JMIR Publications

ABSTRACT

Background:

An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension.

Objective:

This study aims to explore preferences for the scope of involvement of health coaches and healthcare professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs.

Methods:

We conducted focus group discussions (FGD) with 39 patients with diabetes and/or hypertension and 45 HCPs involved in their care. All FGDs were audio-recorded, transcribed verbatim and analyzed using thematic analysis.

Results:

Participants agreed that the main responsibility of HCPs should be identifying patient’s stage of change and medication education while the health coaches should focus on lifestyle education, monitoring and motivational conversation. The importance of health coach’s personal attributes and credentials was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: 1) target population (newly diagnosed and less stable patients), 2) commitment of all stakeholders (discrepancy on targeted times and modality), 3) continuity of care (familiar faces), 4) philosophy of care (person-centered communication), and 5) faces of legitimacy (physician as the ultimate authority).

Conclusions:

Findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in shared decision-making as preferred by patients and HCPs. Based on unified themes, a conceptual model was formulated as a practice tool for future efforts to optimally implement SDM involving health coaches in routine primary care.