Health coaching increases self-esteem and healthy smiles

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1 Health coaching increases self-esteem and healthy smiles Ayse Basak Cinar and Lone Schou Promoting oral health is essential in order to prevent and reduce the negative consequences of type 2 diabetes and to maintain good health. 1 Periodontal inflammation in early old age tends to be associated with mortality in older age 2 and people with diabetes are more likely to have periodontal disease than people without diabetes. 3 Besides sharing common biological mechanisms, type 2 diabetes and oral diseases, 4,5 also called lifestyle diseases, share the same lifestyle related risk factors such as poor dietary habits or smoking. Project overview This BRIDGES project aims to assess the impact of Health Coaching (HC) on diabetes and oral health management among people with type 2 diabetes in Turkey and Denmark. In principal, HC focuses on transformation and maintenance of positive health behaviours by person-centred empowerment. It is directly associated with positive lifestyle outcomes including smoking cessation and improved management of obesity and diabetes. HC creates awareness about individual values and empowers people to transition towards a healthy lifestyle. The HC process enables people with diabetes to adapt and change health behaviours for long-term compliance. In this study, coaching focused on empowerment for daily diabetes health-related practices, and compliance, and oral June 2014 Volume 59 Special Issue DiabetesVoice 47

2 self-management and education 48 DiabetesVoice June 2014 Volume 59 Special Issue

3 health related self-care regimes. Health-related capacity skills, self-monitoring skills and taking responsibility for health and quality of life were also targeted. Participants set up their own goals and action plans with supervision of their health coach. Coaching sessions were individualised and tailored to expectations, challenges, and progress of the person living with diabetes. After the last HC session, participants were told to fill in open-ended semi-structured questionnaires. Examples of their results, featured at the end of this article, represent gratitude for the HC opportunity and an increased sense of empowerment. One year-old participant living with diabetes for 14 years discussed how he had improved his lifestyle habits, but wished for regular oral health service. Another participant in her 50 s who has lived with diabetes for 12 years expressed how the coaching had given her a fresh start. Overall, the aim of the study is to highlight how HC can be effective for the adoption of healthy lifestyles and better diabetes management. Material and methods This international prospective intervention study among people with type 2 diabetes (Turkey, n=186; Denmark, n=130) randomly selected participants from the outpatient clinics of two hospitals in Istanbul, Turkey and the electronic patient registry of Department of Odontology, University of Copenhagen in Denmark. The phase in Turkey is complete ( ) and the phase in Denmark is to be finalised in November 2014 ( ). 6,7 Eligibility criteria were: 1) confirmed type 2 diabetes; 2) olds with at least four functional teeth; 3) no psychological treatment and no hospitalisation due to diabetes. Procedure and randomisation At the baseline visit, participants provided informed The health coach focused on empowering people with diabetes for daily health-related practices. consent and filled out questionnaires including background, psychosocial and behavioural information. The last current medical reports (HbA 1c, fasting blood glucose, HDL, LDL, triglyceride) were drawn from the hospital. Following the oral examination, participants were allocated to HC or formal Health Education groups. The intervention included two phases (initiation and maintenance and follow-up). During the initiation and maintenance, all participants in both groups were invited for free periodontal cleaning and were called between one and three times for an appointment. The cleaning included the removal of soft and calcified deposits by an ultrasonic device. Educational and motivational brochures supported each participant in the HC group. An internationally accredited health coach with a Master-level degree in Behavioural Sciences and a PhD in Community Dentistry was assigned to the HC group. 7 Each participant had a face-to-face session with the coach within two weeks of the first visit. The health coach focused on empowering people with diabetes for daily health-related practices, compliance to diabetes and oral health related self-care regimes. Additional coaching objectives included building up health-related capacity skills, self-monitoring skills and taking responsibility for health. Participants set up their own goals and action plans, focusing on improvement of lifestyle and clinical June 2014 Volume 59 Special Issue DiabetesVoice 49

4 self-management and education measures, under the supervision of the coach. Each coaching session was utilised as the foundation for the next coaching session, and influenced progress towards the achievement of target goals. Duration for face-to-face coaching sessions was between minutes. Sessions covered needs, expectations, challenges, and progress of the person living with diabetes. Telephone monitoring also supported progress of the participants. A Wheel of Health (Figure 1) was administered during the initial HC session to explore values, establish priorities, and set goals. Participants reported how satisfied they were (0%-100%) recently and how satisfied they would like to be in the future. Participants were then asked to define each domain on the Wheel of Health and choose a specific goal and action plan. Although the coach regularly asked participants to explore goals in relation to oral health and diabetes care, participants were free to select any additional goals such as stress management. Figure 1. an example for Wheel of Health, each domain defined by person living with diabetes 100% 100% Diet/Weight Oral Health 100% 0% Physical Exercise Examples: Stress management Socialising The Health Education group received standard lifestyle advice referring to oral healthcare practices, diet and physical exercise. One dentist provided Health Education interventions and group participants were supported by the same educational brochures as the HC group. Qualitative outcome variables and results After cessation of the intervention, participants in the HC group were asked to answer semi-structured questions to evaluate the HC intervention and its impact on their life. A selection of those are featured below: By the year 2012, Turkey aged male with a diabetes history of 14 years I have adopted healthy eating habits and regular tooth brushing. I didn t know how oral health was important for my diabetes. Additionally I lost some of my teeth and I suffered from bleeding of my gums. I wish there was an oral healthcare service at diabetes polyclinics aged female with a diabetes history of 2 years I learned everything about oral health and diabetes management by coaching sessions. My psychology is much better. My life has completely changed in a positive direction. Before the coaching sessions, my life was a misery and hopeless aged male with a diabetes history of 14 years My self-esteem has increased by the coaching sessions. I felt and recognised that I was worthy as a person during these sessions. All the negative thoughts about living with diabetes were erased by these sessions. By the year 2014, Denmark aged female with a diabetes history of 12 years My lifestyle and social life have changed; I started a new life. I found new ideas and rebuilt my life. 50 DiabetesVoice June 2014 Volume 59 Special Issue

5 70-75 aged male with a diabetes history of 10 years I am now more physically active (going swimming, walking) and drinking more water and less alcohol. I changed and adopted these new habits because I have recognised that I want to do better during the coaching sessions. I changed the wrong behaviour and replaced it with the healthy one. Health Coaching may be used as an effective common health promotion approach for better management of diabetes and oral health. Summary Dentists, physicians and diabetes educators undergo extensive education and training to learn what is best for people with diabetes. However, traditional delivery of education and training can miss how to achieve that best. How is implied in a person s motivation and specific motivators need to be identified with support and encouragement of healthcare providers. Health Coaching may be used as an effective common health promotion approach for better management of diabetes and oral health. Ayse Basak Cinar and Lone Schou Ayse Basak Cinar is Assistant Professor at Section 1, Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. Lone Schou is Head of Section 6 (Section for Global Oral Health), Institute of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark. BRIDGES project Smile healthy with your diabetes: a translational randomized trial of culturally specific health coaching intervention for patients with diabetes (phase II Denmark) Acknowledgement We express our deepest thanks to our collaborators in Turkey (Prof Nazif Bagriacik, Asst Prof Mehmet Sargin, Head Nurse Sengul Isik, Prof Inci Oktay) and Denmark (Christian Dinesen, Prof Maximilian de Courten). Many thanks are due to our study patients for their participation and cooperation. The Turkish phase is supported by FDI and the University of Copenhagen, and Danish Phase by TRYG Fonden. This project is supported by BRIDGES. BRIDGES is an International Diabetes Federation programme supported by an educational grant from Lilly Diabetes. References 1. WHO European Region. Health21: The Health for All Policy Framework for the WHO European Region. WHO. Denmark, Avlund K, Schultz-Larsen K, Krustrup U, et al. Effect of inflammation in the periodontium in early old age on mortality at 21-year follow-up. J Am GeriatrSoc 2009; 57: Sandberg GE, Sundberg HE, Fjellstrom CA. Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects. Diabetes Res Clin Pract 2000; 50: Genco RJ, Grossi SG, Ho A. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol 2005; 76: Nishimura F, Kono T, Fujimoto C. Negative effects of chronic inflammatory periodontal disease on diabetes mellitus. J IntAcadPeriodontol 2000; 2: Cinar AB, Schou L. Health Promotion for patients with diabetes: Health Coaching or Health Education? Int Dent J 2014; 64: doi: /idj [Epub ahead of print] 7. Cinar AB, Oktay I, Schou L. Smile healthy to your diabetes : health coaching-based intervention for oral health and diabetes management. Clin Oral Investig [Epub ahead of print] June 2014 Volume 59 Special Issue DiabetesVoice 51

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