set or were incomplete, and there was a lack of detail in the provided information and in the provision of next steps for coaching. HCs mostly reported that the coaching went well.
Conclusions
The results show that the structured, partly automated approach can be used in a telehealth context by means of health coaches. MAY appeared to be a suitable tool for providing input for psychosocial care. HCs attitudes towards the structured approach were positive, which is crucial to the success of the implementation of MAY. Based on these results, we recommend to continue this approach as it may strengthen the wellbeing of patients (to be evaluated in future work). However, improvements are necessary. The tool should get a better fit in the current working procedures, and support the translation from recommendations to action. Further automation may facilitate this.
In conclusion, this study shows that it is possible for HCs to implement structured psychosocial care in a telehealth program but that combining digitalized and human efforts in one structure is a challenge. The appreciation of the health coaches is an important first step in this process.
Acknowledgements
We would like to thank Margaret Comford for her support in the making of the structured care plan, the development of the study and study execution. Furthermore, we would like to thank all the participating health coaches for their effort in working with this new structured care plan and filling out the surveys.
References
Fleuren MAH, Paulussen TGWM; Van Dommelen P; Van Buuren S (20014), International Journal for Quality in Health Care, 26,5.
Hibbard JH, Stockard J, Mahoney ER, Tusler M (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research, 39.
Lorig K., Holman, H. (2003). Self-management education: History, definition, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1-7.
Keywords:
telehealth,
coaching,
Chronic Disease,
Intervention Studies,
self management
Conference:
2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016.
Presentation Type:
Poster presentation
Topic:
Practitioner
Citation:
Van Genugten
L,
Calo
R,
Van Wissen
A,
Vinkers
C and
Van Halteren
A
(2016). Psychosocial health coaching for chronically ill in a telehealth context: a pilot study.
Front. Public Health.
Conference Abstract:
2nd Behaviour Change Conference: Digital Health and Wellbeing.
doi: 10.3389/conf.FPUBH.2016.01.00108
Copyright:
The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers.
They are made available through the Frontiers publishing platform as a service to conference organizers and presenters.
The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated.
Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed.
For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions.
Received:
27 Nov 2015;
Published Online:
09 Jan 2016.
*
Correspondence:
PhD. Lenneke Van Genugten, Philips Research, Eindhoven, 5656 AE, Netherlands, lenneke.van.genugten@philips.com