Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Apr;34(4):552-558.
doi: 10.1007/s11606-019-04861-7. Epub 2019 Feb 12.

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Sarah S Nouri  1 , Laura J Damschroder  2 , Maren K Olsen  3   4   5 , Jennifer M Gierisch  2   4 , Angela Fagerlin  6   7 , Linda L Sanders  3   4 , Felicia McCant  4 , Eugene Z Oddone  3   4
Affiliations
Randomized Controlled Trial

Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE

Sarah S Nouri et al. J Gen Intern Med. 2019 Apr.

Abstract

Background: Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.

Objective: To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).

Design: Secondary analysis of a randomized controlled trial.

Participants: Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly.

Methods: A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy.

Results: The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04).

Conclusions: We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS.

Gov identifier: NCT01828567.

Keywords: health literacy; health numeracy; health risk assessment; telephone coaching.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

References

    1. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40:1918–1930. doi: 10.1111/j.1475-6773.2005.00438.x. - DOI - PMC - PubMed
    1. Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. J Gen Intern Med. 2012;27(5):520–26. doi: 10.1007/s11606-011-1931-2. - DOI - PMC - PubMed
    1. Sontag U, Wiesner J, Fahrenkrog S, Renneberg B, Braun V, Heintze C. Motivational interviewing and shared decision making in primary care. Pat Educ Couns. 2012;87(1):62–6. doi: 10.1016/j.pec.2011.07.026. - DOI - PubMed
    1. Harvey L, Fowles JB, Xi M, Terry P. When activation changes, what else changes? The relationship between change in patient activation measure (PAM) and employees' health status and health behaviors. Patient Educ Couns. 2012;88(2):338–43. doi: 10.1016/j.pec.2012.02.005. - DOI - PubMed
    1. Hendren S, Griggs JJ, Epstein RM, et al. Study protocol: a randomized controlled trial of patient nativation-activation to reduce cancer health disparities. BMC Cancer. 2010;10:551. doi: 10.1186/1471-2407-10-551. - DOI - PMC - PubMed

Publication types

Associated data