Coaches share with patients relevant health recommendations. A behavioral recommendation for activity could be to engage in moderately paced activity of 150 minutes/week; a clinical recommendation could be for blood pressure (BP) to be <130/80. These recommendations are needed to serve as reference points, that is, standards, against which people can compare their current behavioral and/or clinical states. Patients can compare their current states to the corresponding health recommendations. For example, some patients’ current activity levels may be walking 10 minutes/day on 3 day/week; some patients’ current BP may average 148/82. By making comparison(s), patients receive feedback about whether their current states are congruent or discrepant with recommendations. In the examples above, the patients’ activity levels are too low and BPs are too high; the states are discrepant with recommendations. Many peoples’ behaviors are discrepant with recommendations. Given that coaches create supportive environments and collaborate to set feasible goals, coaches and patients collaborate to set goals that are short-term goals, proximal to clinical recommendations. If this is the case, then patients compare their current states to their goals, rather than to the more distal recommendations. After comparing their current states to their goals, patients receive feedback. If their states are congruent with their goals, then patients can affirm their progress, decide whether to maintain efforts, and plan to monitor their states again. If patients receive feedback that their states are discrepant with their goals, then patients can decide whether to alter their efforts so their current states meet recommendations. They could do so by:
Increasing their efforts, for example, so their a) behavior/output corresponds with activity recommendations or b) BP levels decrease Decreasing their barriers, for example, to a) activity or b) BP reduction, by asking friends to join activities or by using less salt at the table Revising their goals for feasibility
Coaches can provide some structure for patients in a discussion about identifying short-term goals and action plans that correspond to patients’ abstract goal/value. Coaches collaborate with patients to identify SMART goals because these are most likely to be achieved:
(S)pecific, (M)easurable (A)ttainable (R)ealistic (T)ime bound
Coaches elicit from patients the likely barriers to the proposed SMART goals; coaches collaboratively problem-solve with patients about coping plans to deal with external and personal barriers (e.g., inclement weather, social gatherings, feeling tired). Coaches and patients monitor goal progress as patients strive to meet SMART goals. At a pre-determined time, coaches and patients assess whether patients met SMART goal(s). They can repeat the process described here with revised, feasible goals, increasingly difficult goals, or with maintenance of goals.
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