November 02, 2022 Health Coaching

Grace: Welcome everybody to a Diabetes Canada webinar. I am very excited. We have Diana Sherifali here to talk about Health Coaching. We’re very excited to have you here, Diana. Before we get started, I’d just like to thank Nestle Boost for sponsoring today’s webinar.

Grace: Diana is an Associate Professor in the School of Nursing and the inaugural holder of the Heather M. Arthur Population Health Research Institute/Hamilton Health Sciences Chair in Interprofessional Health Research. Dr. Sherifali is also the Lead of the McMaster Evidence Review and Synthesis Team, which supported the development of guidelines for Diabetes Canada, Obesity Canada. She has been funded by the Diabetes Canada, the Heart and Stroke Foundation, the Canadian Institutes for Health Research, and more recently has been selected as an Emerging Leader 2020 by the World Heart Federation. Dr. Sherifali’s research interests include the implementation and evaluation of strategies to optimize diabetes self-management at the patient through health coaching.

Diana: Thank you. Grace, for that kind introduction. It's an absolute pleasure to join everyone for this Webinar, and a pleasure for me to talk about health coaching. I've been a nurse Diabetes educator for several years, and I've been passionate about supporting people living better lives with diabetes, or for those at risk for diabetes.

Um! So it's a delight for me to share a little bit about my clinical experience. But more recently my research experience around health coaching.

Diana: So to start off, I want to talk a little bit about context and background. Um, I will then um discuss the development or developing and evaluating a diabetes coaching model. Um! This is still developing and still being evaluated in various forms.

Diana: And then I want to conclude the Webinar today with some reflections, some rethinking or re-imagining of diabetes coaching and then revising this for the future, and what the future looks like.

Diana: So I certainly don't need to tell this audience that in in the grand scheme of things we do see the cases of diabetes on the rise type, one type, two gestational um we're seeing different forms of diabetes. Um. So for the most part, where we're feeling a lot of pressures on the system are the rising rates or prevalence rates of type, two diabetes. And really, you know, you've heard the analogy of the perfect storm where

Diana: um, you know, as a society we're becoming a little bit more overweight or obese. We've had Covid. We've had, you know, locked down. So All of this tends to be a perfect storm for this context of rising uh cases of type, two diabetes.

Diana: We also know that diabetes management in general requires a team based care, approach.

Diana: And we know that this is really about um engaging, empowering individuals to, uh become informed and hopefully self manage their diabetes.

Diana: So at that point self management, if we dig a little bit deeper, is really up all about an individual's ability to manage their their diabetes, including their symptoms, their treatment protocols adhering to treatment, adhering to the physical. Uh, you know, uh activity nutrition, but also help support themselves in terms of psychosocial consequences and well being,

Diana: and even saying that is overwhelming, let alone trying to live with diabetes and manage this

Diana: so to facilitate diabetes management as educators. We've often talked about. Well, we need to distill the knowledge, the skills, the capabilities. Um assess readiness. We need to get a sense of people's um empowerment or motivation, and then their problem solving skills

Diana: in terms of diabetes, self management support that support was really around. Um uh supporting behavior, change and goal setting. And our goals typically have been outlined to smart goals. Um

Diana: that are really aligned closely with, uh, the clinical practice guidelines, whether it's nutritional goals, physical activity, goals medication into here inherent schools, and such

Diana: a little bit more about self management. And this is really coming from, I would say, in the last decade or so

Diana: I have been writing a little bit about self management and the evidence for it. Um, It's based on a lot of other chronic conditions, and I make this point, because I I could certainly understand that people can argue that uh the the the needs and and um demands of chronic disease management vary from condition to condition. But I truly, in my heart of heart believe that diabetes, whether it's type one and type two

Diana: um carrie a myriad of challenges, Problem-solving skills As patients have said, the daily grind of managing their diabetes looks very different in comparison to other chronic conditions from which the self evidence or self management evidence comes from.

Diana: So with that in mind, when we feel back the layers of the evidence, we see that there's a great great variation and heterogeneity in terms of the methods, and how those studies were done, and then subsequently, because the methods are are um variating so much, we have a harder time sort of distilling understanding, trusting the results. And then subsequently, how do we implement that in actual real world settings, where, for example,

Diana: patients are being renumerated, their parking is not paid for. They're not given, you know, football tickets or hockey tickets for completing trial um assessment. So with that in mind we know that by the time we take some of that self management evidence and implement it in real world. Clinical settings doesn't quite carry the same way.

Diana: We also know that one size does not fit all approach when it comes to self management, and some of this comes down to the person in the circumstances. I can reflect as a young girl

Diana: um going through the experience of my mom being diagnosed with type two diabetes.

Diana: Um, If you can imagine the movie, my big, fat Greek wedding. I'm not Greek, but my family is from former Yugoslavia. I was that girl that would take cabbage rules to lunch uh at school, and all I wanted was peanut butter, sandwiches. So all of the education that my mom was getting was not relevant to her circumstances. In her personal context we was always a constant struggle of getting peanut butter in the house, unfortunately, and I didn't have it until later on in life.

Diana: So this really reminded me of persons and circumstances and context as being important.

Diana: We also know that the delivery method and content doesn't um really reflect A one. Size fits all. Some people benefit from a group or peer based learning, environment. Other people don't uh. Some people appreciate asynchronous learning. Some people like to be in that same context, so synchronous learning.

Diana: We also know that there's many other organization and process barriers. So how do we book appointments for self management? Are they based on a one? C levels every three months. Um! Are they based on daytime hours that are not conducive to uh people living with diabetes, and and you know their their work uh schedules as well.

Diana: So all of this gives us some insight in terms of context. And um, you know what is essentially driving some of this literature for health coaching.

Diana: So the origin story for me really lands on a couple of instances.

Diana: One was as a young girl going through a nursing school, always taking what my mom was learning about her type two diabetes management, and reflecting it back to her in a way that was conducive to her, meaningful to her, and really context driven for her.

Diana: A second point in sort of conflection point for me was um in my post doctoral fellowship uh, under the supervision of Dr. Hertzel. We had a negative trial where it was um an intervention in the community that was paper based.

Diana: Um, and it wasn't until uh I spoke to a patient in the clinic after the trial, and he asked me, You know, Diana, what were the results of that trial, and I, in in so many words explain to him that it was a negative trial. We, you know, didn't find a difference between um. The paper based guideline recommendations versus usual care what they were assessing in the community,

Diana: and this comment to me literally stopped me in my tracks, and he said to me, Well, Diana, Paper doesn't talk to me,

Diana: and that set me on a whole other trajectory in terms of coaching.

Diana: So, in terms of talking in terms of engaging, I also reflected on my own clinical experiences that certified diabetes Educator. There were many instances where, you know, we were reflecting sort of the pillars or the tenants of self management that people should uh acquire the skills, the competencies, the knowledge, and then off they go, and self-manage. But there was something more there for me. I would often call patients, particularly after starting insulin or after

Diana: they're being discharged from hospital, calling them, and just checking up on them, not from a diabetes standpoint, not from a policing standpoint, or are they compliant but more. How are you doing? How's life now that you've started insulin So it's really about providing support beyond diabetes. But what was life like living with diabetes?

Diana: And so all of this led me on this trajectory of coaching or health coaching. So when I explored the literature a little bit more,

Diana: lo and behold! To my surprise, I found that it was really resonating and reflecting what I was thinking for all these years. It was a eureka moment for me, and I kept thinking to myself, Where have you been all my life, so to speak,

Diana: so health coaching isn't new. It's been around for a couple of decades and really comes out of the clinical psychology field. Now, i'm not a clinical psychologist. I don't pretend to be, but I think there are certainly elements to health coaching that people can acquire. Um can gain skills and education, so that they have the skills and competencies for this,

Diana: so very briefly help Coaching is described as being super super patient centered. It includes patient, determined goals. So it's not about me using a formula and smart goals. It's about what's important to the patient.

Diana: It incorporates self-discovering active learning processes,

Diana: and the self discovery piece is absolutely earth-shattering for me when patients and people with lived experience can come forward and say, You know what this is, what i'm seeing. This is what i'm reflecting on. This is what i'm toying with. What do you think? Um, It's really about patients being the experts in driving that

Diana: it encourages accountability, but from a non-judgmental support we're there as health coaches as a sounding board, so patients can bounce off ideas um to help further crystallize behaviors or some of those smaller habits that they're looking to work on towards a bigger goal.

 Diana: What I love about this is that there's always some degree of education alongside coaching. So it is not the group based to our coaching sessions. Um, that I used to do. It's really about what I've coined as just in time Education and I borrowed that terminology from

Diana: um industry, where, uh, they don't have a lot of inventory sitting uh alongside manufacturing lines, et cetera, but just the right amount of inventory and parts to put something together. So for me, this is really about your coaching. You're supporting someone through that self discovery, learning process phase. You're putting in a little bit of education enough that can continue the momentum around self discovery and learning.

Diana: And then ultimately, the health care, professional is trained in behavior, change, communication, and motivational skills.

Diana: The second bullet point really talks um, and sort of further explains that it's about education, psychosocial support, and all about the individuals health related goals, and then the final bullet point is what I've sort of coined

Diana: um that health coaches, particularly in diabetes, are seen as care translators. So we're taking abstract clinical practice, guidelines or goals, or recommendations, and translating it back to what does this mean for the person in front of me? What does this mean for the individual living with diabetes,

Diana: and maybe the word translation comes to mind for me from the standpoint of my mom. You know English as a second language. But I really feel that that's an expression or a term that really resonates with people. It's taking guidelines and recommendations, or best clinical practices, and translating it into a way that really means something to the individual living with diabetes.

Diana: So I had a working definition, and I thought this really resonates with me. My next choice was to go to the literature to see how was this expressed in terms of clinical benefit at all, if at all, in the literature?

Diana: So I embarked on a literature review of randomized control trials, and found eight randomized controlled trials that looked at interventions of diabetes, health coaching, and of those eight trials we extracted the data. We numerically synthesize the data in a meta-analysis

Diana: found was that if you were exposed to diabetes, health coaching it reduced the a one, c. By zero point five, seven. If the intervention was longer than six months, if it was less than six months, it reduced your a one, c. By zero point two, three

Diana: um. All of those results were statistically significant, and I would argue absolutely, clinically significant as well.

Diana: Then in two thousand and eighteen a few years later, um colleagues uh perk a blue ritual, et cetera, from York University looked at twenty-two studies, so they were a little bit more liberal in terms of their inclusion. Criteria,

Diana: and what they looked at again was health coaching, so not necessarily health coaching that was diabetes, specifically trained individuals, but just broadly health coaching to help people with type two diabetes, and they found very similar results. So again, at three months there was a reduction in a one c. Of point, three percent,

Diana: four to six months was a reduction of point. Five, seven to nine months point six, six, and then anything twelve months and longer. That sort of magnitude or benefit of reduction weaned off.

Diana: So what was interesting was, we noticed, longer term benefits. Six months or greater uh per the blue and colleagues noticed four to nine months of that point, five or point six, six again very compelling to show us that you know what where there's smoke, there's fire. We're on to something here.

Diana: So in addition to the randomized or sorry, the Meta analysis that I did of eight trials, I dug a little bit deeper, so not just a matter of you know. How well does this work in terms of glycemic control? I wanted to get a sense of Why did this work? What was the secret sauce?

And from this I basically looked at all of the literature

Diana: that was found in my systematic review and considered. What were those core ingredients of coaching? What was the diabetes health coach doing, and the the doing components fell into four broad categories, those categories included case management and monitoring.

Diana: So what the the important thing to think about here, with case management is case management was in some instances helping people navigate uh the health care system, navigating referrals, navigating options in terms of when to seek additional support, when might they need additional help?

Diana: Um! But again, it was always done in a non-judgmental approach, so the monitoring component might be. Let's talk a little bit about what's happening with your blood glucose level. So it wasn't so much. Let me see the levels Are you testing? Are you taking your insulin, but rather that self discovery exploring? What's going on with really the person living with diabetes driving the agenda.

Diana: The second component of the diabetes coach model was self management education. And this comes back to the whole idea of that just in time. Education, not a lot not too little. Just the right amount. That sort of Goldilocks level, if you will.

Diana: Behavior change was also a crucial crucial component to this, and this is something that I really struggled with,

Diana: because I found behavior change difficult even in my own personal life,

Diana: playing Um, you know athletics and and uh varsity soccer all the way up to, you know, managing my own nutrition and physical activities. A busy mom uh with a career, et cetera. So behavior change to me became quite abstract and up to. If I was looking at smart goals, and only seeing people every three months or every six months to work on their goals.

Diana: So, behavior change. I dug a little bit deeper into this, and what was remarkably notable by all of this

Diana: was that it was not waiting three, six months to assess and support behavior change, but rather frequent interactions around behavior change. So those bigger goals quickly became small adjustable habits, if you will.

Diana: The final component that really really resonated with me in terms of what I was supporting people with was more than just the insulin, the glucose levels, the testing. But the psychosocial aspects of living with diabetes.

Diana: And what really resonated with me was that people had stories to tell. People wanted to talk about their diabetes. They want to talk about their life, living with diabetes. They wanted to talk about their life despite diabetes, and so this became an important aspect as well in coaching that oftentimes it it would be listening. Um! So this was certainly articulated in the literature. And again, that concept that really rang true to me was care. Translator.

Diana: All of these aspects, and this coaching model is published in the Journal of Diabetes in two thousand and seventeen.

Diana: And then, finally, what also came about after looking at the literature distilling the components of coaching, was a working session in April, uh, twenty, fourth of two thousand and seventeen, where we had experts uh involved in the coaching space, in diabetes and in obesity,

Diana: and we included a bunch of uh subject matters, twenty interdisciplinary subject matters, including uh folks from universities, clinical practice. So research, clinical practice, decision makers, all sorts of stakeholders and people with lived experience to really look at. If we were to create a pathway or um, an education program of health coaching for diabetes, what might that look like?

Diana: And the result of that is a learning pathway that's described here in the box on your left side of the screen, and this is a learning pathway through the Um Health Coach Institute at York University. So i'm proud to say that i'm a co-founder of this learning pathway for health coaching um for chronic conditions that could certainly be relevant for uh diabetes health coaching.

Diana: I'm. Also very proud and happy to say that this is one of the only uh health coach. Professional certificates that are board certified. Um uh a handful in the world, and the first, and only in Canada to um meet the national standards for health and wellness coaching

Diana: Ah! Approved in Canada.

Diana: So the totality of all of this then, made me think, Okay, with all of that in mind with this crystallized evidence-informed model,

Diana: and knowing about the magnitude or that sweet spot. When it came to the duration intensity of coaching, I thought I needed to go test this so in good fashion. As a researcher I applied for funding um and grateful for funding from the um from Chr. Our Federal um Health research body and partnered with the Community Health Center in Cambridge lanes and their community diabetes program

Diana: and receive some additional support from hamilton

Diana: Austin University. Um. We embarked on a pragmatic community-based trial of people living with type two diabetes

Diana: Um. Our criteria was that they had to have an a one C level of seven point, five percent or above. So a a little bit above target uh good uh sort of guideline recommendations.

Diana: They had to have access to a telephone, read, write English, and have access at some point Diabetes education, and that was just simply to ensure that they were in um a system where we could uh document and and uh chart in an emr.

Diana: So we sought to recruit uh three hundred and forty participants randomized uh one to one, to usual care diabetes, education.

Diana: So they would initially come through classes, and then it was just ad hoc as needed, or um as determined, appropriate by uh the nurse or dietitians in the local diabetes education programs,

Diana: or they could have access to a diabetes health coach for one year. In addition to the diabetes, education is needed so as needed.

Diana: Sometimes they're they're back there at the education program once or twice a year. Um, But it, generally speaking, was not um sort of frequent touch points and contact points.

Diana: Our primary outcome of interest was, uh galicated hemoglobin, and again that sort of three month marker of glycemic control. But our secondary outcomes really aligned beautifully with the triple aim.

Diana: So we looked at patient reported outcomes in quality of life, and we had two types of quality of life. We had a generic type of quality of life, but also a diabetes specific called the add call

Diana: um. So we could look at generic, which we could then extract some of that data and use that for cost effectiveness. So that was the next component of our triple aim outcomes. So we had clinical care or sort of, you know, care of the population population outcomes patient or reported outcomes, but we also had costs as well.

Diana: We also wanted to capture what was actually happening at the behavioral level of the individual, and there we use the self Care behaviors tool

Diana: um to assess that as well. Um. The results of this trial are are published in the Canadian Journal of Diabetes, along with the protocol as well.

So just, very quickly. The intervention was, uh happened to be delivered by a gradual prepared nurse. I think this could be a nurse that's prepared, and uh undergraduate level. I think the most important piece here is that they are certified diabetes educator and have a good solid baseline footing um in diabetes uh education and training.

Diana: They were trained in the coaching model and given additional support in uh motivational interviewing and behavior design, and this was a specific boot camp that was offered through Bj. Fog Um. Stanford University Professor Um, who's done a lot of work with um behavior, design, and tiny habits.

Diana: Um! This was delivered over the phone exclusively. So people actually never met that the diabetes health coach in person. It was just strictly over. The phone.

Diana: Coaching was offered for about fifteen minutes for once a week. For the first six months this was offered to individuals, and then once a month for the last six months. So there was a bit of a weaning off or tapering off in the last six months,

Diana: and the The thrust of the whole coaching intervention was that this was patient driven.

Diana: Every single phone call was uh started off with, You know. How are you? How is your week going? Last week we talked about this. How are things going? So it was really driven by the patient for the patient and the agenda, the topics, et cetera, sometimes would be indirectly related to diabetes, or immediately jump into diabetes, specific topics, but really all about the individual living with diabetes, and what they wanted.

Diana: So we recruited participants from May, two thousand and sixteen, and then, uh fine uh, our final participants uh participant was recruited in December, two thousand and seventeen. We actually went a little bit higher. We got to three hundred and sixty-five participants Um! And you can see between the intervention uh in that middle column and the usual care group, the far right column based on age, gender, race, diabetes, duration,

Diana: Bmi weight, and a one, c. There were no statistically significant differences in the two groups, although it looks like there are some differences. But um! None of those differences were statistically significant.

Diana: I will also draw your attention to Diabetes duration in terms of years. These are folks who had diabetes for nine, ten years on average, so you can imagine they've gone through multiple forms or durations of diabetes education. So what was really compelling was the fact that they still came forward and signed up for Diabetes health, coaching trial, and in in subsequent slides you'll hear some of the feedback from individuals which was really quite fascinating.

Diana: So, after receiving Diabetes health coaching for twelve months, both groups improved their a one, c. And we we kind of knew that was going to happen. So the fact that they actually still had options and the opportunity to go for diabetes education. We weren't surprised by seeing both groups improve. However, the difference between both groups was a difference of point four-nine so close to that point five percent

Diana: drop. Anyone see that we saw in our earlier meta-analysis

Diana: after adjusting for age baseline, a one c. Level gender ethnicity be a mind di diabetes duration. The um main difference in in change in a one, c. Was virtually the same at zero point four eight, both statistically and clinically significant

Diana: when we looked at the patient reported outcome. In other words, was this of value to patients. How important was this for their quality of life? Um. We saw a clinically and statistically significant improvement in the add call. Test the audit of diabetes dependent quality of life.

Diana: So this is a quality of life tool that's nuanced and detailed enough to pick up on some of those variations about. What is it like to live with diabetes? So again the change between the two groups was an improvement in increase in point. Two, five, eight units of the add call, and when we dug a little bit deeper we saw that there were meaningful, statistically and clinically different um improvements in terms of the interpersonal relationship. So how people

Diana: talked about their diabetes with others, how they were managing their diabetes around others. So we thought that that was very insightful.

Diana: We did not see clinically or statistically significant changes in the summary of diabetes self-care activities. And this is noteworthy, because we suspect that the self-care activities tool just wasn't detailed or specific enough to capture some of those nuance things that people were doing. These are broad categories about monitoring your blood glucose, and we know that the whole intervention was more than just counting how many blood tests you've taken

Diana: how many times you've taken your medication. This was a more nuanced approach that was patient-centered

Diana: and then, in terms of how this was actually used and implemented. What was quite fascinating is, we estimate that people had access to the coach about thirty times in one year. If we factor in once once a week for the first six months, and then once a month for the last six months.

Diana: The main time or mean interaction counts, was only eleven, and that was fascinating in and of itself. People use the coach when they needed how they needed.

Diana: And um the main length of time per interaction. We allocated fifteen minutes was just over ten minutes, so it was enough that if they were connecting with the coach frequently, it was just a quick touch, base tune up fine tune things gather some information, gather some reflections on that sort of self discovery. Um

Diana: uh call! And then off they went. The most common type of strategy used by the health coach. If you go back to the model in those four components, the most prevalent component or strategy that was used was case management and non-judgmental monitoring. So again,

Diana: we'll talk about the fact that patients value that non-judgmental accountability. They got to check in with someone but it wasn't a loaded or a predetermined outcome. It was really about what they wanted to talk about on their terms.

Diana: We also found that there was no statistically significant differences in emergency department visits or hospitalization. So for us it was just a safe to offer diabetes health coaching. It was not an abdication of care. Uh, you know we weren't putting anyone in harm by using telephone based only uh intervention to support people with uh diabetes.

Diana: So in terms of reflections, um in general. What we found was that in our our trial, but also looking at some of the systematic reviews and meta analysis,

Diana: diabetes, health coaching is an evidence, and certainly theoretically informed, uh uh intervention or strategy. The theories there, as it relates to health coaching, and there's more and more evidence that's accumulating for health coaching for diabetes in particular. So when people say diabetes, health coaching, or diabetes coaching, these are terms that are analogous with this broader form of of a health coaching

Diana: in our trial. Uh. We were uh successful in in in demonstrating that there was not only clinical improvement, but patient reported outcome. So patients saw the value, and felt that it was important in terms of improving their quality of life.

Diana: We also had a subsequent study published, led by Gary Riley um the Help Economist, looking at the costs effectiveness, and she demonstrated that telephonic support was absolutely cost effective. So, on the grand scheme of things you could argue that this cost effective, improves glycemic control and meets um, and is approved by, you know, patient reported outcomes and improving their quality of life

Diana: in subsequent interviews, and this is um under peer Review. Currently, participants express that diabetes health coaching supported the adaptation of living with diabetes,

Diana: and this was really profound for me particularly is I've reflected on my interactions with patients. These are patients who have lived with diabetes on average of nine, ten years, and yet they're still seeking support on how to adapt their lives around diabetes, not just around diabetes, but with diabetes and um sort of you know. How How do they live their lives more optimally.

Diana: What they also valued was offered non judgmental support. So the offering of the coach to be there through thick and saying, Good times, bad times. You know where their struggles they could openly discuss and divulge what was happening and what they're thinking.

Diana: They appreciated the guided behavior change. And again, I think, with the frequent contacts sort of the frequency, low touch contacts, quick, fine tuning of some of those behavior design details really led to sort of broader goals, and then, finally,

Diana: patients enjoyed the fact that they were more mindful, mindful of what it is like to live a good, healthy life with diabetes. Um. So they they really talked about mindfulness of diabetes related wellness. Um beyond just the numbers and glucose tests.

Diana: So where we're at now is rethinking. Where do we go with health coaching?

Diana: Um, And obviously, you know, uh, in our in our current health and human resource challenges um in this sort of, you know, Covid pandemic, we can't help. But wonder is the way to optimize and further augment and support Diabetes care. And what might that look like with diabetes coaching.

Diana: So a couple of things we're exploring is the use of technology enabled collaborative care. We have a publication based on our pilot study with Cam H. Uh the center for addictions and mental health,

Diana: where we've collaborated on an integrated care program, we've integrated diabetes, specialists, and a diabetes coach along with mental health training with a virtual care team that's optimized and specializes in mental health. So we're looking to augment and strengthen the uh collaborative, integrated care, but also taking advantage of technology to offer this support in otherwise um challenging circumstances, or, you know, limited re or settings.

Diana: The other thing we're looking at is the use of technology, specifically machine learning and artificial intelligence. And so I say this with a a a big dose of um

Diana: uh cautiousness in that. Uh, myself. Personally, I don't see machine learning or Ai ever replacing a human. I think there's a lot to be said about human contact. But is there a way that machine learning can augment and further support um one human coach. So if we think of sort of a pyramid with three levels, we can um suppose that people can be having conversations with um machines that are adapting based on

Diana: on wearable technology steps. Taken that sort of thing. We certainly do see some of these innovations already in place like um uh text messages that are acknowledging and and um

Diana: congratulating people if they get a certain amount of steps, so can the machine learn some of the behaviors that the coach is doing the recommendations, the strategies, that sort of thing. But ultimately, is there a way to escalate or flag, and escalate um individuals all the way up to the human coach, so that that human coach can further protect their time, support people as needed. And then some of that kind of um bigger population level.

Diana: Um, coaching can be done or augmented by machine learning and Ai,

Diana: And then, finally, what we're thinking about here is um, you know, revising coaching as we as we know it. Um, Currently, I have two publications that are under review. One is looking at further revisiting the diabetes coaching effectiveness, literature. We're seeing coaching trials that are done in diverse communities. Um. Using technologies uh for different lengths of time. Sometimes they're built off of

Diana: um cognitive behavioral therapy programs, et cetera. So what we're doing is sort of calling the literature again to just further build on what we know in terms of effectiveness for a one, c. And also other clinical uh markers like blood pressure weight uh bmi.

Diana: Our other publication is also looking at the implementation challenges, barriers and opportunities.

Diana: So this speaks to okay. If we're having a hard time describing health coaching, how might we optimize the training? The effectiveness, the uh adoption, how they're implemented in current uh clinical settings. And then how do we maintain this? So, in other words, who would pay for the training who would invest in coaching and switch the paradigm of diabetes Education that's not built around, you know. Um

Diana: uh a vague a one, c. Test that patients go, and they have a an understanding of where they should be. But it really doesn't mean anything to them on the day to day, life and self management. So we would flip the paradigm to really make it individually driven. Um! They call and connect with the coach once a week, once every two weeks once a month. So we're really trying to understand. How might this be um adopted, implemented, and then evaluated ultimately.

Diana: Um. The other thing we're looking at is, can diabetes health coaching expand to other populations and models of care? So diabetes prevention comes to mind. And um! We are looking at a a population of women that have experienced gestational diabetes and pregnancy. But looking at health coaching beyond in that sort of fourth trimester, and that work is being led by Dr. Lorraine Lipscomb

Diana: Um and her team at Women's College and um, you know, looking forward to exploring that a little bit more in that fourth trimester, we also have the opportunity to explore uh health coaching or diabetes coaching for diabetes uh prevention in the Pre diabetes population,

Diana: and then subsequently um diabetes remission and um. I'm proud to say that i'm a part of the remit team. That's a house that um located at Mcmaster University that is leading um multi component clinical trials that you know six, seven, eight sites across Canada that is testing and evaluating um complex interpret interventions for remission,

Diana: including health coaching around some of the behavioral aspects,

Diana: and then ultimately, in terms of revising it, might behoove all of us to think about how we're offering diabetes, education, and primary care. Particularly um. I'll speak to some of the provinces, and in Ontario, in in inclusive, is specifically um As we move towards a horizontal integration, if you will, of health care services in Ontario health teams. Is there a role for health coach to help along that spectrum

Diana: of individuals that are at risk or living with diabetes. Um! At this point, so is there a role to embed a health coach in primary care to really help people live healthier lives uh, regardless of where they are in that diabetes uh spectrum.

Diana: And so, in conclusion, um! This whole endeavor for me has been a cooperative enterprise. Um, So i'm always so grateful for the little sort of Eureka moments from patients. Um from my colleagues. Um,

Diana: who have always supported me, challenged me, have been curious, and have listened. And so again it you know none of this would be uh a occurring or happening if it wasn't for the cooperation support, mentorship, guidance, and you know, good faith of all the individuals that have ever helped me along the way. And I really think that health coaching is a cooperative enterprise. It's really about relationships. That's what That's what we're here for, and that's to help people with better lives with. Or

Diana: if they're at risk for diabetes, So to that end I want to thank you all for your attention. And finally if anyone has any questions about the content today or would like to see some of the publications that were discussed or mentioned, please reach out to me at dsherif@mcmaster.ca. And I’m happy to share some resources. And again, thank you all for your time and I wish you a good day.

Grace Leeder: thanks, Diana, That was uh, that was great. Uh, just want to run through a few things. First of all, we'd love your feedback on our Webinar program. You can scan this QR code. Fill out a brief A survey. We would love to hear from you. Um! If you enjoyed today's presentation. Consider donating to diabetes uh uh Canada,

Grace Leeder: a diabetes Canada, as registered charity relies on support and people like you consider donating to diabetes, Canada at diabetes, c. A slash donate to on all areas of type of these Canada's work, including life, saving research and diabetes and to provide more webinars like today's.

Grace Leeder: Uh if you want more up to date information on diabetes care, consider becoming a professional member at diabetes. That's a slash membership. Uh, you get access to the Canadian Journal of Diabetes, a discount to the annual professional conference and access to an online community of peers, and these are all benefits and more of your professional membership. Um. Numbers are invited to continue the conversation at Community dot org to chat more about today's Webinar

Grace Leeder: and Uh, thank you for watching. If you are interested in finding more webinars and podcasts that we've done. Um. You can go to diabetes, dot a slash healthcare providers. We have a Webinar from Dr. Ron Goldenberg on recent and upcoming uh Diabetes outcome trials, and Dr. Shawn Wharton presented on Wait inclusive care uh Dr. James Kim and Dr. As you and Jane are doing a presentation of cultural competency which it all be uh available already, or or in the coming weeks. So. Um, Dana, Thank you again for presenting uh today,

Grace Leeder: thanks to everyone who's watching, and we hope everyone has a great day.