Chronic medical conditions such as diabetes, cardiovascular disease (CVD), and hypertension are highly prevalent among VA healthcare system users. Among VA patients, 72% have one or more chronic medical conditions (compared with 40% to 50% of other U.S. adults), and more than half have at least 2 chronic conditions.¹ The management of chronic medical conditions is a time-consuming process for primary care physicians. One study found that it would take 828 hours per year to provide the required care for the top 10 chronic diseases.² Thus, patients are increasingly being asked to take an active role in the self-management of their chronic medical conditions. Yet many patients leave a physician encounter confused about what to do to manage their own health due to conflicting and contradictory information.^3,4

Enhancing beneficial health behaviors (eg, medication adherence, diet, physical activity) holds great promise for improving outcomes associated with chronic medical conditions, but self-regulating changes in health behaviors can be difficult for patients. On average, only 50% of prescription medications are taken as instructed,⁵ and only one in 5 adults gets the recommended minutes of physical activity each day.⁶ For patients with multiple chronic conditions, recognizing how to prioritize among several possible health behavior changes and manage overall health can be a tremendous challenge.⁷

In recent years, health coaching has emerged as an innovative health promotion intervention approach to enhance patients' adherence to chronic disease self-management⁸ with respect to improving modifiable health behaviors.⁹ While there is no consensus on how to define health coaching¹⁰ or what elements constitute a health coaching intervention, several characteristics serve to define the approach. At its core, health coaching is a patient-centered, collaborative model grounded in theories of health behavior change in which a coach collaborates with the patient to identify goals and action plans that maximize personal well-being and overall health. The holistic approach includes solution-focused techniques like motivational interviewing, goal-setting, and problem-solving and has a central feature of patient empowerment toward autonomy. While a health coaching intervention may include some didactic patient education, the main thrust of health coaching interventions is to provide ongoing, bidirectional communication, motivational processes, support, and accountability to optimize self-management through building patient self-efficacy and skills acquisition. It is a modality grounded in the belief that patients are experts in their own life situations and can draw on these experiences to promote personal change. As such, health coaches work with patients to enhance activation and motivation to change by aligning health-related goals with the patient's personal values.¹¹

Most health coaches receive formal training in behavior change theory, motivational strategies, and communication techniques, but only a small proportion are trained therapists. While health coaching shares common elements with other intervention approaches such as patient education and disease management, it differs in its emphasis on both the overall approach and the process. Patient education and disease management tend to be more expert-directed, task-oriented, and focused on disease-specific content, whereas health coaching is conceptualized to be collaborative, client-centered, and more likely focused on the whole person.¹²