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Live Healthy … Work Well: A Randomized Controlled Trial Empowering Patients to Set Goals to Manage Diabetes and Prevent Complications USPHS Scientific.

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Presentation on theme: "Live Healthy … Work Well: A Randomized Controlled Trial Empowering Patients to Set Goals to Manage Diabetes and Prevent Complications USPHS Scientific."— Presentation transcript:

1 Live Healthy … Work Well: A Randomized Controlled Trial Empowering Patients to Set Goals to Manage Diabetes and Prevent Complications USPHS Scientific and Training Symposium San Diego, CA May 26, 2010 Jean Isip Schneider, MEd, SPHR Rebecca Rude Ozaki, PhD

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3 Learning Objectives Articulate the differences between a traditional compliance-based approach and the empowerment /life coaching approach. Articulate the benefits of the empowerment approach and life coaching as it relates to diabetes self-management. Create interest around replication of the Live Healthy … Work Well life coaching model.

4 Presentation Outline

5 Demonstration to Maintain Independence & Employment (DMIE) HawaiiKansas MinnesotaTexas

6 Overarching DMIE Research Question Can a program of medical and other supports prevent or forestall loss of employment and independence due to a potentially disabling condition? Goal: help those who are NOT YET disabled to stay working and stay off disability benefits.

7 National Projects Hawaii Diabetes Kansas High Risk Pool Minnesota Mental Illness Texas Mental Illness

8 National Evaluation mathematica-mpr.com

9 Random Assignment Enrollment (190) Treatment Group (128) Intervention Control Group (62) Usual Care

10 Data Collection Baseline 6 months 12 months 18 months

11 Measures EmploymentDisabilityHealth Satisfaction Goals

12 Measures EmploymentDisabilityHealth Satisfaction Goals

13 Intervention Components Treatment group participants One Year Intervention Support Services Life Coaching Pharmacist Counseling Other Services Reimbursements Diabetes-related health care costs

14 Intervention Components Treatment group participants One Year Intervention Support Services Life Coaching Pharmacist Counseling Other Services Reimbursements Diabetes-related health care costs

15 Intervention: Service Usage

16 Other Outcomes Discussion Diabetes Intervention and Employment: A Randomized Controlled Mixed Methods Study Today at 4:15 – 4:45 p.m. Nautilus 1

17 Baseline Demographics Diabetes Type Type 2: 86% Gender Female: 63% Years since diagnosis Mean: 8 yrs Age Mean: 48 yrs Hemoglobin A1c Mean: 7.8% Education Bachelor’s degree or higher: 50% Body Mass Index (BMI) Overweight or Obese: 86% 2007 Annual Earnings Mean: $44K Healthcare Coverage Insured: 97% Employment Mean hrs worked/wk in past month: 38 hrs

18 Diverse Ethnicity

19 Guiding Questions What is life coaching? What types of goals are people with diabetes interested in setting to manage their condition? What did treatment group participants think of the life coaching intervention?

20 Data Sources Goals (Quantitative) Participant Perceptions (Qualitative) Online Coaching ToolSatisfaction Surveys Types of goalsFocus Groups Goal attainmentExit Surveys

21 Grant, A. (2003). The impact of life coaching on goal attainment, meta-cognition and mental health. Social Behavior and Personality, 31(3), 253-264. Life Coaching Collaborative Solution- focused Results- oriented Systematic process Facilitate life experiences Goal attainment

22 Contrasting Philosophies Health care provider directs patient to comply with diabetes targets Patient collaboratively selects and sets their own goals TraditionalEmpowerment/ Approach VS.Life Coaching Approach

23 Internal vs. External Motivation Internal Motivation: "Healthy eating is important to me and my family." External Motivation: "My doctor told me to go on a diet."

24 Same Goal

25 8,759

26 8,760hours/year - 1face time with PCP 8,759 “The choices that patients make each day as they care for diabetes have a greater impact on their outcomes than those made by health professionals.” Funnell, MM & Anderson, RM. (2004). Empowerment and self-management of diabetes. Clinical Diabetes, 22(3), 123-127.

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28 Active Listening Reflecting Powerful Questioning Non- Judgmental

29 Goal Setting Process Identify SMART Goal Establish Action Plan Address obstacles Identify supports needed

30 Goal Setting “I was lucky enough to get a life coach, so it’s good because when I was diagnosed, it seemed like this huge thing and she helps me break it down so that there are little goals along the way, so that I’m not looking at it as an insurmountable mountain.”

31 Types of Goals Set

32 Goal Setting “If you have a goal it has to be written you can’t have it in your mind the goal has to be very… you have to look at it…This is my goal… this is my day…this is what I have to do today.”

33 Goal Attainment

34 Satisfaction How satisfied are you with your life coaching experience overall? 12341234 3.80 N = 93 Completely Dissatisfied Completely Satisfied

35 Satisfaction 12341234 3.83 N = 93 How satisfied are you with your coach’s ability to elicit answers and actions rather than directly advising you? Completely Dissatisfied Completely Satisfied

36 Satisfaction with Life Coach “I love my life coach and her willingness to be available and provide insight and thought provoking ideas to consider outside of my comfort zone. She has helped me look at the "big picture" instead of just a portion. I believe she has helped me never to look at a slight falter as a disaster but an opportunity to recover, learn, and do better.”

37 What did you like about life coaching? Motivating Insightful Goal Setting Accountability

38 Life Coaching “Helped me through the hard process. Look at my alternatives, think, do critical thinking about, um, making conscious decisions, and looking at different alternatives to overcome the barriers and challenges.” “I have a lot more self awareness, understanding why I do things, which helps to make the change if you understand why you are doing things, then it’s easier to make the change”

39 Discussion / Questions Patients naturally select goals that are most important to them Managing health becomes a choice rather than a directive Results in higher self- efficacy

40 Thank you! Jean Isip Schneider, MEd, SPHR isip@hawaii.edu Rebecca Rude Ozaki, PhD rozaki@hawaii.edu manoa.hawaii.edu/livehealthy


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