Training health coaches 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 partnered with a network of Central Valley primary care centers to prepare nurses and medical assistants to serve as health coaches. The project, part of the School of Nursing’s focus on care coordination and collaboration among multiple professions, advances the centers’ team-based care model and puts nurses and medical assistants in leadership positions.

“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 focused on diabetes and hypertension, chronic conditions that can be managed effectively when people take ownership of their disease.”

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 24 providers leading intensive hands-on training in health coaching and how to support people with diabetes and hypertension.

“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,” said Kim. “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.”

This is one of a dozen studies underway as part of a research effort spearheaded by Nursing faculty and graduate students in unique collaboration with other health-care disciplines. Together, they seek to incorporate novel technologies to improve quality of care, improve health in populations and lower costs. Kim and Ngo conduct synchronous, remote training once a week to connect with the students in their environment to solve real-life problems they experience on the job. 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 nurse manager and clinical director. “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.”

Once complete, project leaders will enroll people in a health-coaching study then evaluate health outcomes six months and one year after enrollment. 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. Using the train-the-trainer approach, Kim and Ngo will equip Sanders with the skills and knowledge needed to lead the next class beginning in January.