Effect of a health coaching self-management program for older adults with multimorbidity in nursing homes

Figures & data

Figure 1 Structure of the HCSMP.

Abbreviation: HCSMP, health coaching self-management program.

Figure 2 Flow chart for randomized trial.

Table 1 Summary of the HCSMP

Weekly HCSMP structure and contents
Intervention member	Individual-level approach (20 minutes)		Group-level approach (50 minutes)			Facility-level approach
	Research team member (four GNPs)		Staff nurses (four RNs), research team member (four GNPs)			Principal investigator
Week	Individualized assessment	Goal setting and counseling	Group discussion	Enhancing cognition	Exercises	Preference for diet	Preference for physical activity	Preference for relationship
0	1) Individual health assessment (before intervention): physical and psychosocial health status; individual health needs; daily lifestyle; medication, connection with family → 2) health problem list → 3) goal setting exercise
1	Understanding health problem list	Goal setting: contracting health goal, filling-up health calendar	Introduction to self-management program	Creative reminiscence: storytelling on flowers and seasons	Peripheral stimulation movements #1	Menu upgrading	Exercise gym machine setting	Peer-based health-mate setting
2	Identifying perception on their own conditions and causes	Learning how to set health goal	Problem-solving strategies	Using both hands: chopsticks, wheat dough	Peripheral stimulation movements #2	Menu selection list	Walking space	Self-management small group activity according to specific health problem
3	Exploring used coping methods with disease	Exploring self-management resources	Living with chronic diseases	Storytelling on ten symbols of longevity	Stretching and low-intensity aerobics #1		Walking planning into routine schedule	Setting down small group activities
4	Sharing experiences in decision-making process	Making decisions independently	Keeping physical activities	Storytelling after mold activity	Stretching and low-intensity aerobics #2			Family meeting
5	Talking about the effect of diseases on their life	Managing symptoms with CBT	Healthy and safe eating	Laugh therapy: delightful memory	Flexibility exercises for fall prevention #1
6	Demonstrating health assessment method	Learning coping skills	Taking medication	Grieving therapy: first memory	Flexibility exercises for fall prevention #2
7	Exploring difficult communication situations	Learning communication skills	Maintaining oral health	Storytelling after quick drawings	New millennium wheelchair exercises #1
8	Talking about feeling and belief on aging and diseases	Planning for the future: fear and reality	Healthy coping with daily stress	Storytelling after rubber mold activity	New millennium wheelchair exercises #2
9	1) Individual health assessment (after intervention) → 2) evaluation for problem solving status → 3) follow-up planning

Abbreviations: HCSMP, health coaching self-management program; GNP, geriatric nurse practitioner; RN, registered nurse; CBT, cognitive behavioral therapy.

Table 2 Sample goal statements and GAS

Goal attainment level	Score	Goal areas
		Goal 1	Goal 2	Goal 3	Goal 4
		Oral health	Stress reduction	Physical activity	Healthy diet
		I will brush my teeth and gums three times a day for myself.	I will find some time and energy for recreational activities once per week.	I will establish a regular, routine fitness program three times per week.	I will increase intake of fruits and vegetables by one serving per day.
Much better than expected	+2	I brushed my teeth and gums more than four times a day for myself.	I reserved some time and energy for recreational activities several times each week.	I exercised more than four to five times per week.	I increased intake of fruits and vegetables to more than two servings per day.
Somewhat better than expected	+1	I brushed my teeth and gums four times a day for myself.	I reserved some time and energy for recreational activities more than once per week.	I exercised four to five times per week.	I increased intake of fruits and vegetables by two servings per day.
The expected level of attainment	0	I brushed my teeth and gums three times a day for myself.	I reserved some time and energy for recreational activities once per week.	I established a regular, routine fitness program three times per week.	I increased intake of fruits and vegetables by one serving per day.
Somewhat less than expected	−1	Brushing less than three times a day for myself.	No change in time and energy resources related to recreation.	Exercise less than three times per week.	No change in fruit and vegetable intake.
Much less than expected	−2	Brushing less than two times a day for myself.	Less time and energy resources reserved for recreation each week.	Very little or no exercise.	Decreased fruit and vegetable intake.

Abbreviation: GAS, Goal Attainment Scaling.

Table 3 Baseline demographic and clinical characteristics and outcome variables from health coaching self-management intervention

Characteristics	Intervention group (n=22) n (%)	Conventional group (n=21) n (%)	χ^2 or P-value
Sex
Female	19 (86.3)	15 (71.4)	0.325
Diagnosis
Stroke	16 (72.7)	15 (71.4)	0.140
Parkinson’s disease	1 (4.6)	5 (23.8)
Dementia	5 (22.7)	1 (4.8)
Spouse
Yes	6 (27.3)	8 (40.0)	0.356
No	17 (72.7)	13 (60.0)
	Mean (SD)	Mean (SD)	P-value
Measures
Age (years)	77.3 (7.0)	78.0 (6.2)	0.754
Years of education	5.5 (4.9)	7.9 (6.2)	0.184
Self-management behaviors
Exercise behaviors	33.4 (26.2)	49.3 (29.7)	0.070
Cognitive symptom management	7.1 (4.5)	8.4 (3.5)	0.281
Mental stress management/relaxation	1.3 (0.5)	1.6 (0.5)	0.050
Communication with health care professionals	3.7 (2.0)	4.5 (2.7)	0.245
Self-efficacy
Six item chronic disease self-efficacy	4.6 (2.5)	7.0 (3.0)	0.576
Health status
Self-rated health	3.4 (0.7)	3.4 (0.9)	0.909
Illness intrusiveness rating	45.7 (23.3)	42.1 (21.6)	0.599
Fatigue visual numeric	4.1 (1.5)	4.5 (2.0)	0.483
Energy/fatigue	9.8 (2.1)	10.1 (3.3)	0.787
Pain visual numeric	3.7 (1.8)	4.3 (2.5)	0.365
Pain severity/interference	8.1 (4.1)	9.2 (4.3)	0.419
Shortness of breath visual numeric	2.0 (2.3)	0.9 (1.8)	0.105
Eight item HAQ-disability	12.2 (5.7)	13.1 (6.3)	0.602
Health distress	1.9 (1.0)	2.4 (0.9)	0.083
PHQ-9 (depression)	8.7 (5.9)	8.0 (5.9)	0.688
Social/role activities limitations	3.1 (0.8)	2.8 (1.4)	0.311

Abbreviations: SD, standard deviation; HAQ, Health Assessment Questionnaire; PHQ, Patient Health Questionnaire.

Table 4 Changes in self-management and health status variables from baseline to 8 weeks follow-up

	Baseline mean (SD)	8th week mean (SD)	Mean difference	P-value	Effect size (d)	Group × time P-value
Self-management behavior
Exercise behaviors					0.754	<0.001**
Conventional group	49.3 (29.7)	43.6 (25.9)	−5.7	0.365
Intervention group	33.4 (26.2)	46.4 (31.0)	13.0	0.015*
Cognitive symptom management					0.095	0.044*
Conventional group	8.4 (3.5)	8.6 (3.6)	0.2	0.866
Intervention group	7.1 (4.5)	10.5 (4.2)	3.4	0.004**
Mental stress management/relaxation					0.057	0.047*
Conventional group	1.6 (0.5)	1.5 (0.3)	−0.1	0.756
Intervention group	1.3 (0.5)	2.4 (0.7)	1.1	0.023*
Communication with health care professionals					0.028	0.281
Conventional group	4.5 (2.7)	4.1 (3.0)	−0.4	0.514
Intervention group	3.7 (2.0)	4.1 (1.9)	0.4	0.346
Self-efficacy
6-item chronic disease self-efficacy					0.018	0.036*
Conventional group	28.0 (11.7)	28.3 (13.7)	0.3	0.581
Intervention group	27.5 (10.1)	30.6 (11.5)	3.1	0.046*
Health status
Self-rated health					0.126	0.087
Conventional group	3.4 (0.9)	3.3 (1.0)	−0.1	0.680
Intervention group	3.4 (0.7)	2.8 (0.6)	−0.6	0.002**
Illness intrusiveness rating					0.002	0.801
Conventional group	42.1 (21.6)	65.5 (17.0)	23.4	0.003**
Intervention group	45.7 (23.3)	67.0 (15.5)	21.3	<0.001**
Fatigue visual numeric					0.007	0.584
Conventional group	4.5 (2.0)	4.3 (2.2)	−0.2	0.698
Intervention group	4.1 (1.5)	4.4 (2.1)	0.3	0.703
Energy/fatigue					0.018	0.393
Conventional group	10.1 (3.3)	10.4 (3.3)	0.3	0.622
Intervention group	9.8 (2.1)	11.1 (2.9)	1.3	0.063
Pain visual numeric					0.048	0.160
Conventional group	4.3 (2.5)	3.9 (3.3)	−0.4	0.483
Intervention group	3.7 (1.8)	4.5 (2.3)	0.8	0.195
Pain severity/interference					0.833	0.001**
Conventional group	10.0 (3.8)	9.0 (4.0)	−1.0	0.225
Intervention group	9.7 (2.8)	9.0 (3.0)	−0.7	0.294
Shortness of breath visual numeric					0.057	0.125
Conventional group	0.9 (1.8)	1.1 (2.1)	0.2	0.738
Intervention group	2.0 (2.3)	1.1 (2.1)	−0.9	0.094
8-item HAQ-disability					0.000	0.982
Conventional group	13.1 (6.3)	12.6 (5.9)	−0.5	0.570
Intervention group	12.2 (5.7)	11.7 (6.0)	−0.5	0.383
Health distress					0.010	0.529
Conventional group	9.5 (3.4)	8.7 (5.1)	−0.8	0.585
Intervention group	7.5 (3.8)	7.7 (2.2)	0.2	0.757
PHQ-9 (depression)					0.082	0.063
Conventional group	8.0 (5.9)	7.6 (5.8)	−0.4	0.753
Intervention group	8.7 (5.9)	5.3 (3.4)	−3.4	0.001**
Social/role activities limitations					0.160	0.008**
Conventional group	11.1 (5.1)	10.9 (6.0)	−0.2	0.813
Intervention group	12.5 (3.3)	6.9 (6.0)	−5.6	0.001**

Notes:

* P<0.05.

** P<0.01.

Abbreviations: SD, standard deviation; HAQ, Health Assessment Questionnaire; PHQ, Patient Health Questionnaire.

Figure 3 Changes of average GAS in intervention group (n=22).

Abbreviation: GAS, Goal Attainment Scaling.