BEHAVIOUR CHANGE

Asking the
RIGHT QUESTIONS
As part of Health Club Management’s series on behaviour change, Dr Tim Anstiss
offers practical advice for delivering health coaching: questions, tools and strategies

M
ore and more people are developing and experience, self-directed learning and personal growth
living with long-term conditions such as of the coachee”. Other definitions of coaching include
diabetes, obesity, heart disease, cancer and “unlocking a person’s potential to maximise their own
arthritis. That’s partly because we are living performance. It is helping them to learn rather than
longer, partly due to better medical care keeping us alive teaching them” (Whitmore, 2003).
with health problems that used to kill us, and partly due Health coaching, by extension, is the application

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to unhealthy lifestyles such as poor diet, lack of exercise, of coaching psychology to help a person change their

STOCK
smoking and so on. behaviour and aspects of their lifestyle in ways that are
So how might we best help individuals who are likely to be associated with improved health, reduced risk of

UTTER
experiencing poor health and wellbeing, including those who disease or disease complications, and enhanced functional
are already receiving good medical care? And how can we capacity (their ability to do things). One definition of health

SH
OTOS:
help healthy people to stay that way? Health coaching is one coaching might be: “A collaborative conversation style for
approach that’s becoming popular. strengthening a person’s own motivation and commitment

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to change, coupled with guidance and support in helping
What is health coaching? them make changes likely to result in improved health” Effective coaches practise
The first part of Health Club Management’s behaviour (adapted from Miller and Rollnick, 2013). empathetic listening rather
change series looked at the individual as expert (see A large and growing body of research links this way than telling clients what to do
HCM May 13, p46). Health coaching sits very much of talking to people with better outcomes in a range of
alongside this: it’s an approach to helping someone that different behaviours and settings. It helps people to eat
involves guiding them and supporting them, rather than better, lose weight, stop smoking, become more active
instructing them on what to do. and drink less. So how do you do health coaching? The effective health coach uses empathic listening to help you will be able to attend three times a week, and you and
Coaching has been defined by The Association for the other person feel listened to, heard and understood. I will talk again in two weeks’ time to see how it’s going.”
Coaching as “a collaborative, solution-focused, results- Undertaking health coaching This is a very active form of listening involving accurately It cannot be emphasised enough how important empathy
orientated and systematic process in which the coach Firstly, it helps to have the right mindset and assumptions paraphrasing and reflecting back what a person says, but – trying to understand the world from the other person’s
facilitates the enhancement of work performance, life about behaviour change. The effective health coach: using different words that capture the same meaning. perspective, and communicating this effort – is for change
•฀ Has an optimistic view of people’s ability to change It helps to get the person and good relationships. It
•฀ Knows that if the person being coached tells you the talking more and perhaps probably accounts for 30 per
Coaching can reasons why they want to change, and how they might do understanding themselves cent of the power in a typical
help unlock a it, it’s much more powerful than the coach telling them better. These ‘reflections’ are "If all health and fitness professionals health coaching conversation.
person's full •฀ Accepts that the other person is the ultimate decision- combined with summaries were trained in proven methods of health
potential maker, not the coach that draw together several
coaching, more members would achieve Readiness for change
•฀ Works in partnership with the other person, doing things the person has said into
their health goals and retention figures
The health coach knows that
coaching with them, not to them a few sentences – summaries a person’s readiness to change
•฀ Creates the right conditions for the person to think that are used occasionally would climb" their behaviour is related to
things through for themselves throughout the session to check how important they think
understanding, to move the changing the behaviour is,
conversation along, and to bring combined with their self-
the conversation to a close. efficacy – that is, how confident they are that they can
"The health coach knows that a person's A nice summary might – of course depending on what the change (see Figure 1, p56).
readiness to change their behaviour is person has said – sound something like: “The main reasons To build perceived importance for change, the health
you want to lose weight are to feel better about yourself, coach asks open questions such as:
related to how important they think
get into some of your favourite clothes, and get more •฀Why might you want to make this change?
changing the behaviour is, combined with involved in activities with your two young children. Joining •฀What are your three best reasons?
how confident they are that they can change" the club is something you’ve been thinking about for a long •฀How do you hope things will be in four to five months’
time, and you’re really looking forward to attending the time, once you have changed your behaviour?
classes and getting support from other people. You think •฀How do you think things will be if you stay the same?

54 Read Health Club Management online at [Link]/digital June 2013 © Cybertrek 2013 June 2013 © Cybertrek 2013 Read Health Club Management online at [Link]/digital 55
 BEHAVIOUR CHANGE
Figure 1: Readiness to change

Perceived importance of change

PHOTO: [Link]
Confidence about changing
(self-efficacy)
Getting people to reflect on and state their own intentions,
such as changing their diet, is an important process

These questions are combined with reflections to or “have you thought about eating more fruit?”, the skillful
help the person think more deeply and talk about why health coach asks questions that are hard to answer with
they want to change. just one word, such as:
To build self-efficacy or confidence about changing, the •฀How might you go about taking 30 minutes of moderate
health coach might use a scaling question such as: “How activity a day?
confident are you that you can eat better and keep this up •฀What do you think would happen if you were able to eat
for six months, where 0 is not at all confident and 10 is very more fruit and vegetables each day?
confident?” Let’s assume the person says 4 (the number •฀What’s the first step you could take to help you reach
is not that important to be honest) – the coach then your goal?
asks: “Why 4 – why not 1 or 2? Where do you get your •฀How can I help you to succeed?
confidence from?” and lets the person talk. It can also be helpful to have a model or framework in
Once the person has explained why they have some your head that will help to guide the coaching conversation,
degree of confidence, the coach asks: “And what would have such as the GROW model. In this model, the coach starts
to happen for your confidence to become 6?” This gets the by enquiring about the person's own Goals. Then you
person thinking a little more deeply about what they need explore with them how things are now: their Reality. Then
to do in order to change and stay changed, and also the help you explore and share Options for change. And finally you
they need to be successful. agree a Way forward.
If they are stuck, the coach might suggest some further
proven behaviour change techniques such as goal setting, Summary
self-monitoring, using social support and periodic follow-up. Health coaching is a powerful approach to helping people
If the person shows interest, the coach explores how these change their health behaviour. As noted by Debbie
might fit into the client’s behaviour change plan. Lawrence in last month’s feature, however, many people
working in the health and fitness sector will have to ‘unlearn’
Tapping inner resources some of their own behaviours (such as telling people why
The skillful health coach knows that it’s better to discover and how to change) before they can really start to become
what a person already knows about something than it is to an effective health coach.
jump in with information. They use open questions such as Nevertheless, if all health and fitness professionals were
“what do you know about how much physical activity is trained in proven methods of health coaching such as
required for health?” and “what do you know about the motivational interviewing, more members would achieve
benefits of strength training?” If the person doesn’t know their health goals, retention figures would climb – and the
much, or has some wrong information, the coach might first health of the nation might just improve.
ask to share some additional information. Once they have Next month I will share my top tips for wellbeing coaching,
shared it, they then ask: “What do you make of what I have which will build on the concepts covered in this article. ●
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 Tim Anstiss is a medical doctor who has been training
helps check understanding. health professionals in the use of behaviour change
Throughout the conversation, the health coach uses techniques for over 20 years. He helped develop the training
an ‘evoking’ style to draw information from within the materials for the Let’s Get Moving national programme
person, rather than filling them with facts and information for physical activity, and co-authored a National Obesity
from the outside. This style is much more likely to lead to Observatory report on weight loss. He is currently training cancer clinicians
engagement in the conversation and to the person owning in health coaching as part of the National Cancer Survivorship Initiative, and
any behaviour change plan, rather than making them feel as is developing a health coaching qualification in conjunction with SkillsActive.
though it’s been imposed on them. He is also a former international polevaulter and Gladiators contender.
Key to engagement and evoking is the use of open Email: drtim@[Link]
rather than closed questions. Rather than asking Twitter: drtimanstiss
questions such as “could you go for a walk at lunchtime?” Web: [Link]

56 Read Health Club Management online at [Link]/digital June 2013 © Cybertrek 2013