Exploring health coaching and mindfulness as levers for transformation in health: stakeholder perspectives

Fam Pract. 2022 Jul 19;39(4):685-693. doi: 10.1093/fampra/cmab111.

Abstract

Background: Health coaching (HC) and mindfulness (MFN) are proven interventions for mobilizing patients' inner resources and are slowly being integrated into public primary care. Since 2015 the medical community in Gibsons BC has integrated physician-led HC and MFN-based programs into team-based care. This exploratory study aimed to understand the mechanisms by which these rural programs helped both patients and clinicians, and to elicit priorities for future study in these fields.

Methods: Using a qualitative participant-engaged constructivist approach in focus groups and large-group graphic facilitation, we elicited perspectives from patients and their physicians during a 1-day event held in September 2018. Thematic analysis of transcripts using Nvivo identified emergent themes that were regularly reviewed with coresearchers, and member checked with participants via online videoconferences held at 6 weeks and 4 months postevent.

Results: We identified six main themes relating to the successful implementation of these programs: (i) accessibility and affordability, (ii) offering a toolbox of practical skills, (iii) providing attuned and openhearted care, (iv) generating hope and self-efficacy, (v) experiencing a shared humanity and connection, and (vi) addressing the health of the whole person.

Conclusion: These themes highlight critical qualities of HC and MFN programs when implemented in a Medicare system. Key features include reducing stigma around mental health through making programs physician-led and a natural part of primary care, enriching accessibility through public funding, and enhancing patient agency through cultivating embodied awareness, self-compassion, and interpersonal skills. These themes inform the next steps to support upscaling these programs to other communities.

Keywords: anxiety; burnout; depression; empowerment; mindfulness; post-traumatic; psychological; stress disorders.

Plain language summary

Health coaching (HC) and mindfulness (MFN) are proven patient-centered interventions for mobilizing patients’ inner resources and changing the trajectories of many chronic physical and psychological conditions. However, though widely available in the private sector, they have been slow to find their way into public primary care in Canada. Since 2015 a rural medical community in BC Canada has integrated physician-led HC and MFN-based programs into primary care. This exploratory study aimed to understand how these programs are working to help both patients and clinicians, providing insights that other communities might use. We elicited perspectives from patient participants and their physicians through focus groups and large-group graphic facilitation during a 1-day event held in September 2018. We identified six themes contributing to successful implementation. Key features include reducing stigma around mental health through making programs publicly accessible and physician-led, and enhancing patient hope and empowerment through cultivating awareness, self-compassion, and interpersonal skills. It also mattered that the facilitators created psychological safety where participants could grow these skills in a nurturing environment, while addressing various dimensions of health. These themes refine our understanding of how these programs can work within public systems to support patient self-management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Health Personnel
  • Humans
  • Medicare
  • Mentoring*
  • Mindfulness*
  • Physicians*
  • United States