Community-based health coaching for the uninsured: A pilot program combining access to care with health behavior change

Chronic diseases are the leading cause of death in the U.S., and are a primary driver of rising healthcare costs. Attempts to educate the public on the link between lifestyle choices and chronic disease prevention have not been enough to reverse these trends. Knowledge is only one of many factors that affect behavior; individual values, responsibilities, priorities, strengths and limitations also influence one's choices. The field of Health Coaching has emerged to help individuals navigate the factors that influence their behaviors, and to identify realistic ways to maintain healthy lifestyle changes. Health Coaching has been embraced by the Healthy Howard Health Plan, an affordable non-profit health plan for the uninsured in Howard County, Maryland. Health Plan members are required to take personal responsibility for creating healthier lifestyles, and a compulsory health coaching program has been piloted to help members toward that end. A transdisciplinary team of coaches combine their backgrounds as health professionals with principles of behavior change, Motivational Interviewing, professional coaching, and cultural competence to guide and support members through the process of change. All members are assigned a personal Health Coach with whom they regularly meet at community locations such as libraries and coffee shops. While it has been a challenge to provide such services to a culturally diverse population experiencing socioeconomic instability, a formal evaluation study by the Johns Hopkins Bloomberg School of Public Health is being combined with anecdotal evidence to demonstrate the effectiveness of the Healthy Howard Health Coaching model in improving health outcomes.