Training health coaches in primary-care clinics to empower people with chronic diseases

From brief primary-care encounters to language barriers, the constraints of the health care system present challenges for Latinos with chronic diseases in California’s Central Valley. The Betty Irene Moore School of Nursing at UC Davis developed a sustainable program whereby Central Valley primary-care centers prepare medical assistants and nurses to be health coaches.

“We initially listened to the challenges that nursing leadership faced and recognized their desire to improve quality of care and care coordination efforts,” explained Victoria Ngo, health coaching program director. “After an assessment, we customized the UC Davis medical assistant health coaching curriculum, focusing on diabetes and hypertension. These are chronic conditions that can be managed effectively when people take ownership of their disease.”

Yessi Hernandez-Ovegel, left, a medical assistant at Golden Valley Health Centers, role plays with fellow health coaching student Lola Roth, a medical assistant with Livingston Community Health.

Through their community clinics, Golden Valley Health Centers and Livingston Community Health provide comprehensive primary health and dental care to an ethnically diverse population in Merced and Stanislaus counties. School of Nursing Assistant Professor Katherine Kim and Ngo spent a week in Merced with the first class of providers leading intensive hands-on training in health coaching and how to support people with diabetes and hypertension. Project goals included building nursing leadership skills, developing better care teams and exploring avenues of career progression for those who complete the program. Ultimately, 26 people completed the health coach training.

“We covered motivational interviewing techniques and an understanding of chronic disease, so they can draw on their patients’ strengths allowing them to be the driver of their health change,” Kim said. “The medical assistants and nurses are not just there to take vitals, but are a vital part of the care team. The clinicians look to these new health coaches as experts building trust and eliciting information to improve care.”

Initially, Kim and Ngo conducted on-site training, and then maintained synchronous, remote training once a week to help students solve real-life problems they experience on the job. Ngo then trained-the-trainer, so nurse managers at the centers could lead future instruction and oversee the health coaching activities of the medical assistants. While the long-term goal is person-centered, team-based care, an immediate benefit is the empowerment the students receive as part of the training.

“I’m seeing a lot of enhanced knowledge. Usually task-oriented, our medical assistants are connecting the ‘why’s’ of health care and learning how to ask open-ended questions,” explained Lisa Sanders, Golden Valley’s director of nursing. “They are invested to get more information from patients and reinforce providers’ instructions.”

“Not only are we able to work with the people who are providing care in the clinic, but we talk about their goals outside of work,” Kim said. “Many of these students now envision furthering their education at a school like the Betty Irene Moore School of Nursing. It’s amazing.”

Sanders hopes the program creates a system where providers can focus resources on the sickest of the population and redirect people with chronic diseases into avenues where education and goal setting is reinforced by health coaches.

 “I know I always have the UC Davis team on my side,” Sanders said. “They’ve provided an incredible education for me and our classes as a whole.”