Coaching nutricional y motivación para el cambio de conducta alimentaria / Nutritional coaching and motivation for change of eating behavior

RESUMEN La mayoría de las áreas del campo laboral del nutricionista, involucran en algún momento ya sea directa o indirectamente, estimular, guiar o inducir el cambio de conductas ligadas a la alimentación, proceso que se realiza a través de la enseñanza y el aprendizaje. Sin embargo, en la actualidad, esto se reduce en muchas ocasiones a la transmisión del conocimiento de manera unidireccional, donde la persona a cargo de realizar los cambios en realidad es un sujeto pasivo a cargo de seguir indicaciones. Por el contrario, el Coaching Nutricional (CN), es un proceso a través del cual la persona es totalmente activa en su cambio, identifica y vence sus obstáculos, crea el entorno adecuado, adopta una actitud y determinación necesarias para conseguir adaptar su alimentación, logrando a su vez mejorar otros aspectos de su persona y de su estilo de vida. En esto es clave evaluar el grado de motivación del sujeto, estableciendo estrategias específicas de acuerdo a los intereses y factores que motivan su cambio de conducta, de manera de favorecer la adherencia terapéutica y el cambio real de conductas en salud.

ABSTRACT Most of the areas of the nutritionist's labor field involve directly or indirectly stimulating, guiding or inducing the change of behaviors linked to food, a process that is carried out through teaching and learning. However, at present, this is often reduced to the transmission of knowledge in a unidirectional manner, where the person in charge of making the changes is actually a passive subject in charge of following directions. On the contrary, nutritional coaching is a process through which the person is active in their change, identifies and overcomes their obstacles, creates the appropriate environment, adopts the attitude and determination necessary to adapt their diet, and, in turn, improves other aspects of his/her person and lifestyle. Thus, it is key to evaluate the degree of motivation of the subject, establishing specific strategies according to the interests and factors that motivate their behavior change, in order to favor therapeutic adherence and a real change in health behaviors.

Health coaching improves interventional effects in high-risk population of stroke / 中华全科医师杂志

Objective@#To assess the effect of health coaching on interventional effect in high-risk population of stroke.@*Methods@#A baseline survey was conducted among 897 residents aged 40 years and above selected by cluster sampling method in a community of Shijiazhuang city from January 2016 to June 2016, and 178 subjects were identified as high risk population of stroke. The high-risk subjects were randomly divided into two groups: the control group (n=89) was given routine health education, while the intervention group (n=89) received health coaching based on motivational interview for 13 months. The behavioral risk factors and self-efficacy scores were compared between two groups before and after intervention.@*Results@#There were no significant differences in behavioral risk factors between the two groups: for hypertension 72 vs. 74 cases (χ2=0.152, P=0.67), for hyperglycocemia 44 vs.48 cases (χ2=0.360, P=0.55), for dyslipidemia 62 vs. 60 cases (χ2=0.104, P=0.75), for smoking 35 vs.32 cases (χ2=0.215, P=0.64), for obesity 50 vs.52 cases (χ2=0.092, P=0.76), for lack of exercises 72 vs.70 cases (χ2=0.139, P=0.71), for atrial fibrillation 14 vs. 16 cases (χ2=0.160, P=0.19). And there was no significant difference in self-efficacy scores between the two groups [(5.3±1.2) vs. (5.6±2.0), t=0.997,P=0.32]. After intervention, there were significant differences between the two groups in behavioral risk factors: for hypertension 25 vs. 34 cases (χ2=19.984, P<0.05) , for hyperglycaemia 16 vs.32 cases (χ2=8.448, P<0.05) , for dyslipidemia 30 vs. 48 cases (χ2=13.216, P<0.05) , for smoking 20 vs.28 cases (χ2=7.583, P<0.05) , for obesity 18 vs.38 cases (χ2=14.158, P<0.05) , for lack of exercises 28 vs. 36 cases (χ2=10.235, P<0.01) , for atrial fibrillation 5 vs. 13 cases (χ2=6.451, P<0.05) . And the self-efficacy scores of intervention group were higher than those of control group[ (8.4±2.1) vs. (6.8±2.2), t=4.852, P<0.01].@*Conclusion@#Health coaching based on motivational interview is beneficial to reduce risk factors and improve self-efficacy in high risk population of stroke, which is worthy of popularization.

Health coaching improves interventional effects in high-risk population of stroke / 中华全科医师杂志

Objective To assess the effect of health coaching on interventional effect in high-risk population of stroke. Methods A baseline survey was conducted among 897 residents aged 40 years and above selected by cluster sampling method in a community of Shijiazhuang city from January 2016 to June 2016, and 178 subjects were identified as high risk population of stroke. The high-risk subjects were randomly divided into two groups: the control group (n=89) was given routine health education, while the intervention group (n=89) received health coaching based on motivational interview for 13 months. The behavioral risk factors and self-efficacy scores were compared between two groups before and after intervention. Results There were no significant differences in behavioral risk factors between the two groups:for hypertension 72 vs. 74 cases (χ2=0.152,P=0.67),for hyperglycocemia 44 vs.48 cases (χ2=0.360,P=0.55), for dyslipidemia 62 vs. 60 cases (χ2=0.104,P=0.75), for smoking 35 vs.32 cases (χ2=0.215,P=0.64), for obesity 50 vs. 52 cases (χ2=0.092, P=0.76), for lack of exercises 72 vs. 70 cases (χ2=0.139, P=0.71), for atrial fibrillation 14 vs. 16 cases (χ2=0.160,P=0.19). And there was no significant difference in self-efficacy scores between the two groups [(5.3 ± 1.2) vs. (5.6 ± 2.0), t=0.997, P=0.32]. After intervention, there were significant differences between the two groups in behavioral risk factors:for hypertension 25 vs. 34 cases(χ2=19.984, P<0.05), for hyperglycaemia 16 vs. 32 cases(χ2=8.448, P<0.05), for dyslipidemia 30 vs. 48 cases(χ2=13.216, P<0.05),for smoking 20 vs.28 cases(χ2=7.583,P<0.05),for obesity 18 vs.38 cases(χ2=14.158,P<0.05),for lack of exercises 28 vs. 36 cases(χ2=10.235,P<0.01),for atrial fibrillation 5 vs. 13 cases (χ2=6.451,P<0.05). And the self-efficacy scores of intervention group were higher than those of control group[(8.4±2.1) vs. (6.8±2.2), t=4.852, P<0.01]. Conclusion Health coaching based on motivational interview is beneficial to reduce risk factors and improve self-efficacy in high risk population of stroke, which is worthy of popularization.

Técnicas de coaching de bem-estar na mudança do estilo de vida no sistema público de saúde / Lifestyle change coaching techniques in the Public Health System

De acordo com o último relatório da Vigitel 2017 as Doenças Crônicas Não Transmissíveis (DCNT) são responsáveis por 68% de um total de 38 milhões de mortes ocorridas no mundo em 2012. No Brasil, esse cenário não é diferente: em 2011 as DCNT foram responsáveis por 68,3% do total de mortes. Milhares de dólares são gastos hoje com políticas que estimulam hábitos de vida mais saudável, mas essa estratégia, por si só, tem continuamente falhado em produzir resultados consistentes e duradouros. É necessário uma nova abordagem, que promova mudanças no estilo de vida, possibilitando a melhora dos parâmetros de saúde das pessoas. O processo de coaching apoia o desenvolvimento de um relacionamento de ajuda, incentivando o paciente a identificar sua visão, necessidades e objetivos. Além disso, o coaching visa ajudar na organização de rotinas e prioridades, enquanto coloca o paciente no controle de seu destino de saúde.

According to the latest Vigitel 2017 report, non-communicable chronic diseases accounted for 68% of a total of 38 million deaths worldwide in 2012. In Brazil, the scenario is no different; in 2011 the non communicable diseases were responsible for 68.3% of all deaths. Thousands of dollars are spent today on policies that encourage healthier living habits, but this strategy, by itself, has continually failed to produce consistent and long-lasting results. A new approach is needed that promotes lifestyle changes, making it possible to improve people's health parameters. The process of coaching supports the development of a helporiented relationship, encouraging patients to identify their vision, needs and goals. In addition, coaching aims to assist in the organization of routines and priorities, while putting patients in control of their health endgoal.

Type 1 diabetes mellitus: can coaching improve health outcomes?

ABSTRACT Objective: To evaluate the introduction of coaching in the interdisciplinary care of individuals with type 1 diabetes mellitus in the public health care system. Subjects and methods: Ten patients routinely attending a public health care service and with a glycated hemoglobin (HbA1c) level above 75% participated in eight coaching sessions. This study evaluated the patients' self-management of the disease and personal behavior. The participants were assessed at the beginning of the program and on two occasions after the intervention, with evaluation of biochemical and anthropometric data, and frequency of self-monitoring of blood glucose (SMBG). Questionnaires were applied during these evaluations to analyze emotional burden (B-PAID), medication adherence (Morisky Adherence Scale), and self-efficacy (IMDSES). Results HbA1c had a median level of 8.0% (range 76-10.3%) at the beginning of the study and reduced significantly 3 months after initiation of the intervention (7.78% [6.5-10%], p = 0.028), with no significant increase at 6 months (8.3% [713-9.27%], p = 0.386). SMBG improved significantly from the beginning to the end of the study, with the median number of glucose tests per week varying from 16.5 (range 0-42) at baseline to 29.0 (7-42) at 3 months and 27.5 (10-48) at 6 months (p = 0.047). No significant differences were observed in anthropometric parameters or in the scores of the instruments between the three measurements. Conclusion: A coaching intervention focused on patients' values and sense of purpose may provide added benefit to traditional diabetes education programs and could be an auxiliary method to help individuals with type 1 diabetes achieve their treatment goals.

Coaching de salud: un nuevo enfoque en el empoderamiento del paciente con enfermedades crónicas no transmisibles / Health coaching: a new approach to the empowering of the patient with non - communicable chronic diseases

Se describe el coaching de salud como nueva tendencia en la promoción y educación sanitarias en el nivel primario de atención, tendiente a lograr el empoderamiento y autocontrol de pacientes con enfermedades crónicas no transmisibles. Se exponen las limitantes en la educación para la salud tradicional y las funciones del profesional en el citado nivel que decida ser coach; también se ofrecen ejemplos de técnicas de coaching, se evalúan las evidencias científicas de efectividad, así como se valoran la posibilidad de la intersectorialidad para apoyar los cambios conductuales y la necesidad de entrenar a los profesionales del sector para tales fines.

Health coaching is described as a new tendency in the health promotion and education in the primary health care, aimed at achieving the empowerment and self-control of patients with non-communicable chronic diseases. Restrictions in the education are exposed for the traditional health and the professional's activities in the mentioned level in which to be a coach; examples of coaching techniques are also offered, the scientific evidences of effectiveness are evaluated, and the possibility of intersectors participation to support the behavioral changes and the necessity of training the professionals of the Branch for such aims are evaluated as well.