Natalie Digate Muth, MD, MPH, RD, is the ACE senior consultant for healthcare solutions, a practicing pediatrician and registered dietitian. Recognized as a Certified Obesity Specialist, Natalie has written for more than 50 publications and, in 2012, published her first book, 'Eat Your Vegetables' and Other Mistakes Parents Make: Redefining How to Raise Healthy Eaters.
Coaching Behavior Change: A Better Way of “Teaching”
When working with individuals and families desiring to generally be healthier and achieve or maintain a healthy weight, it is tempting to overwhelm them with an abundance of information—eat more vegetables and fruits; incorporate 60 minutes of physical activity into every day; and make these changes to avoid the onslaught of scary conditions like diabetes and heart disease. But here’s the thing: Most people already know this information. It is the skills needed to translate the information into behavior changes that are often missing. If we really want to help people make healthful behavior changes, it is not “teaching” or “health education” that we should be doing, but rather “skills training.”
In learning how to do this, it helps to borrow from two well-studied and effective methods: andragogy and motivational interviewing. Andragogy refers to the key principles of teaching adult learners, first studied and described by the late Malcolm Knowles. Essentially, andragogy boils down to this: Adult learners learn best when information is shared in a way that is practical and relevant, built upon previous knowledge and useful for making a change right now. The second method is a process referred to as elicit-provide-elicit in motivational interviewing. Elicit-provide-elicit is a practical method for putting andragogy into practice. It goes like this:
- Ask open-ended questions to get a sense of a client’s current knowledge or understanding of the topic (elicit).
- With permission, provide a useful tidbit or two of information (provide).
- Query the client to get a sense of the client’s understanding and the usefulness of the information that was shared (elicit).
Health and fitness professionals can put andragogy and elicit-provide-elicit into action with the following five-step skills-training process, which can be viewed as “a better way of teaching.”
- Ask, “What do you know about this already?”
- Ask permission to share additional information (such as, “Would it be O.K. if I share with you a little bit of information that other clients have found to be helpful?”).
- Provide information in a way that is relevant and practical and that builds upon prior knowledge.
- Ask the client to recap his or her understanding of what was shared.
- Ask, “Knowing this, what might you do differently?”
Here is an example using a standard “teaching" method versus this new "coaching" method for helping a client adopt healthier nutrition habits for weight loss, specifically incorporating more fruits and vegetables into the daily diet.
Standard “Teaching” Method
“After going through your meals and snacks over the past 24 hours, I noticed that you didn’t eat very many fruits and vegetables. There are a lot of studies that show that fruits and vegetables have an abundance of health benefits, from containing lots of nutrients and antioxidants, to being high in fiber and low in calories. It is recommended that adults eat nine servings of fruits and vegetables per day. Do this and you will really experience tremendous health benefits. Why don’t you work on that over the next week and then we can go through this process again next week and see how you did.”
[Client is likely to say “O.K.” and do nothing differently.]
New “Coaching” Method
Step 1. Assess current knowledge: “After going through your meals and snacks over the past 24 hours, I noticed that you didn’t eat very many fruits and vegetables. It seems like looking into this more might help in your goal to be healthier. What do you know already about the health value of fruits and vegetables?”
[Client answers. Most likely, client will say things such as: “I know that fruits and vegetables are really healthy for me. It’s just really hard to remember to eat them. And they are expensive and it takes time to clean them.”]
Step 2. Affirm current knowledge and ask permission to provide information: “You really know a lot already about the health benefits of fruits and vegetables. And you’ve also identified some challenges with eating them more often. Would it be O.K. with you if I share a little bit more information about why we are always pushing fruits and vegetables so much, as well as some ways that other clients have addressed some of the very issues that you’ve raised that make it difficult to eat more vegetables and fruits?”
[Client will almost always answer “sure” or some other affirmative response when permission is sought to provide the information. By asking for permission, the client’s autonomy is respected and the client is much more likely to feel the conversation is engaging and equal rather than a “lecture.”]
Step 3. Provide information in an adult-learner-centered way: “You’ve shared that one of your major goals is to lose weight. One way that eating more fruits and vegetables can help to do this, in addition to their overall health value, is because they are high in fiber and fiber helps you to feel full. Many of my clients have replaced other snacks with fruits and vegetables for this reason. For example, to make it easier, some clients will clean and prep their vegetables and fruits right after they buy them and then put them in the refrigerator in a Ziploc bag or clear container so they are a ready-to-go snack.”
[Client will likely respond with something like “Oh, that’s a good idea.” Or, “I could do that.” Or “Yes, but…”]
Step 4. Ask an open question to get a sense of client’s current understanding and thinking about this information: “I’ve been doing a lot of talking, but really I’m most interested in understanding what you think about this conversation and how it might impact what you choose to eat.”
[Client will give an overall summary of the conversation and clues to his or her intended next steps or existing knowledge or skill gaps. It might be something like: “Well, I already knew that vegetables and fruits were healthy, but I didn’t realize that they might also help me lose weight by replacing other snacks. I thought it would be hard to eat them more often, but actually I think I could do it. Maybe not nine times a day, or whatever the recommendation is, but at least a couple.”]
Step 5. Prompt the client to identify behavioral changes based on the information shared: “It sounds like you’ve really bought into the importance of eating vegetables and fruits. What might be one way that you can build eating them into your daily habits?”
[Client is likely to identify a solution that is equivalent to a behavior change based on the discussion of this information on the benefits of fruits and vegetables.]
This method of skill-building (rather than “teaching”) relies on a lot more “asking” than “answering" for the health and fitness professional. The reason for this is simple. For adults, information is useful to the extent that it is actionable. How will knowing the information change a person’s habits or behaviors? The best way to help make the direct connection between providing information and ultimately helping to promote behavioral change is through open-ended, probing questions. These questions help the client to directly connect current knowledge and behaviors with the new knowledge or information and possible paths by which having this new information might change current habits.
Earn an ACE Behavior Change Specialty Certification
No matter how you work with clients and patients, effective coaching can further heighten the impact of your program. As an ACE Behavior Change Specialist, you will possess the knowledge of behavior-change philosophy and emotional intelligence and, most importantly, the practical, hands-on skills to put it to use. Our comprehensive learning experience incorporates expertise from renowned experts and pioneers in psychology and coaching to help you learn how to develop rich, productive relationships and guide people toward sustainable change in one-on-one, group and virtual settings.