Improving Health Literacy with Health Coaching

Improving Health Literacy
with Health Coaching
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counseling CEUs
Objectives
– Define health literacy
– Explain why health literacy is important
– Explore health literacy in a recovery oriented system of care
– Identify at least 5 ways to improve health literacy
– Explain what health coaching is
– Differentiate it from counseling or medical practice
– Describe different skills a health coach needs

What is Health Literacy
– Health literacy is the degree to which individuals can obtain, process, and understand basic health information to make appropriate health decisions.
– Includes math skills to manage levels, understand risks, measure medication, understand nutrition labels and even manage insurance.
– Includes general health information about requirements for good health including exercise, sleep, nutrition and regular checkups as well as ways to prevent or mitigate common risk factors for disease
– Only 12 percent of adults have proficient health literacy, or the skills needed to manage their health and prevent disease. 
What is Health Literacy
– Health literacy (what a person needs to know and how to help them understand and use that information) is dependent on:
– Communication skills of lay persons and professionals
– Lay and professional knowledge of health topics
– Demands of the situation/context
– Health literacy affects people's ability to:
– Find information and services
– Communicate their needs and preferences and respond to information and services
– Process the meaning and usefulness of the information and services
– Understand the choices and consequences of the information and services
– Decide which information and services they need and take action

Health Literacy Skills
– Anyone who provides health information and services needs health literacy skills to
– Help people find information and services
– Effectively communicate information about health promotion and conditions to people of varying ages, cultures and cognitive abilities.(teach back)
– Understand what people are explicitly and implicitly asking for
– Decide which information and services work best for different situations and people so they can act

Health Literate Services
– A Health Literate Case Manager or Clinician
– Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement
– Has a high level of health literacy
– Works with clients in the design, implementation, and evaluation of the service plan
– Uses health literacy strategies in communications and confirms understanding
– Provides easy access to health information and services
– Designs and distributes print, audiovisual, and social media content that is easy to understand and act on.
– Regularly addresses health literacy in high-risk situations, including care transitions and medication changes
Health Literate Services
– A Health Literate Case Manager or Clinician
– Evaluates client understanding of the condition, treatment options, and services available at admission
– Evaluates client’s understanding of general health and wellness behaviors
– Assesses client’s ability to seek out, obtain and use health-related information
– Identifies obstacles to client health literacy and set goals for improvement (unclear videos, handouts with small type, lack of clear way to transition knowledge to practice– “It is important to get enough sleep.”)
– Promotes changes in the health care system that improve health information, communication, informed decision-making, and access to health services

Health Literate Services
– A Health Literate Case Manager or Clinician
– Supports and expands local efforts to provide adult education (English and math), and culturally and linguistically appropriate health information services in the community.
– Supports efforts to provide services in people’s native language
– Builds partnerships, develop guidance, and change policies
– Schools, churches, community centers, physicians
– Advocates to increase accuracy of health information in all media programming

Good Resources
– Are accurate, accessible, and actionable
– Use plain language instead of technical terminology or confusing statistics in communications (1 in 10) (1 in 1000 vs 1/10th of a percent)
– Organize information so that the most important points come first
– Break complex information into understandable chunks
– Provide recommendations and explanations of risk and benefits that are clear, concrete, understandable to the person
– A focus on translating information from increased awareness to specific steps for action and behavioral changes. (Sleep, physical activity)

Good Resources
– Use multiple modes of communication, not just text (videos (importance of nutrition in prevention and recovery), pictures (food pyramid), experiential (measuring food))
– Respect cultural preferences and practices
– Involve members of the target population in planning, developing, implementing, disseminating, and evaluating effectiveness of information.
Dissemination Strategies
– School curricula—daycare-college
– YouTube
– Social Media
– PatientsLikeMe.com
– Podcasts
– Handouts from MDs, pharmacists, CMs, counselors, teachers, etc.
– CDC, NIMH, SAMHSA, N4A, NIDA
– News Broadcast “Minutes”
– Local magazine columns
– Mobile Apps
– Health Fairs
– Church circulars
– Libraries
– T-Shirts
– Peer facilitated education

– Where else does your population frequent?

What Do People Need to Know
– Basic health promotion behaviors and how to implement them
– Basic health needs by developmental stage
– Parenting and self-parenting skills
– Basic coping and distress tolerance skills
– Basic math and reading skills to manage nutrition, weight, blood sugar and medication
– Basic reading skills to manage learn about health and problems when they arise (warnings, contraindications, illnesses)
– Time management skills
– Communication and assertiveness skills including self-advocacy

What Do People Need to Know
– How to identify and mitigate risk and enhance protective factors for development of mood disorders, addictive behaviors and stress-related health conditions including adverse childhood experiences
– How to access accurate, understandable health-related information to identify wellness behaviors as well as symptoms of mental health, addictive or physical health problems (self-advocacy)
– How to identify community based resources (support groups, housing, medical care, transportation, childcare, respite services, etc.)
– Risks and effects of use of pornography, gambling, internet games, substances

Overview of Health Coaching
– Health coaches:
– Provide self-management support
– Educate clients
– Bridge the gap between clinician and patient
– Help patients navigate the health care system
– Offering support and encouragement
Health Coaching Research
– Significant improvements in one or more of the following
– Nutrition
– Physical activity
– Weight management
– Exercise frequency
– Perceived social support
– Patient engagement and “activation”
– Medication adherence
– Common features of effective programs are goal setting, motivational interviewing, and collaboration with health care providers
Enhancing Motivation
– Emotional (How will this help client be happier?)
– Mental (How does this make sense to the client?)
– Physical (How can this improve the client’s health and energy?)
– Social (How will it enhance important relationships? Who is supportive of this change?)
– Environmental (What things can be placed in the environment to enhance motivation)
– Spiritual (In what ways does this change help the client live more in harmony with personal values and feel a greater sense of connection?)
Motivational Techniques (ROADS)
– Reflective Listening
– Open Questions
– Affirmations of Self-efficacy and Optimism
– Develop Discrepancy
– Summarize
Adult Learning Theory
– Provide explanations of why specific concepts are being taught
– Ensure learning that is connected to their health goals (make room for meaning)
– Use self-assessments to assess different levels of prior experience and education
– Remember prior learning will be the filter with which they conceptualize new information
– Use multiple methods of instruction (auditory, visual, kinesthetic)
– Ensure access to sufficient resources
– Adult students prefer a self-directed approach that allows for discovery on their own.

Behavior Change Theory
– When presented with a need to act (behave) people choose the most rewarding
– One issue many people have is delay of gratification. They choose what is most rewarding in the moment instead of overall.
– Rewards (reinforcers) encourage a behavior to be repeated
– Consequences (punishments) discourage a behavior
– Stimuli prompt a person to engage in a behavior
Behavior Change Examples
– Emotional Eating
– Food is associated with pleasure and happy times
– Food is readily available (stimulus)
– When people are stressed or bored the sight or smell of food IRL or in the media can prompt eating behaviors
– Habit
– Sally smokes a cigarette when she is driving to work, after lunch, on the way home from work, after dinner and before bed “to relax”
– Smoking strongly activates pleasure centers in the brain
– Triggers: Car, meal time, when she needs to relax
– Goal: Make not smoking more rewarding and less punishing
Creating a Wellness Vision
– Describe your body and mind in their ideal state
– What would you look and feel like?
– What types of things would you be doing (or not doing)?
– What are the most important elements in your vision?
– Why are these elements important? (i.e. How will they improve your life?)
– Which one do you want to work on first?
– On a scale of 1-5 what is your level of confidence you can achieve this?
– What types of assistance might you need in achieving it?
– What obstacles do you anticipate and how can you deal with them?
– What strengths and resources do you have that will help you accomplish these goals
Visualize Goals
– Pictures/collages/scrapbooks
– Push notifications
– Narratives
– Charts
– Mental Imagery
Goal Setting
– KSAs
– Knowledge of
– The problem in general
– The problem for them
– General interventions
– Interventions for them
– Skills
– Demonstrate awareness and effective use of skills at appropriate times
– Abilities
– Generalize awareness and skills to other life areas

Scaffolding (GROW-ME)
– Goals are specific and shared
– Rescue (Help) is immediately available
– Optimal level of help
– Encourage self-efficacy
– Concrete prompts
– Use prior knowledge
– Use preferred learning method
– Whole-task, holistic approach
– Cognitive: What is the goal?
– Emotional: What are your concerns? Elicit confidence.
– Behavioral: What do you need to do?
– Model desired behaviors
– Empower to take chances

Summary
– Health literacy is imperative to empower people to take charge of their health and wellbeing.
– Ensure clients understand their current condition, the causes and treatment options and use that information to make an informed choice about what to do next
– Advocate to enhance health literacy from birth.
– Health coaching improves client retention and success
– Health coaches have the opportunity to
– Increase people’s health literacy
– Teach people how to enhance motivation
– Teach people how to set SMART goals
– Help people attain those goals