Abstract
BACKGROUND: Enhanced patient engagement has been linked to health service sustainability. The Structured Agenda-free Coaching Conversation (StACC) model aims to support people with one or more long-term conditions through a strengths-based approach: emphasising patient ownership and engagement rather than specific health-related knowledge, skills or lifestyle-related goals. The intervention consists of five or six personalised one-to-one coaching sessions with a non-clinical coach. This evaluation explored the impacts of StACC on patient activation, self-management capabilities, patient experience and health service use. METHODS: A prospective service evaluation was conducted across seven UK general practices between 2015 and 2018. Patient-reported outcome measures were the Patient Activation Measure (PAM-13) or the Health Education Impact Questionnaire (heiQ). Patient stories and feedback were thematically summarised. Health service usage (encounters) was explored for a small subgroup 12 months before and after the intervention. RESULTS: A total of 1,031 participants were onboarded, and 630 (61.1%) completed the intervention. Of those, 575 (91.3%) provided paired evaluative data for either PAM-13 (n = 110) or heiQ (n = 465), 586 completed feedback questionnaires (93.0%), and 376 (59.7%) agreed to share their individual stories. Complete health service data were provided for a small subgroup (n = 58, 9.2% of completers). The pre-intervention mean PAM-13 score was 57.1 (SD = 13.6, 95% CI = 54.5-59.7). This increased to 70.8 (SD = 14.7, 95% CI = 68.1-73.6) post-intervention (p < 0.0001). There were improvements across all eight domains of heiQ (effect sizes between 0.36 and 0.66). Health service data suggested a sustained impact. Participants who were previously disengaged reported taking action and gaining more control. Of the 586 feedback questionnaires, 567 (96.8%) were positive. CONCLUSIONS: Personalised health coaching delivered through the StACC model increased patient activation (quantitative evidence) and improved self-management behaviours (qualitative evidence) for participants. This is supported by exploratory health service data. As this was an uncontrolled service evaluation, and the appointment data subgroup was small, follow-up efficacy and economic studies are warranted.