The aim of this study was to evaluate the effectiveness of a 1-year telephone-based health coaching intervention among high-risk chronic disease patients using a multimethod, multidisciplinary longitudinal approach. The study was conducted using a randomized controlled trial design; 1534 type 2 diabetes, coronary artery disease and cardiac heart failure patients were randomized into an intervention group (usual care and monthly telephone health coaching; N=1034) and a control group (usual care; N=501).
Effectiveness was evaluated based on four dimensions — clinical outcomes and cost-effectiveness in the short term (1-year follow-up) and social and health care costs and mortality and morbidity in the long term (8-year follow-up). The data were collected from patient health records and research nurses’ measures, from patients with a 15D questionnaire on the health-related quality of life and national health and social care registries. The factors associated with effectiveness were also studied by interviewing health coaches (N=7; additional results in the summary). The evaluation process and results were reviewed and discussed from the perspective of rational decision making. Analyses were conducted using modified intention-to-treat (included available results), intention-to-treat (all allocated patients) and per protocol (patients who participated in the study) methods. In the sub-studies, statistical and health economic analyses were used, and interview material was analysed using inductive content analysis.
In the short term, significant improvements in diastolic blood pressure due to the health coaching were found, and health coaching increased health-related quality of life with acceptable costs. In the long term, severe chronic disease complications occurred less frequently, and the total social and health care costs were lower in the intervention group from 2.5 years onwards. Statistically significant differences were found in the per protocol analysis. Based on the health coaches’ interviews, the learning of coaching skills took 1–3 years, and continuous support, mentoring and quality assurance were essential in developing the coaching skills. The coaches also observed that it took time for patients to integrate behaviour changes into their daily lives. Therefore, the evaluation of health coaching interventions should extend to at least 3 years using a multidisciplinary, multidimensional approach.
From the rational decision-making viewpoint, understanding the nature of the intervention is essential for decision makers to set realistic targets and to evaluate them in a timely fashion. The overall results suggest that health coaching has a positive effect on health, quality of life and social and health care costs, particularly for those patients able and willing to participate in the intervention. Therefore, health coaching could be the part of self-care support in the chronic care delivery system.
The doctoral dissertation of Erja Mustonen, entitled Telephone-based health coaching for chronic disease patients: evaluation of short- and long-term effectiveness of health benefits and costs will be examined at the Faculty of Social Sciences and Business Studies. The opponent in the public examination will be Minna Kaila (University of Helsinki) and the custos will be Professor Johanna Lammintakanen (University of Eastern Finland).
