As noted earlier, health coaching is defined as‘a regular series of phone calls between patient and health professional . . . to provide support and encouragement to the patient, and promote healthy behaviours such as treatment control, healthy diet, physical activity and mobility, rehabilitation, and good mental health’.5
The health coaches explained the importance of building this relationship, especially during the initial call:
. . . whatever message I’m going to deliver I’ve still got to build that side of it first or else I feel they won’t really listen. I’ve got to listen to them and they’ve got to listen to me, so I have to build up the relationship . . . Even the tone of your voice, which you will notice in that bit of building a relationship, it’s . . . I don’t like to say win a person over, but I think in some ways whatever direction you’re going in it has to be that, it’s that first impression of you to them and them to you isn’t it?
Developing a relationship with participants was a core part of the intervention. All participants described the health coaches as warm and empathetic. There was agreement that it was preferable if a single health coach made all six calls. One of our health coaches retired during the intervention period and, despite trying to ensure that she had completed all calls, a small number of participants had to be transferred to an alternative health coach:
Oh I don’t think they could relate with different people. You build up a relationship. We just did. I felt quite comfy, quite comfy.
PROTECTS 1, M73
During observations it was clear that the health coaches had formed good rapport with their participants. In only one instance was a participant referred to by their title rather than their first name. Negotiating what people wanted to be called was always addressed during the first call, and in many cases the name we had been given was the not the name that the participant preferred to be known by.
The health coaches were not provided with any information from the CLASSIC questionnaire and they were all in agreement during the focus group that they preferred not to access hospital data at the first call to avoid making assumptions about patients.
Most people enjoyed the conversational approach adopted by the health coach, with some describing their calls as akin to a‘chat’or‘a talk with a friend’. For others, the calls appeared to have more structure. This was true from observations, with the health coaches typically starting out asking how the person was, but invariably following this up with a reminder from the previous session and a plan for what they thought might be useful for that particular call. They were very keen to get agreement from people on what to discuss and were flexible where needed:
I started talking on what she’d asked me to do or what she talked about and I would answer like I’m talking to you now, that whatever she was talking about I would talk about, you know?
PROTECTS 7, M73
She just told me she was like a carer or whatever, and would I mind to talk to her, and things like that you know? If I need anything, how I feel. I feel very lonely, that’s one thing, I’m very lonely, . . . and I would chat to her for half an hour . . .
PROTECTS 2, F77
The health coaches could meet a variety of functions depending on patient circumstance. Many of those interviewed found talking to someone outside their family helpful, particularly around health issues, when they did not want to cause worry:
. . . it’s as if because she was a stranger, you’d tell a stranger something that you wouldn’t tell your family . . .
PROTECTS 9, F73
You could talk to them [the health coach] more about different things, you know? I don’t like complaining to my son and my daughter, I’m not well or something, because they will get fed up with me. And I’m not really complaining to them, I don’t. I keep it for myself, and that’s the trouble sometimes.
PROTECTS F77
Alternatively, the role of the relationship within health coaching was important in the case of isolated patients. Often, as people age, their circle of friends can became smaller and some who have poor mobility can
became isolated and lose their sense of community. People who move into smaller‘retirement’communities or sheltered accommodation can often support each other, but they can also then feel impending loss as friends around them die.
some people with their community via participation in local activities, although often ill health meant this was difficult:
I have one friend, she lives in Yorkshire . . . So I’ve got no friends [locally], and then I said,‘if I would just have somebody, to go out for a coffee, or a lunch or something’. . . [she asked] have I made any progress going to meet some people, but I couldn’t because of my eyes.
PROTECTS 2, F77
I had one lady . . . she had lost her husband for like 2 years before, but it was still quite raw for her and also she felt that she had to be strong for the rest of the family, because the girls were upset, her daughters were upset, so she didn’t want to cry in front of them. But, sometimes she did get upset when she was talking about her husband and things like that on the phone to me.
Health coach