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Confi dence about changing (self-effi cacy)

Getting people to refl ect on and state their own intentions, such as changing their diet, is an important process

These questions are combined with refl ections to

help the person think more deeply and talk about why they want to change. To build self-effi cacy or confi dence about changing, the

health coach might use a scaling question such as: “How confi dent are you that you can eat better and keep this up for six months, where 0 is not at all confi dent and 10 is very confi dent?” Let’s assume the person says 4 (the number is not that important to be honest) – the coach then asks: “Why 4 – why not 1 or 2? Where do you get your confi dence from?” and lets the person talk. Once the person has explained why they have some

degree of confi dence, the coach asks: “And what would have to happen for your confi dence to become 6?” This gets the person thinking a little more deeply about what they need to do in order to change and stay changed, and also the help they need to be successful. If they are stuck, the coach might suggest some further

proven behaviour change techniques such as goal setting, self-monitoring, using social support and periodic follow-up. If the person shows interest, the coach explores how these might fi t into the client’s behaviour change plan.

Tapping inner resources The skillful health coach knows that it’s better to discover what a person already knows about something than it is to jump in with information. They use open questions such as “what do you know about how much physical activity is required for health?” and “what do you know about the benefits of strength training?” If the person doesn’t know much, or has some wrong information, the coach might first ask to share some additional information. Once they have shared it, they then ask: “What do you make of what I have just said?” This little sequence – Ask-Share-Ask – is respectful of the other person, helps the coach understand their knowledge first, prevents information overload, and helps check understanding. Throughout the conversation, the health coach uses

an ‘evoking’ style to draw information from within the person, rather than fi lling them with facts and information from the outside. This style is much more likely to lead to engagement in the conversation and to the person owning any behaviour change plan, rather than making them feel as though it’s been imposed on them. Key to engagement and evoking is the use of open

rather than closed questions. Rather than asking questions such as “could you go for a walk at lunchtime?”


• How might you go about taking 30 minutes of moderate activity a day?

• What’s the fi rst step you could take to help you reach your goal?

or “have you thought about eating more fruit?”, the skillful health coach asks questions that are hard to answer with just one word, such as:

• What do you think would happen if you were able to eat more fruit and vegetables each day?

• How can I help you to succeed? It can also be helpful to have a model or framework in

your head that will help to guide the coaching conversation, such as the GROW model. In this model, the coach starts by enquiring about the person's own Goals. Then you explore with them how things are now: their Reality. Then you explore and share Options for change. And fi nally you agree a Way forward.

Summary Health coaching is a powerful approach to helping people change their health behaviour. As noted by Debbie Lawrence in last month’s feature, however, many people working in the health and fitness sector will have to ‘unlearn’ some of their own behaviours (such as telling people why and how to change) before they can really start to become an effective health coach. Nevertheless, if all health and fi tness professionals were

trained in proven methods of health coaching such as motivational interviewing, more members would achieve their health goals, retention fi gures would climb – and the health of the nation might just improve. Next month I will share my top tips for wellbeing coaching, which will build on the concepts covered in this article. ●

Tim Anstiss is a medical doctor who has been training health professionals in the use of behaviour change techniques for over 20 years. He helped develop the training materials for the Let’s Get Moving national programme for physical activity, and co-authored a National Obesity Observatory report on weight loss. He is currently training cancer clinicians in health coaching as part of the National Cancer Survivorship Initiative, and is developing a health coaching qualifi cation in conjunction with SkillsActive. He is also a former international polevaulter and Gladiators contender. Email: Twitter: drtimanstiss Web:

Read Health Club Management online at June 2013 © Cybertrek 2013


Figure 1: Readiness to change Perceived importance of change

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