How personalized relationships, meaningful education, proactive planning, and continuous support can help bridge the gap between healthcare recommendations and sustainable changes in everyday life.
Imagine leaving a medical appointment with several recommendations.
Improve your nutrition. Exercise more frequently. Prioritize sleep. Reduce stress. Monitor your health. Follow up when necessary.
You understand that these changes are important.
You may even feel motivated to begin.
But as you walk out of the office, several questions remain.
What should you prioritize first?
How do these recommendations apply to your particular circumstances?
What happens if your work schedule makes the suggested routine unrealistic?
Who can help you understand the reasoning behind your care plan?
And who will help you adjust that plan when life inevitably changes?
These questions represent an important challenge within modern healthcare.
Healthcare professionals can provide excellent recommendations while patients still lack the time, guidance, resources, and ongoing support necessary to implement them.
Health coaching was developed, in part, to address this disconnect.
In a 2013 publication, researchers associated with Duke Integrative Medicine described integrative health coaching as an emerging professional approach designed to improve patient engagement, facilitate behavior change, and support proactive health planning.
The authors argued that healthcare needed professionals trained specifically in helping individuals translate health-related knowledge into sustainable action.
In 2016, David Thom and colleagues published A Qualitative Study of How Health Coaches Support Patients in Making Health-Related Decisions and Behavioral Changes in Annals of Family Medicine.
Their research explored how patients, family members, coaches, and clinicians experienced the coaching relationship.
Rather than focusing exclusively on laboratory outcomes, the investigators examined what health coaches actually contributed to patients' experiences.
Their findings identified several interconnected characteristics: sufficient time together, personal connection, education, emotional and practical support, and improved communication between patients and clinicians.
A separate publication by Gordon and colleagues examined the clinical effectiveness of a comprehensive lifestyle health-coaching program and discussed the organizational barriers that often prevent preventive care from receiving adequate attention.
Together, these investigations offer a valuable perspective.
The distinguishing value of health coaching may lie not only in the recommendations it helps patients implement, but also in the quality of the relationship, the development of patient capability, and the continuity of support surrounding those recommendations.
1. Healthcare Needs More Than Better Information
Scientific knowledge has expanded dramatically.
We understand more about cardiometabolic disease, physical activity, nutrition, sleep, and other important determinants of health than at any previous point in history.
Healthcare professionals have access to increasingly sophisticated diagnostic technologies and therapeutic options.
Yet chronic disease remains a substantial challenge.
The problem is not exclusively a shortage of scientific knowledge.
It also involves how effectively that knowledge reaches patients and becomes integrated into everyday behavior.
Smith and colleagues, writing in 2013, identified three major issues that health coaching might help address.
First, healthcare delivery and financing have historically emphasized the treatment of established disease more than proactive prevention.
Second, advances in lifestyle-related research have not always translated into comprehensive implementation support within routine healthcare.
Third, many patients lack the knowledge, confidence, resources, or practical assistance necessary to participate fully in managing their health.
These problems are interconnected.
A healthcare system may identify risks accurately while offering insufficient support for addressing those risks through everyday behavior.
Health coaching offers one possible solution within a broader, interdisciplinary model of care.
It provides a professional relationship specifically oriented toward helping individuals develop and implement meaningful health-related changes.
However, coaching is not a substitute for preventive medical services or a complete solution to healthcare financing and access problems.
Its role is to strengthen a specific part of the healthcare process that may otherwise receive inadequate attention.
2. Patient Engagement and Patient Activation: Two Related but Different Goals
Two concepts are particularly important to understanding the purpose of health coaching: patient engagement and patient activation.
Although frequently used together, they describe different dimensions of healthcare participation.
Patient engagement concerns the actions individuals take to participate in their health and healthcare.
Examples include attending appointments, asking questions, communicating concerns, monitoring relevant conditions, and implementing appropriate recommendations.
Patient activation concerns the knowledge, skills, and confidence necessary to manage one's health.
An individual may be highly engaged with healthcare services while still lacking confidence in making everyday health decisions.
Another person may possess considerable health knowledge but experience barriers that prevent consistent participation.
Effective coaching considers both.
The objective is not merely to increase the number of actions someone performs.
It is also to develop their understanding and capacity to make appropriate decisions independently.
For example, a patient who understands why physical activity supports glucose regulation may be better equipped to adapt their exercise routine when their circumstances change.
A patient who understands the purpose of a prescribed medication may be better prepared to communicate concerns to the prescribing clinician.
Someone who develops confidence in meal planning may become less dependent on rigid external dietary instructions.
These capabilities support greater participation in health-related decisions.
3. Why Time Is an Important Part of the Coaching Relationship
One of the most practical findings from Thom and colleagues' 2016 study concerns the importance of time and availability.
The researchers conducted focus groups and interviews with patients, family members, coaches, and clinicians.
Their qualitative analysis identified seven interconnected themes that helped explain how coaching supported health-related decision-making.
Time spent with patients and perceived similarities between coaches and patients helped establish the coaching relationship.
That relationship, in turn, supported education, personal assistance, practical decision-making, and communication with clinicians.
This finding is important because time is not merely a scheduling consideration.
It can influence the depth of the professional relationship.
A patient may require additional time to explain a complex history, understand a recommendation, identify concerns, or explore barriers.
Some questions emerge only after a person has had an opportunity to reflect.
Others may require a more detailed conversation than is practical during a brief clinical encounter.
Extended coaching appointments can create opportunities for this discussion.
For example, when a program provides 60–120-minute appointments, there may be time to explore nutritional habits, daily routines, previous experiences, and the practical circumstances influencing behavior.
However, longer appointments are not automatically more effective.
Their value depends on how the time is used, the individual's needs, and the coach's ability to facilitate a productive discussion.
The goal is not simply more conversation.
It is more meaningful engagement.
4. Establishing Trust: Why the Relationship Matters
Trust is a fundamental component of effective professional relationships.
Patients need to feel comfortable discussing uncertainty, admitting confusion, and asking questions.
They may also need to disclose information that feels personally difficult.
For example, someone may feel embarrassed about repeatedly abandoning exercise programs.
Another person may hesitate to explain that they cannot afford a recommended dietary strategy.
Someone managing a chronic condition may worry that admitting difficulty following a treatment plan will be interpreted as irresponsibility.
A supportive coaching relationship creates opportunities for these concerns to be discussed without unnecessary judgment.
The Thom study suggests that the relationship itself is an important foundation for the practical coaching activities that follow.
This is a meaningful distinction.
A technically correct recommendation may not be useful if the patient does not feel comfortable explaining why it is difficult to follow.
Trust can support more accurate understanding of the patient's actual circumstances.
However, trust should not be confused with personal familiarity alone.
Professional trust also depends on competence, reliability, appropriate boundaries, transparency, and honest communication.
An effective coach should be willing to acknowledge uncertainty and recognize when a concern falls outside their professional qualifications.
5. Shared Humanity: The Value of Understanding the Patient's Experience
Another theme identified by Thom and colleagues involved perceived similarities between coaches and patients.
Participants described characteristics that helped them relate to their coaches and establish a more supportive relationship.
This finding has an important implication for health coaching.
Patients do not necessarily want to feel that they are receiving instructions from someone who exists outside the ordinary difficulties of life.
They may benefit from knowing that their coach understands the challenges of maintaining routines, balancing responsibilities, and adapting to setbacks.
Professional expertise remains essential.
However, empathy and practical understanding can make that expertise more accessible.
A coach who has personally navigated demanding schedules, exercise setbacks, or difficult lifestyle changes may be able to offer useful perspective.
At the same time, personal experience is not a substitute for scientific evidence.
A strategy that worked for one individual may not work for someone with different medical conditions, responsibilities, or preferences.
The objective is to combine professional knowledge with the humility to recognize individual differences.
The coach should not assume that their personal experience defines the patient's journey. Instead, it can help them appreciate why the journey deserves individualized attention.
6. Professional Integrity: Practicing the Values We Encourage
An important distinction in our philosophy at Arete Health concerns professional integrity and the embodiment of health-related values.
We believe healthcare professionals should take seriously the principles they encourage others to practice.
A coach promoting physical activity should understand the challenges involved in developing consistent exercise habits.
Someone teaching sustainable nutrition should appreciate the practical realities of food selection, preparation, and long-term adherence.
A professional discussing stress management should recognize the importance of boundaries, recovery, and realistic expectations.
This does not mean healthcare professionals must demonstrate perfect health or flawless habits.
Such expectations would be unrealistic and could encourage unnecessary judgment.
Rather, professional integrity involves congruence between the values we communicate and the standards we strive to practice.
It also requires recognizing the limits of personal experience.
Evidence-informed recommendations must remain grounded in research and appropriate professional expertise.
Nevertheless, practical familiarity with behavior change can contribute to empathy, credibility, and more realistic coaching conversations.
This aspect of Arete Health's philosophy extends beyond the findings of the three studies and reflects our approach to professional accountability.
7. Education Is More Than Giving Patients Information
The Thom study identified education as one of the important activities through which coaches support patients.
However, effective education involves more than transferring facts.
A patient needs to understand information in relation to their circumstances.
Consider a recommendation to increase dietary fiber.
A brief explanation might identify general health benefits.
A more comprehensive educational discussion could explore what dietary fiber is, which foods contain it, how it influences gastrointestinal function, and why different individuals may tolerate fiber differently.
The patient could then discuss how to implement appropriate changes within their existing dietary habits.
The same principle applies to exercise, sleep, and stress-related behaviors.
The objective is not for patients to memorize instructions without understanding them.
It is to help individuals understand the reasoning behind recommendations.
This supports informed decision-making.
It can also improve flexibility.
A person who understands the purpose of an intervention may be better equipped to adjust their behavior appropriately when circumstances change.
We want patients to understand not only what they are doing, but why they are doing it.
Importantly, education provided by a coach must remain within their professional scope. Medical diagnoses, medication decisions, and specialized treatment recommendations require appropriately qualified clinicians.
8. From Health Literacy to Health Independence
Health literacy involves the capacity to access, understand, evaluate, and use health-related information and services.
However, having information available does not guarantee that it can be applied effectively.
People must often make decisions under uncertainty.
They encounter conflicting advice, changing recommendations, and health information of widely varying quality.
Health coaching can help develop practical information-use skills.
For example, a coach may help a patient prepare questions for a clinical appointment.
They may support the individual in identifying which recommendations came from qualified professionals and which claims require further verification.
They may also help someone recognize when a new symptom warrants clinical evaluation rather than attempting to resolve it through self-directed lifestyle changes.
This is an important dimension of patient empowerment.
The goal is not to make patients independent of healthcare.
It is to help them become more capable participants in their healthcare.
Over time, the individual may need less assistance performing routine health-related tasks while becoming more confident recognizing situations that require professional guidance.
9. Personal Support Without Creating Dependency
The role of a coach is sometimes misunderstood as rescuing the individual from difficult decisions.
However, coaching is intended to support capability rather than replace it.
A coach can provide encouragement, ask questions, help clarify priorities, and facilitate problem-solving.
But the individual should remain an active participant in determining their goals and selecting appropriate actions.
Smith and colleagues describe integrative health coaching as a forward-focused approach that helps individuals develop personalized health plans aligned with their values and circumstances.
This means the coaching relationship is not simply a system of reminders and external pressure.
It is also an opportunity to develop internal resources.
For example, someone struggling with consistency may learn how to set more realistic goals.
Someone feeling overwhelmed may learn how to prioritize a manageable number of changes.
Another individual may recognize that an unsuccessful routine reflects a mismatch between the plan and their circumstances rather than a lack of character.
The coach helps maintain progress while encouraging increasing independence.
This is especially important when health-related goals require long-term adaptation.
10. Decision Support: Helping Patients Navigate Their Options
Another major theme identified in the Thom study involved practical decision-making support.
Coaches helped patients identify available choices, develop action plans, recognize barriers, locate resources, and implement decisions.
This role is particularly valuable because health-related decisions rarely occur in ideal circumstances.
A person may need to choose among several exercise options while considering time, cost, physical limitations, and personal enjoyment.
Someone trying to improve nutrition may need to develop a plan that accommodates family preferences, work schedules, or financial constraints.
Another patient may need help finding appropriate community resources.
Health coaching can make these decisions more manageable.
However, an important principle is preserving patient autonomy.
The coach may help identify options, but the individual's preferences and circumstances should inform the decision.
The relationship brings together two complementary forms of expertise.
The coach understands behavior-change methods and relevant wellness strategies.
The patient understands their own life.
When these perspectives are combined appropriately, the resulting plan may be more realistic and personally meaningful.
11. The Coach as a Bridge Between Patient and Clinician
One of the most distinctive findings from Thom and colleagues concerns the coach's role in supporting communication between patients and clinicians.
Patients may leave appointments uncertain about instructions or reluctant to ask additional questions.
Some may feel anxious about discussing difficulties with their healthcare provider.
Others may struggle to organize information about their symptoms, medications, or daily experiences.
Health coaches can help patients prepare for these conversations.
For example, a coach may encourage someone to write down questions before an appointment.
They might help the person identify which aspects of a care plan are difficult to implement.
They may support the individual in communicating those concerns accurately to the treating clinician.
Within appropriately organized healthcare teams, coaches may also help reinforce established recommendations and identify when further professional guidance is needed.
However, coaches should not independently reinterpret prescriptions, resolve conflicting medical instructions, or make treatment decisions outside their qualifications.
Their role is to improve communication and support informed participation.
This bridging function can be particularly useful when patients receive care from multiple professionals.
12. Healthcare Navigation: An Important but Overlooked Form of Support
Navigating healthcare can be challenging.
Patients may need to understand referrals, prepare for appointments, access resources, or coordinate multiple recommendations.
A person managing several chronic conditions may encounter instructions from different specialists.
Even when the recommendations are clinically appropriate, integrating them into everyday life can require substantial organization.
The Thom study describes how coaches provided practical and navigational support.
This may involve helping patients identify useful resources or formulate questions for their healthcare team.
These activities can reduce some of the practical burden involved in managing health.
However, navigation is not identical to formal clinical case management.
A coach should not assume responsibility for coordinating complex medical treatment unless their professional role and qualifications explicitly include that function.
The value of coaching lies in supporting the individual while preserving appropriate professional responsibilities.
13. Why Health Coaching Is Relevant to Preventive Healthcare
Smith and colleagues identified proactive planning as one of the central functions of integrative health coaching.
This is an important distinction from healthcare organized primarily around responding to established symptoms or disease events.
Prevention often requires action before an urgent problem develops.
For example, individuals may benefit from developing consistent physical activity, nutritional adequacy, healthy sleep routines, or appropriate management of cardiometabolic risk factors.
However, preventive recommendations are meaningful only when they can be implemented.
A patient may understand the long-term benefits of exercise but prioritize immediate responsibilities over future health risks.
This does not necessarily indicate ignorance.
Human behavior is influenced by immediate demands, environmental conditions, motivation, and competing priorities.
Health coaching can help individuals connect long-term goals with actions that are realistic in the present.
It can also help them anticipate potential barriers.
The objective is to make preventive behavior more accessible rather than simply communicate future risks.
14. The Economic and Organizational Challenge of Lifestyle Care
Gordon and colleagues described an evidence-based lifestyle health-coaching program in a paper published in the American Journal of Lifestyle Medicine.
The authors discussed how conventional healthcare structures can limit the delivery of sustained lifestyle support.
They highlighted pressures involving appointment schedules, resources, and reimbursement.
Their publication described a structured, technology-enabled coaching model involving behavioral strategies, ongoing communication, and outcome monitoring.
The broader issue is that complex behavior change frequently requires support extending beyond a short clinical encounter.
However, it is important to distinguish the paper's findings from universal conclusions about healthcare economics.
Demonstrating benefits in a particular coaching program does not establish that all coaching services are cost-saving or clinically effective.
Similarly, healthcare financing arrangements differ among organizations and populations.
Nevertheless, the paper raises an important question:
If long-term health outcomes depend partly on behaviors occurring outside clinical encounters, how should healthcare systems support those behaviors?
Health coaching represents one potential response.
15. Why Accessibility and Continuity Matter
Access to a coach can take several forms.
Some programs use in-person appointments.
Others provide telephone conversations, virtual sessions, or digital communication.
The most appropriate model depends on the patient's needs and the service being delivered.
Accessibility can matter because questions do not always emerge during scheduled appointments.
Someone may encounter a barrier while trying to implement a recommendation later in the week.
Another person may need to review an unsuccessful strategy before repeating it.
Ongoing communication can create opportunities for more timely adjustments.
However, greater access is not automatically equivalent to better outcomes.
Programs need clear boundaries concerning communication frequency, response expectations, privacy, and the types of concerns appropriate for coaching.
Urgent medical or mental health concerns require the relevant professional services.
Effective continuity therefore combines accessibility with responsible organization.
16. Why a Long-Term Relationship Can Support Meaningful Change
Many lifestyle-related behaviors develop through years of repeated experience.
Changing them may require gradual experimentation and adjustments.
A single successful week does not necessarily establish a sustainable habit.
Similarly, one unsuccessful attempt does not demonstrate that a strategy is inappropriate.
The longer-term coaching relationship provides opportunities to observe patterns across time.
A coach and patient may recognize that certain routines work well during normal workweeks but become difficult during travel.
They may discover that a particular exercise schedule repeatedly conflicts with family responsibilities.
They may identify that dietary changes are easier to sustain when food preparation occurs on specific days.
These observations can inform increasingly practical adjustments.
The goal is not to maintain coaching indefinitely without a clear purpose.
It is to provide support while the individual develops the skills and confidence necessary for increasingly independent decision-making.
17. The Difference Between Compliance and Empowerment
Traditional models of care often emphasize whether patients comply with recommendations.
Although following necessary treatment instructions is important, compliance alone is an incomplete measure of successful care.
A patient may follow instructions without understanding their purpose.
Another may struggle with adherence because the plan is incompatible with their circumstances.
A coaching-oriented approach asks additional questions.
Does the individual understand the recommendation?
Can they explain why it matters?
Do they possess the skills and resources needed to implement it?
Can they identify barriers and develop appropriate alternatives?
Do they know when to seek professional guidance?
These questions shift the focus toward capability.
An empowered patient is not someone who independently determines every aspect of medical care.
Rather, they are someone who can participate effectively, make informed choices within appropriate boundaries, and manage relevant health-related behaviors.
This is one of the most important contributions health coaching can make.
18. What the Research Does—and Does Not—Demonstrate
The three publications informing this article offer complementary perspectives.
Smith and colleagues present a conceptual and educational model describing how integrative health coaching may support preventive healthcare and patient activation.
Thom and colleagues provide qualitative evidence concerning how patients, coaches, family members, and clinicians experience coaching relationships.
Gordon and colleagues describe the implementation and outcomes of a particular lifestyle health-coaching program.
These publications help explain the rationale, processes, and potential benefits of coaching.
However, they answer different scientific questions.
The Thom study identifies themes associated with patients' experiences; it does not establish that longer appointments or stronger perceived relationships independently cause improved clinical outcomes.
The Smith publication offers a framework for healthcare transformation, not definitive proof that coaching can correct structural limitations across healthcare systems.
The Gordon study provides evidence from a specific program rather than demonstrating that every coaching service produces equivalent results.
These distinctions are important for scientifically responsible patient education.
Health coaching has promising applications, but programs should continue to evaluate their effectiveness through appropriate behavioral, functional, and clinical outcomes.
19. How This Research Informs Our Health Coaching
We believe that exceptional healthcare should consider not only what patients need to know, but also what they need to understand, practice, and sustain.
Our approach places particular importance on the quality of the professional relationship.
We recognize the value of having sufficient time to explore questions, understand individual circumstances, and discuss the reasoning behind relevant recommendations.
Within our health-coaching services, longer appointments can provide opportunities for more detailed education and practical planning than may be possible during a conventional brief encounter.
We also recognize that patients are not passive recipients of care.
They bring their own knowledge, experiences, values, preferences, and challenges.
Our role is to combine research-informed professional guidance with respect for that individual expertise.
Through Eat Well, Move Well, Sleep Well, and Stress Well, we aim to support meaningful changes involving nutrition, physical activity, recovery, and everyday stress-related behaviors.
These services emphasize education, practical implementation, and accountability.
Depending on the individual's needs, coaching may involve identifying obstacles, developing realistic routines, preparing questions for other healthcare professionals, or evaluating progress.
We also believe professional integrity matters.
The principles we encourage should be reflected in our commitment to continuing education, responsible clinical reasoning, personal accountability, and a serious appreciation for the challenges involved in changing behavior.
When patients require specialized diagnosis or treatment, our role includes recognizing appropriate professional boundaries and supporting collaboration.
Our objective is not to create dependence on a provider.
It is to help individuals become increasingly capable of understanding and participating in their own health.
Conclusion: The Missing Ingredient May Be the Relationship
Healthcare has made extraordinary progress in understanding disease and developing effective treatments.
Yet many individuals still struggle to translate health-related knowledge into meaningful everyday behavior.
The challenge is not always a lack of information.
Sometimes it is a lack of time.
Sometimes it is a lack of confidence.
Sometimes it involves limited resources, insufficient support, or uncertainty about where to begin.
And sometimes it reflects a healthcare system that has limited capacity to help patients navigate the practical realities of long-term change.
The research of Smith, Thom, and Gordon highlights why health coaching may provide a valuable complementary service.
It offers a structured relationship through which individuals can receive education, practical support, encouragement, and assistance with health-related decision-making.
However, the most important outcome is not simply whether someone follows instructions.
It is whether the individual develops greater understanding, confidence, capability, and independence.
Health coaching is not about having someone make health decisions for you. It is about developing the knowledge, skills, resources, and support necessary to participate more effectively in making those decisions yourself.
We believe that meaningful patient empowerment requires more than telling people what to do.
It requires listening carefully enough to understand their circumstances, educating thoroughly enough to explain the reasoning, and supporting consistently enough to help translate that understanding into practice.
Because the true value of health coaching is not measured simply by what happens during an appointment.
It is reflected in what individuals become capable of doing long after the appointment ends.
Research References
Thom DH, Wolf J, Gardner H, et al. A qualitative study of how health coaches support patients in making health-related decisions and behavioral changes. Annals of Family Medicine. 2016;14(6):509–516. https://doi.org/10.1370/afm.1988
Smith LL, Lake NH, Simmons LA, Perlman A, Wroth S, Wolever RQ. Integrative health coach training: a model for shifting the paradigm toward patient-centricity and meeting new national prevention goals. Global Advances in Health and Medicine. 2013;2(3):66–74. https://doi.org/10.7453/gahmj.2013.034
Gordon NF, Salmon RD, Wright BS, Faircloth GC, Reid KS, Gordon TL. Clinical effectiveness of lifestyle health coaching: case study of an evidence-based program. American Journal of Lifestyle Medicine. 2017;11(2):153–166. Published online 2016. https://doi.org/10.1177/1559827615592351