The Experiences of a Multi-ethnic Group of Participants Engaging in Health and Wellness Coaching: results from the PREVENTS Study
Mohamed Iqbal, Hafsa
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Globally, stroke is the second largest cause of death. Stroke can also lead to permanent disability. Stroke can impact individuals in various ways including an individual’s physical, psychological, emotional, functional and cognitive domain. However, stroke is a preventable illness with associated risk factors (such as hypertension, diet and physical activity) that can be targeted in prevention. In terms of prevention, a combined high risk and population-wide strategies are recommended. Strategies can be implemented at an individual level, such as targeted health behaviour change via referrals to useful programs, and strategies can be implemented to the whole population (for example, smoking cessation programs; Feigin et al., 2016a). HWC is widely utilized for the management of chronic disease. HWC focuses on the client and aims to elicit motivation for health behaviour change. Health coaching has been reported to be effective for CVD health in participants with coronary heart disease, in diabetes management; and in leading to better LDL cholesterol levels, fruit and vegetable intake and reducing tobacco use in participants. Although the efficacy of health coaching has been explored in ethnic minority communities, there is still limited supported for utilizing HWC for primary prevention in a multi-ethnic community. The PREVENTS study was conducted to evaluate the efficacy of HWC in a NZ multi-ethnic community for cardiovascular disease and stroke prevention. This was a randomized controlled trial (n=320) where HWC was implemented on participants in the intervention group versus a usual care group. The current study is a qualitative study which aimed to explore participant experiences of HWC and whether the experiences differed by ethnicity. The current study recruited participants (n=8) from the intervention group of PREVENTS. Semi-structured, face-to-face interviews were conducted. An interpretive descriptive approach was utilized; and thematic analysis was used to analyse the data. Six final themes emerged from the current study: 1) Ethnicity/culture not directly relevant to health and wellbeing; 2) The importance of the coaching relationship; 3) Awareness of health; 4) Person-centered nature of coaching; 5) HWC was beneficial at a personal level; and 6) Practical strategies in HWC. The findings highlight that a culturally sensitive HWC intervention is essential when working within a multi-ethnic community in NZ. The findings suggest that ethnic identity was not directly relevant to health and wellbeing although there appears to be indirect influences which were addressed in HWC. Participants felt their cultural needs were being met in HWC. The findings suggest that participants were receptive to a person-centered approach, where the coach is working from the client’s agenda, and that this leads to health behaviour change. Personal issues were often addressed in HWC, and this seemed to be a part of the process of health behaviour change. This study emphasised the importance of the coaching relationship and how this contributes to the efficacy of HWC. This study found that practical strategies utilized in HWC was useful; and reported participants’ awareness of health and how this has influenced health behaviour change. The current study is unique in highlighting these aspects of HWC in relation to health behaviour change, in a NZ multi-ethnic community, for cardiovascular disease and stroke prevention. It has also illustrated the importance of a culturally appropriate HWC intervention when addressing stroke and cardiovascular disease prevention in a multiethnic community.