Health Coaching Practice and Behavior Change
The Coaching Frame
Health coaching is a client-centered, collaborative process that uses evidence-based behavior-change methods to help clients set and reach self-directed health goals. Know the difference between coaching and advising: coaching elicits the client's own reasons for change rather than prescribing them. Candidates should be fluent in the transtheoretical model (stages of change: precontemplation, contemplation, preparation, action, maintenance, and often termination), the decisiveness balance (pros vs. cons of changing versus staying the same), and self-efficacy as a predictor of persistence.
Core Behavior-Change Constructs
Understand self-determination theory's three needs-autonomy, competence, and relatedness-and why supporting them sustains motivation. Distinguish intrinsic from extrinsic motivation and recognize that extrinsic rewards can undermine intrinsic drive. Know SMART goal characteristics (specific, measurable, achievable, relevant, time-bound), the value of small, incremental goals, and the role of self-monitoring, action planning, coping planning, and relapse prevention. Social cognitive theory contributes observational learning, outcome expectations, and reciprocal determinism.
Traps
Questions love to test stage-mismatch: an action-oriented plan offered to a contemplative client is a classic wrong answer. Another trap is confusing the decisional balance with goal setting, or treating relapse as failure rather than a normal part of the cycle. Watch for answers that impose the coach's values or that promise outcomes the coach cannot guarantee.
Rule of Thumb
Match the intervention to the stage: raise awareness and explore ambivalence in early stages, build commitment and plan in preparation, then problem-solve and prevent relapse in action and maintenance. If a client says "I know I should, but I'm not ready," you are in contemplation-explore, don't prescribe.