Vision and Mission Statement for Family & Peer Health Coaching Guidebook
Overview—Vision and Mission
Networks of transformational leaders, change agents and trainers can collaborate to inspire individuals within their health care organizations and communities to become peer coaches for health behavior change. Working together as coordinated teams within their respective organizations and communities, leaders can act altruistically by empowering individuals and aligning populations to improve their own health habits. Within community-oriented health systems, health educators, health care practitioners and teachers can develop coordinated strategies for delivering peer coaching programs across a wide variety of settings.
First, leaders can invite their work colleagues and staff to participate in peer coaching programs before replicating the same process with clients/patients and their families. This organizational strategy can also foster collaborative activation between health educators /practitioners and their clients/patients that is needed to enhance the impact of these programs. Furthermore, the continued use of these strategies can develop the next generation of leaders from within their own organizations and communities. In so doing, this creates a transformational leadership development network to sustain a long term, high-profile commitment to health promotion.
Horizontal peer-coaching strategies for health promotion are in sharp contrast to top-down, hierarchal health care organizations that manage limited resources for treating diseases. Within such organizations, their actions often represent more of their own professional and organizational self-interests than the common good of the overall community. Such priorities drain resources away from integrating health promotion into health care that could otherwise reduce the demands for treating diseases in the first place.
Both hierarchal and transformational leadership styles are needed given that there are finite resources within health care. The challenge is how to develop synergies between these contrasting leadership styles. Hierarchal leaders and institutions can make decisions about allocating limited resources appropriately for integrated health care delivery systems that incorporates health promotion. To build on these strategies, transformational leaders can mobilize human resources outside of the health care sector to promote the use of behavior change programs in a variety of ways. Such population-based strategies can reduce the rates of preventable mortality and morbidity. In turn, these health promotion activities can help health care systems use their limited resources more effectively on treating non-preventable diseases.
A prerequisite for developing transformational leaders at all levels is to provide leaders and trainers with shared learning experience in how to improve their own health habits before helping their practitioners and staff. In turn, practitioners and staff can use the same collaborative learning process to improve their health habits before helping their patients and families to do the same. As leaders, trainers, practitioners and staff gain more experience in putting this learning process into practice within their organizations, they will deepen their understanding about how organizations can support individual change, and how individual change can facilitate organizational change. This reciprocal process can spiral upwards into a rapidly expanding circle of synergistic influences that promote health habits.
What works for an individual, group or organization does not necessarily work for another. Learning lessons or best practices from one context may or may not translate effectively into another context. At an individual level, this discovery process can begin with yourself when evidence-based guidelines fail to help you change your own unhealthy habits. A learning community can help you experience the power of peer health coaching, transformational learning and the benefits of positive social supports.
This process of developing personal evidence about behavior change will help you discover your path to healthy habits. As you gain more experiences in assisting others through the same learning process, you will deepen your understanding about the diversity in how individuals, groups, families and organizations change. These experiences will enhance your leadership skills in cultivating health-promoting organizations and communities. Furthermore, you can alignment with other like-minded organizations to add momentum in the fight against formidable anti-health opponents, such as unethical corporations that use amoral marketing to boost their profits at the expense of public, community and global health.
Our media-bombarded, hyper-connected, short attention-span, and instant-gratification culture has greatly enhanced the complexity of coordinating such individual and organizational alignments. To compound this challenge, amoral marketing strategies have promoted unhealthy products (such as tobacco) and the over consumptions of products such as alcohol and energy-dense, manufactured and refined foods (high-fat, high-sugar, high-salt). These anti-health influences perpetuate the epidemics of unhealthy habits.
To reverse these anti-health influences, effective leadership must focus and sustain a long-term commitment to a vision and mission of health promotion.
- Vision—Create professional and social movements that reverse the epidemics of unhealthy habits and reduce the burden of chronic diseases
- Mission—Build leadership development networks that enhance the capabilities and capacities of organizations and communities to disseminate peer health coaching programs to professional and lay audiences
This mission calls for transformational ideas, learning and leadership. Organizational and community leaders can work to continuously improve and evaluate the impact of their peer health coaching programs. Using top-down strategies, they can use resources to train trainers who promote the horizontal spread of these programs at different levels within their organizations and communities.
Within healthcare, everyone can assume different levels of leadership roles in learning how to model and promote healthy habits. Your leadership roles can range from working with your family and peers to your patients and their families with your health care organization and community.
To further enhance your leadership skills, you can contribute toward disseminating peer coaching programs locally and then expand to regional, national and/or global initiatives. Many global health initiatives exist for several infectious diseases, but only one for risk behaviors, namely tobacco control.85
You can use this guidebook to accelerate your learning curve, along with your colleagues and staff, in how to address the complexities and challenges of motivating healthy behavior change. This process first involves you using self-reflective learning exercises, sharing personal stories about change with your colleagues and staff, and learning from each others’ experiences. These collaborative learning experiences can help your health care organization set up similar programs for your patients and their families. This learning process addresses the limitations of content-focused, teaching approaches.
Faculty, practitioners, trainees and students can use this guidebook to implement longitudinal curriculums for developing peer health coaching programs for families and communities. These programs can focus any risk behaviors (such as tobacco, excessive alcohol, obesity, sedentary lifestyles and unsafe sex practices), together with any issues related to promoting self-management of chronic diseases and drug adherence. This integrated approach serves the learning needs of health care professionals, patients and their families.
This guidebook also links personal change to professional and leadership development. Learning portfolios that track personal, professional and practice-based changes can provide evidence for personal, professional, leadership and organizational development. This organic journey involves developmental tasks that move you beyond doing and experiencing learning exercises to belonging and becoming.86 What does this mean?
Your professional sense of belonging arises from developing social identities and roles through the socialization process of your professional training. Such identities and roles can arise from:
- Intra-professional experiences (for example, “I belong to the allied health, medical, nursing, public medical or social work profession.”
- Inter-professional experiences (for example, “I belong to the health care team.”)
Your individual sense of becoming involves differentiating yourself from your social identities to develop your own unique personal and professional identities as a healthy person, practitioner, trainer and leader, depending on your aspirations.
Programs based on this guidebook provide a framework of lifelong learning that need continuous improvement, ongoing evaluation and dissemination. Such strategies are essential for developing current and future leaders who can develop workforces, inside and outside of health care, that promote health habits. These strategies call for transformational learning.
Facilitate Transformational Learning
What to change is easy, but how to change is difficult. Informational learning is about what to change. This process addresses surface change, such as increasing knowledge and setting goals. On the other hand, transformational learning is about how to make deep change, such as changing perceptions about risks, benefits and harms, lowering emotional resistance, exploring motives and addressing discrepancies in your value systems in order to inspire, develop and sustain effective motivation.
Transformational learning can overcome the limitations of evidence-based guidelines that predominantly address surface change. This book describes a collaborative self-reflective (CSR) learning method that enables individuals to develop personal evidence about deep change. What does CSR mean?
Counseling and coaching techniques about motivating healthy behavior change have been converted into a menu of self-reflective learning exercises that are described in Section III of this book. Individuals can conduct their own research on health behavior change by completing and reflecting about these learning exercises. Afterwards, they can use different methods of communication (in-person, by telephone, online) to collaborate and share their experiences with any combination of the following:
Pairing up with a peer coach (family member, friend or work colleague),
- Working in groups (family, peer, work, education, community and/or religious)
- Consulting with a practitioner or a health coach (individually or in a group).
Such communication can help to facilitate transformational learning. However, such experiences are unfamiliar to most students and practitioners. To prepare for such experiences, some learners need to understand and address their resistance to using unfamiliar educational methods before they can effectively engage in learning how to change.
Adopt Disruptive Innovations
Innovative products and services that are relatively inexpensive and accessible to large populations become disruptive when the right supports (technology enablers, business models and networks) coalesce to promote their rapid dissemination that permanently transforms the status quo.31, 87, 87 Such disruptive learning innovations are urgently needed to reverse the epidemics of unhealthy habits and reduce the burden of chronic diseases. These programs must span the full risk continuum to address health promotion, disease prevention and disease management. Such integrated programs face the overwhelming challenge of expanding their reach and impact, given finite resources for serving large populations.
At the one extreme, web-based programs have shown varying degrees of impact in terms of delivering tailored interventions for lifestyle changes,88-94 such as for smoking,95-105 alcohol risk and harm reduction,106, 106-109 weight reduction,110-113 physical activity,114-118 and for chronic diseases.119 Web-assisted tobacco interventions are effective for helping smokers quit.120-131 They are particularly useful in countries where the capacities for health practitioners to intervene are limited due to lack of time, knowledge, skills and personnel support.These programs can have high reach but relatively low impact.
At the other extreme, there are expensive, one-to-one counseling programs, such as health coaching for high-risk patients. These programs can have high impact but limited reach. Even with these web-based programs and counseling services, large segments of at-risk populations remain untouched.
Ideally everyone should access a personal health coach, but clearly this is impossible. This calls for the de-professionalization of coaching and counseling processes in order to expand the promotion of healthy habits. Low-cost, high-reach and high-impact learning innovations are needed, such as group and online learning communities led by peer, lay and family health coaches. Leaders can help to promote and disseminate such programs, both within and beyond educational institutions and the health care sector.
This guidebook provides an educational foundation for launching such learning programs. Educational institutions, clinical organizations, employers and health care companies can adopt and adapt these programs, using a variety of blended (online/offline) communication channels, for mass dissemination purposes. The programs can help individuals and families develop lifelong learning skills for maintaining healthy habits as part of the social fabric of their daily lives.
Such strategies can greatly expand the reach of providing behavior change programs. They gain access to the greatest untapped human resources by empowering individuals, families and communities to access learning opportunities about healthy behavior change. These strategies leverage human resources more effectively by:
- Appealing to, engaging and activating people to research how to develop their own personal evidence about deep change
- Tapping into their social networks for mutual health gains
The process of helping yourself and others change can combine altruism with self-interest to create win/win situations. Helping others change can help you change, and vice versa. This positive, mutually reinforcing process can access collective wisdom to co-create self knowledge about behavior change.
An educational evolution has taken place that is in sync with this disruptive learning innovation. Generational stereotypes are used to capture the essence of this evolutionary trend.132 The Baby boomer generation (1946-1955) was educated more with teaching processes that were solitary, competitive and passive in nature, such as the traditional continuing medical education lecture format. Generation X (1956-1996) was exposed more to problem-based, small group learning processes. The (Y) Net Generation (1977-1997) and the (Z) Next Generation who have only grown up in the digital age (1998-onwards) have extensive online learning experiences that are collaborative and participatory in nature. Leaders and trainers can advantage of this latest trend to enhance the reach and impact of behavior change learning programs.
Generate Dissemination Capabilities and Capacities
The internet provides a highly efficient way of creating communities for learning how to develop healthy habits. Leaders and trainers can use Web 2.0 and 3.0 social media and networking technologies (such as Facebook, LinkedIn, Ning and Twine) and open source learning management systems (such as Moodle) to disseminate innovative behavior change programs to professional and lay audiences. Using these social networking technologies for learning purposes, they can recruit, engage and activate different groups to collaborate in learning communities about behavior change.
This re-created e-mail exchange (see below) between the author and a colleague with obesity illustrates the potential of online engagement and learning.
Physician (BMI >30): This newspaper article, Does it matter what the doctor weights, unfairly criticizes Regina Benjamin’s obesity as a disqualifier for her appointment as the US Surgeon General.
Overweight physician: Such vitriolic attacks could be used for developing weight loss movements for all health care professionals. I was officially overweight (BMI 25-30) with a BMI is 25.9. I lost 6 pounds to reduce my BMI to 24.9, but then I gained three pounds back to become overweight again.
Physician (BMI >30): But I don’t believe that being overweight puts you at increased risk.133 This Canadian study challenges conventional wisdom. http://www.nature.com/oby/journal/vaop/ncurrent/full/oby2009191a.html
Overweight physician: I agree about being “low-risk”, but my dieting gave me a personal experience about the challenges of weight reduction. Developing such personal evidence can enhance one’s empathy for working with obese patients.
Physician (BMI >30): If losing a few pounds counts as personal evidence, then I have loads of personal evidence. I do that all the time. It’s the weight gain that follows the weight loss that concerns me. The weight loss is always intentional and periodically sustained. Only the gain is non-intentional.
Overweight physician: Personal evidence also includes addressing the non-intentional variations in weight, ideally with social and family support. The challenge is to address the relapse triggers that revert conscious weight reduction efforts into automatic eating patterns or backsliding. How to break the yo-yo cycle or re-program the autopilot? Sound familiar?
Physician (BMI >30): All too familiar! But I remain skeptical that your weight loss is comparable to someone who is obese and losing weight.
Overweight physician: I agree, but it does give me a greater appreciation about the yo-yo cycle of conscious weight reduction efforts and automatic eating patterns. Fortunately, I am genetically programmed with high dietary thermogenesis, so that my furnace can easily burn off calories. Your metabolism is green and conserves energy. You would survive during times of famine, and the likes of me would perish.
Physician (BMI >30): This level of understanding was absent in the media coverage of the surgeon general’s weight. One could argue that Dr. Benjamin’s weight issue makes her more qualified for the position.
Overweight physician: Imagine there being online communities of overweight physicians and political leaders who address the “all too familiar” yo-yo cycle and work on preventing the backsliding from mindful eating of reasonable food portions to automatic eating of oversized portions. What if physicians and health care professionals worked together to create online learning communities that developed professional movements to fight the obesity epidemic, using protected web portals such as Sermo?
Physician, nurse and healthcare leadership is critical in addressing the obesity epidemic. Dr Kessler, who was past commissioner of the US Food and Drug Administration under the Clinton and Ford Administration), had struggles with his weight control. In his book, “The End of Overeating: Taking Control of the Insatiable American Appetite”, he describes a process of using Food Rehab for treating conditioned hypereating.134
The internet provides a highly scalable way to deliver a variety of behavior change programs to different audiences: political, policy-making, leadership, professional, community, practice, peer and family. These programs can use a blend of learning resources and options to cater to the specific needs of these learning communities, such as advocacy and leadership groups.
The best known example for addressing a single risk behavior is Globalink, hosted by the International Union against Cancer. Globalink (http://www.globalink.org/) connects tobacco control practitioners with researchers, advocates, and policy makers from around the world. To advance the impact of such networks, academic institutions can use Portals and Web 2.0 technologies to provide educational resources and faculty to learners internationally.123 For example, the Johns Hopkins Bloomberg School of Public Health (www.globaltobaccocontrol.org) provides online courses for developing capacities in international tobacco control, with a focus on low- and middle- income countries.122
Academic institutions can also capitalize on Web 2.0 and 3.0 technologies for local learners. They can combine small group learning with online programs to harness the collaborative learning power of Generations Y-Z. Selected peer mentors (one or more years ahead of each class) can serve as online and small group facilitators to this learning process. The process of creating such learning organizations within professional institutions can provide students with experiences that prepare them for creating learning communities outside of health care settings for families in their communities.
Shared, meaningful and compelling learning experiences can provide the glue to maintain ongoing social support networks for professional and lay audiences. Such experiences can also create the energy for viral marketing (http://www.sethgodin.com/ideavirus/) that promote healthy habits via the internet. Viral marketing can spread like a flu epidemic. Online communications can also promote word-of-mouth communications.
Together, online and direct communications can create learning communities about health behavior change. These communities minimize the need for one-on-one, professional services. They do not replace counseling and coaching services. Quite to the contrary, these programs can be used in conjunction with coaching and counseling services to enhance their effectiveness and efficiency.
Online and offline communication channels can also help to build learning organizations and communities, both virtual and real. Virtual online groups can vary in size from intimate (4 or more) to large communities (up to 150), whereas the real small groups may vary from 4- 12 people. These groups can multiply to create a groundswell of learning organizations and communities. Collectively, they can develop professional and social movements to promote healthy habits: locally, regionally, nationally and internationally.
Developing countries can work with sponsors and donors from developed countries to spearhead health care policies that support online learning programs about health behavior change. These programs can provide the foundation for systematically disseminating innovative learning programs to leaders, change agents, trainers, practitioners and students. The integration of leadership development, social media and networking, and continuous improvement of the learning processes can expand their reach and enhance their impact of these programs. Local public-private research, academic-community partnerships, and implementation-dissemination research are needed to work on this continuous improvement goal.135
Use Executive Coaches for Leadership Development
Executive health coaches can give leaders (politicians, policy makers, senior executives) the first hand experience of developing personal evidence about improving their own health habits. Such experiences can generate the buy-in and support to generate transformational leadership development networks, within and beyond the health sector. These networks can provide guidance to leaders in how to implement, evaluate, improve and disseminate behavior change programs. Effective social marketing and online learning can help these networks generate momentum to maintain these programs.
Coaches can use the transformational ideas and learning (described Chapter 4) to create leadership development networks. Blended learning methods that use online educational platforms will evolve to enhance the quality, effectiveness and efficiency of these networks over time. These improvements will accelerate the future development of leaders, executive coaches, leadership consultants, change agents and trainers.
Public policy institutes, accreditation bodies, professional training organizations, universities, colleges, schools and communities can collaborate to support the development of these networks. In turn, these networks can establish similar programs within educational, clinical and community settings. These networks are the most important determinant for building the capacities to scale up and accelerate the dissemination of behavior change learning programs.
Coaches can also guide senior leadership teams in how to implement transformational leadership programs, first within and then outside of their educational, clinical and community organizations. Effective leaders facilitate the development of learning organizations and communities for professional and lay audiences, respectively. Together, these organizations and communities can generate professional and social movements to promote healthy behavior change, respectively
To initiate the dissemination process, leaders begin by experiencing how to develop personal evidence about deep change for themselves. Using blended learning methods, leaders work in teams to share their personal experiences of improving their own health habits. This collaborative process is the first step toward developing transformational leadership teams that can disseminate these learning programs.
In educational institutions and clinical organizations, the leadership group can set up a coaching team to build learning organizations and communities that promote healthy habits, first within and then beyond their respective settings. In educational settings, the coaching team can invite faculty, trainees and students to experience and share how they improved their own health habits. As part of their service learning experiences, students and trainee practitioners can also work longitudinally over time to guide a small panel of families through the same learning process. In health care organizations, coaching teams can do the same with practitioners and staff from within their own clinical settings. As part of their clinical and community service programs, they can guide patients and their families through the same learning process.
The speed of scaling up the dissemination process is dependent on leaders mobilizing top-down strategies that leverage bottom-up approaches.
Top-down strategies involve mobilizing leaders and stakeholders at international, national, regional and local levels to develop policies and practices that implement and disseminate learning programs that undergo continuous innovation, evaluation and improvement.
- Bottom up approaches generate the proactive power of social movements whether online using social networking technologies or via the grapevine by word of mouth.
These strategies and approaches can work synergistically together to accelerate the dissemination process. To do this, learning organizations can provide the stewardship for fostering local grassroots movements. For example, health care settings can provide training to voluntary peer mentors who set up peer coaching programs for and led by patients. In turn, these learning communities can build into social movements that promote healthy habits.
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