If the goal is to promote contraceptive continuation, health coaching tactics could be the answer, according to a recent study.1
“Health coaching is a health intervention that is done by professionals or paraprofessionals. It’s a more person-centered approach to behavior change,” explains C. Alix Timko, PhD, study co-author and director of psychiatric and behavioral health research at the Eating Disorder Assessment and Treatment Program at Children’s Hospital of Philadelphia. “It helps individuals think about what their goals are and identify any barriers to adherence. They can identify what may be getting in the way of their making changes, and it creates a sense of accountability for making behavior change.”
Other behavior change tactics include motivational interviewing and healthcare navigation interventions, which are designed to activate an individual’s intrinsic desire to make a behavior change, notes Aletha Y. Akers, MD, MPH, lead study author and vice president for research at the Guttmacher Institute. “Health coaching goes beyond that,” she says. “It’s more holistic in how it helps individuals.”
In a feasibility study, Akers, Timko, and colleagues tailored the intervention to young women younger than age 25 years. Most of the participants were single Black women.
“Our goal was to identify young individuals who were using a new method of contraception. We were recruiting individuals at the time they were initiating a new method,” Akers explains. “We provided them with intensive support throughout the first six months of their using a new method as opposed to waiting until they were struggling or having specific difficulties.”
Akers’ personal interest in this program stems from her observation that young patients often need more support than what healthcare organizations typically provide.
“For example, we’ll set up someone on a method and see them in three to six months to see how they’re doing,” she says. “But what I’ve learned is they may have questions the next week or week after that.”
Health coaches found that within the first 14 days of starting a new method, young women needed a lot of reinforcement about their contraceptive method, when it works, and when it is used.
“What I liked about the health coaching model is it acknowledges that healthcare providers may not be well-positioned to provide that intensive support, but we can capitalize on others to provide that support,” Akers says.
Health coaching also helped when patients decided to switch methods. “For example, if someone started using one method and found it didn’t fit in with their lifestyle, like forgetting to take the pills, part of coaching was discussing that,” Timko says. “We determined ways they could manage the side effects, and if a different form of birth control would be the best solution, we helped them transition in a smooth way.”
Health coaches helped facilitate a seamless transition in which the woman would continue with the first birth control method until safely on the new method. “They would transition smoothly without any break in contraception from one type to another,” Timko adds.
Coaches supported women in considering their options and providing them with information. “They helped them think through their priorities and whether the method they were using was meeting those priorities,” Akers says. “They helped them get the care they needed to make that change.”
The coaches were health educators, not clinical care providers with prescribing capabilities. They did not make clinical care decisions. “The coach helped a person determine if they needed a switch and helped them identify the steps they needed to make to [ensure] there was not a gap in contraceptive use,” Akers explains. “We made sure they continued on their current method until they could see a provider.”
Whatever a person’s motivator for a contraceptive change, the coaches would try to learn more about it. “It could be side effects. It could be the individual was struggling to keep up with getting refills,” Akers notes. “It could be the individual was on a shot and was in college and going home for the shot was hard.”
Coaches listened to the patients’ challenges and helped them think of solutions by asking:
- “Do you really like the method?”
- “Are there other ways you can manage your method?”
- “Would a 12-month supply work better than a three-month supply?”
- “It sounds like you are having trouble with transportation. Are there other people you can think of who would support you with this?”
- “Is there anyone in your family network who could help you?”
- “Is there a guidance counselor or social worker at your school who could help?”
- “If the person decided what was best was a method change, the coach would help them facilitate the change, without putting them at risk of pregnancy,” Akers says. “They could help the individual go through the process of making an appointment.”
While healthcare providers also played a role, the young people who participated in the studies often faced barriers that reflected their contextual challenges, including transportation problems and needing a better understanding of the healthcare system.
“Coaching is an adjunct and develops an appropriate way to support young people who decided they want to avoid a pregnancy at this moment — and avoid this pregnancy while navigating a complex system — as efficiently as possible,” Akers notes.
The coaches consider barriers that are outside the medical realm, help patients articulate the problems, and find ways to resolve them. “One of the wonderful things about the coaches is they meet the adolescents where they are,” Timko says. “Instead of saying, ‘Here are solutions to your problem,’ they help them think through it.” This encourages the adolescent to take ownership of the solution.
Researchers found that participants might not always recall the contraceptive information they were taught.
“Once they started using the methods, they realized they didn’t remember as much as they thought they had,” Akers says. “They’d say, ‘Once I started having side effects, I couldn’t remember if it was OK, and having the coaches telling me it was OK was reassuring.’”
The coaches also helped young women learn about condom use and negotiating strategies for condoms. “There were instances where participants had changed relationships between visits, so the coaches would remind them that if you’re changing partners, think about getting STD testing and remind them to make sure they were using condoms again with the new partner,” Akers explains. “Those were some of the things participants shared and the ways coaches helped them.”
When the young women could contact coaches more frequently, they received answers when they most needed them. Physicians and nurses do not see patients frequently enough to educate them in the same just-when-needed way.
“They also had family members who talked with them about these things, but they pointed out that coaches knew more, and the coaches’ approach of really listening to them and tailoring information to the individual honored their decisions and choices. This is what our participants found the most useful,” Akers explains.
REFERENCE
- Akers AY, Skolnik A, DiFiore G, et al. Feasibility study of a health coaching intervention to improve contraceptive continuation in adolescent and young adult women in Philadelphia, Pennsylvania. Perspect Sex Reprod Health 2021;53:27-43.