Empirical Studies
The effects of health coaching on frequent attenders’ adherence to health regimens and lifestyle factors: a quasi-experimental study
Kirsi Kivelä PhD,
Satu Elo PhD,
Helvi Kyngäs PhD,
Maria Kääriäinen PhD,
Corresponding Author
Kirsi Kivelä PhD
Service Manager
Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
Correspondence to:
Kirsi Kivelä, Research Unit of Nursing Science and Health Management, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
E-mail: [email protected]
Search for more papers by this authorSatu Elo PhD
Principal Lecturer
Lapland University of Applied Sciences, Kemi, Finland
Search for more papers by this authorHelvi Kyngäs PhD
Professor
Medical Research Center Oulu, University Hospital, University of Oulu, Oulu, Finland
Search for more papers by this authorMaria Kääriäinen PhD
Professor, Consultant
Research Unit of Nursing Science and Health Management, Oulu University Hospital, University of Oulu, Oulu, Finland
Search for more papers by this authorKirsi Kivelä PhD,
Satu Elo PhD,
Helvi Kyngäs PhD,
Maria Kääriäinen PhD,
Corresponding Author
Kirsi Kivelä PhD
Service Manager
Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
Correspondence to:
Kirsi Kivelä, Research Unit of Nursing Science and Health Management, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.
E-mail: [email protected]
Search for more papers by this authorSatu Elo PhD
Principal Lecturer
Lapland University of Applied Sciences, Kemi, Finland
Search for more papers by this authorHelvi Kyngäs PhD
Professor
Medical Research Center Oulu, University Hospital, University of Oulu, Oulu, Finland
Search for more papers by this authorMaria Kääriäinen PhD
Professor, Consultant
Research Unit of Nursing Science and Health Management, Oulu University Hospital, University of Oulu, Oulu, Finland
Search for more papers by this authorClinical Trial Registration number ID: NCT04134858.
Abstract
Aims
The aim of this study was to evaluate the effects of nurse-led health coaching on adherence to health regimens and lifestyle factors among frequent attenders in primary health care.
Methods
One hundred and ten patients were enrolled in the quasi-experimental study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received conventional care at primary healthcare centres between 2015 and 2016. Data were collected before the intervention and 12 months afterwards using a questionnaire on adherence to health regimens and lifestyle factors. The intervention consisted of individual health coaching provided by a nurse, health-coaching sessions, and a written action plan.
Results
Frequent attenders exhibited good adherence to health regimens. After the intervention, there were no significant differences in adherence to health regimens and/or lifestyle factors between the experimental and control groups. However, nurse-led health coaching improved adherence to health regimens and physical activity in the experimental group.
Conclusion
Nurse-led health coaching appears to promote participation and adherence to health regimens among frequent attenders at primary healthcare facilities. Before starting the health-coaching programme, it is recommended to carefully specify the content of health coaching and test the nurses’ health-coaching competence.
Conflicts of interest
No conflicts of interest have been declared by the authors. The authors alone are responsible for the content and the writing of the paper.
References
- 1Vedsted P, Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health 2005; 119: 118–37.
- 2Leskelä R, Komssi V, Sandström S, Pikkujämsä S, Haverinen A, Olli S-L, Ylitalo-Katajisto K. Heavy users of social and health care services in the city of Oulu. Suom Laakaril 2013; 48: 3163–9.
- 3Karlsson H, Joukamaa M, Lahti I, Lehtinen V, Kokki-Saarinen T. Frequent attender profiles: different clinical subgroups among frequent attender patients in primary care. J Psychosom Res 1997; 42: 157–66.
- 4Jatic Z, Jatic D. Socio-demographic and health characteristics of frequent attender in family practice. HealthMED 2008; 2: 206–13.
- 5van Steenkiste B, Knevel MF, van den Akker M, Metsemakers JF. Increased attendance rate: BMI matters, lifestyles don’t. Results from the Dutch SMILE study. Fam Pract 2010; 27: 632–7.
- 6Norton J, David M, De Roquefeuil G, Boulenger J, Car J, Ritchie K, Mann A. Frequent attendance in family practice and common mental disorders in an open access health care system. J Psychosom Res 2012; 72: 413–8.
- 7Smits FT, Brouwer HJ, ter Riet G, van Weert HC. Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders. BMC Public Health 2009; 9: 36.
- 8Gili M, Luciano JV, Serrano MJ, Jimnez R, Bauza N, Roca M. Mental disorders among frequent attenders in primary care: a comparison with routine attenders. J Nerv Ment Dis 2011; 199: 744–9.
- 9Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Smeets HM, Bosmans JE, Schene AH, Van Weert HC, ter Riet G. Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data. BMC Fam Pract 2013; 14: 138.
- 10Buja A, Toffanin R, Rigon S, Lion C, Sandon P, Carraro D, Damiani G, Baldo V. What determines frequent attendance at out-of-hours primary care services? Eur J Public Health 2015; 25: 563–8.
- 11Kaattari A, Tiirinki H, Turkki L, Nordström T, Taanila A. Characteristics of frequent users of primary care. Sos Laaketiet Aikak 2015; 52: 191–201.
- 12Dinkel A, Schneider A, Schmutzer G, Brähler E, Häuser W. Family physician–patient relationship and frequent attendance of primary and specialist health care: results from a German population-based cohort study. Patient Educ Couns 2016; 99: 1213–19.
- 13Glaser J, Van Os J, Portegijs PJ, Myin-Germeys I. Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitioners. J Psychosom Res 2006; 61: 229–36.
- 14Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Schene AH, van Weert HC, ter Riet G. Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. J Psychosom Res 2014; 77: 492–503.
- 15Pymont C, Butterworth P. Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare. BMJ Open 2015; 5: e008975.
- 16Kapur N, Hunt I, Macfarlane G, McBeth J, Creed F. Childhood experience and health care use in adulthood. Br J Psychiatry 2004; 185: 134–9.
- 17Koskela T, Ryynänen O, Soini EJ. Risk factors for persistent frequent use of the primary health care services among frequent attenders: a Bayesian approach. Scand J Prim Health Care 2010; 28: 55–61.
- 18Hirsikangas S, Kanste O, Korpelainen J, Kyngäs H. Adherence to health regimens among frequent attenders of Finnish healthcare. Int J Circumpolar Health 2016; 75: 30726.
- 19Smits FT, Wittkampf KA, Schene AH, Bindels PJ, van Weert HC. Interventions on frequent attenders in primary care. Scand J Prim Health Care 2008; 26: 111–6.
- 20Haroun D, Smits F, van Etten-Jamaludin F, Schene A, van Weert H, ter Riet G. The effects of interventions on quality of life, morbidity and consultation frequency in frequent attenders in primary care: a systematic review. Eur J Gen Pract 2016; 22: 71–82.
- 21Olsen JM, Nesbitt BJ. Health coaching to improve healthy lifestyle behaviors: an integrative review. Am J Health Promot 2010; 25: e12.
- 22Kivelä K, Elo S, Kyngäs H, Kääriäinen M. The effects of health coaching on adult patients with chronic diseases: a systematic review. Patient Educ Couns 2014; 97: 147–57.
- 23Hale R, Giese J. Cost-effectiveness of health coaching. Prof Case Manag 2017; 22: 228–38.
- 24Jørgensen JT, Andersen JS, Tjønneland A, Andersen ZJ. Determinants of frequent attendance in Danish general practice: a cohort-based cross-sectional study. BMC Fam Pract 2016; 17: 9.
- 25Hirsikangas S, Kanste O, Korpelainen J, Kyngäs H. The effects of intervention on frequent attenders’ adherence to health regimens, depression, somatization and hypochondriasis. J Nurs Educ Pract 2017; 7: 98–106.
10.5430/jnep.v7n9p98 Google Scholar
- 26Hirsikangas S, Kanste O, Korpelainen J, Bloigu R, Kyngäs H. The effects of intervention on the quality of life, sense of coherence and daily activities of frequent attenders. J Nurs Educ Pract 2018; 8: 63–71.
10.5430/jnep.v8n2p63 Google Scholar
- 27Palmer S, Tubbs I, Whybrow A. Health coaching to facilitate the promotion of healthy behaviour and achievement of health-related goals. Int J Health Promot Educ 2003; 41: 91–93.
10.1080/14635240.2003.10806231 Google Scholar
- 28Hayes E, McCahon C, Panahi MR, Hamre T, Pohlman K. Alliance not compliance: coaching strategies to improve type 2 diabetes outcomes. J Am Acad Nurse Pract 2008; 20: 155–62.
- 29Kivelä K, Elo S, Kääriäinen M. Frequent attenders in primary health care: a concept analysis. Int J Nurs Stud 2018; 86: 115–24.
- 30Strömberg A. Patient-related factors of compliance in heart failure: some new insights into an old problem. Eur Heart J 2006; 27: 379–81.
- 31Kähkönen O, Kankkunen P, Saaranen T, Miettinen H, Kyngäs H, Lamidi M. Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention. J Adv Nurs 2015; 71: 2364–73.
- 32Oikarinen A, Engblom J, Kääriäinen M, Kyngäs H. The effects of risk factor-targeted lifestyle counseling intervention on working-age stroke patients' adherence to lifestyle change. Scand J Caring Sci 2017; 31: 555–68.
- 33Lunnela J, Kyngäs H, Hupli M. Compliance of a patient with glaucoma and associated factors. Hoitotiede 2006; 18: 151–9.
- 34Kääriäinen M, Paukama M, Kyngäs H. Adherence with health regimens of patients on warfarin therapy. J Clin Nurs 2013; 22: 89–96.
- 35Kyngäs H, Skaar-Chandler C, Kroll T. The development of an instrument to measure the compliance of adolescents with chronic disease (CDCI). J Adv Nurs 2000; 32: 1499–506.
- 36 WHO. Global status report on noncommunicable diseases 2010. 2011, World Health Organization, https://www.who.int/nmh/publications/ncd_report_full_en.pdf (last accessed 12 May 2020).
- 37Carmona-Teres V, Lumillo-Gutierrez I, Jodar-Fernandez L, Rodriguez-Blanco T, Moix-Queralto J, Pujol-Ribera E, Mas X, Batlle-Gualda E, Gobbo-Montoya M, Berenguera A. Effectiveness and cost-effectiveness of a health coaching intervention to improve the lifestyle of patients with knee osteoarthritis: cluster randomized clinical trial. BMC Musculoskelet Disord 2015; 16: 38.
- 38Huffman MH. Health coaching: a fresh, new approach to improve quality outcomes and compliance for patients with chronic conditions. Home Healthc Now 2009; 27: 490–6.
10.1097/01.NHH.0000360924.64474.04 Google Scholar
- 39Simmons LA, Wolever RQ. Integrative health coaching and motivational interviewing: synergistic approaches to behavior change in healthcare. Glob Adv Health Med 2013; 2: 28–35.
- 40Wolever RQ, Dreusicke MH. Integrative health coaching: a behavior skills approach that improves HbA1c and pharmacy claims-derived medication adherence. BMJ Open Diabetes Res Care 2016; 4: e000201.
- 41Tülüce D, Kutlutürkan S. The effect of health coaching on treatment adherence, self-efficacy, and quality of life in patients with chronic obstructive pulmonary disease. Int J Nurs Pract 2018; 24: e12661.
- 42Roldan PC, Ho GY, Ho PM. Updates to adherence to hypertension medications. Cur Hypertens Rep 2018; 20: 34.
- 43Wu J, Cummings DM, Li Q, Hinderliter A, Bosworth HB, Tillman J, DeWalt D. The effect of a practice-based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care. J Clin Hypertens 2018; 20: 757–64.
- 44Munro BH. Statistical Methods for Health Care Research. 2005, Lippincott Williams & Wilkins, Philadelphia, PA.
- 45Kyngäs H. A theoretical model of compliance in young diabetics. J Clin Nurs 1999; 8: 73–80.
- 46Ylimäki E, Kanste O, Heikkinen H, Bloigu R, Kyngäs H. The effects of a counselling intervention on lifestyle change in people at risk of cardiovascular disease. Eur J Cardiovasc Nurs 2015; 14: 153–61.
- 47Oikarinen A, Engblom J, Kyngäs H, Kääriäinen M. A study of the relationship between the quality of lifestyle counselling and later adherence to the lifestyle changes based on patients with stroke and TIA. Clin Rehabil 2018; 32: 557–67.
- 48Borodulin K, Saarikoski L, Lund L, Juolevi A, Grönholm M, Helldán A, Peltonen M, Laatikainen T, Vartiainen E. Kansallinen FINRISKI 2012-terveystutkimus-osa I: Tutkimuksen toteutus ja menetelmät. 2013, http://urn.fi/URN:ISBN:978-952-302-053-5 (last accessed 12 May 2020).
- 49Yamada T, Ishiguro A, Kyngäs H. Assessment of reliability and validity of a Japanese version of the asthma compliance instrument (a questionnaire). J Med Biol 2009; 5: 143–51.
- 50Wales S, Crisp J, Fernandes R, Kyngäs H. Modification and testing of the chronic disease compliance instrument to measure treatment compliance in adolescents with asthma. Contemp Nurse 2011; 39: 147–56.
- 51Kähkönen O. Adherence to treatment of patients with coronary heart disease after a percutaneous coronary intervention. Publications of the University of Eastern Finland. 2017, Jyväskylä, Grano Oy.
- 52 Finnish Advisory Board on Research Integrity. Responsible Conduct of Research and Procedures for Handling Allegations of Misconduct in Finland. 2012, TENK, Helsinki.
- 53Johnson C, Saba G, Wolf J, Gardner H, Thom DH. What do health coaches do? Direct observation of health coach activities during medical and patient-health coach visits at 3 federally qualified health centers. Patient Educ Couns 2018; 101: 900–7.
- 54Wolever RQ, Simmons LA, Sforzo GA, Dill D, Kaye M, Bechard EM, Southard ME, Kennedy M, Vosloo J, Yang N. A systematic review of the literature on health and wellness coaching: defining a key behavioral intervention in healthcare. Glob Adv Health Med 2013; 2: 38–57.
- 55Gannon M, Qaseem A, Snow V, Snooks Q. Using online learning collaboratives to facilitate practice improvement for COPD: an ACPNet pilot study. Am J Med Qual 2011; 26: 212–9.
- 56Vin A, Schneider S, Muir KW, Rosdahl JA. Health coaching for glaucoma care: a pilot study using mixed methods. Clin Ophthalmol 2015; 9: 1931.
- 57Oliveira JS, Sherrington C, Amorim AB, Dario AB, Tiedemann A. What is the effect of health coaching on physical activity participation in people aged 60 years and over? A systematic review of randomised controlled trials. Br J Sports Med 2017; 51: 1425–32.
- 58Matalon A, Nachmani T, Rabin S, Maoz B. The narrative approach as an effective single intervention in functional somatic symptoms in a multi-disciplinary referral clinic for primary care frequent attenders. Fam Pract 2004; 22: 114–7.
- 59Matalon A, Nahmani T, Rabin S, Maoz B, Hart J. A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics and their use of medical resources. Fam Pract 2002; 19: 251–6.
- 60Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, Hunter B, Wheeler AJ. Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect 2015; 18: 312–24.
- 61Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice. 2012. 9th edn., Lippincott Williams & Wilkins, Philadelphia.
