Health coaching for people with long-term conditions and multimorbidity: a mixed methods prospective service evaluation of Structured Agenda-free Coaching Conversations (StACC) in UK primary care
File(s)s12889-025-23535-0-1.pdf (1.97 MB)
Published version
Author(s)
Henry, Kate
El Osta, Austen
Leedham-Green, Kathleen
Type
Journal Article
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.
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.
Date Issued
2025-07-03
Date Acceptance
2025-06-09
Citation
BMC Public Health, 2025, 25
ISSN
1471-2458
Publisher
BMC
Journal / Book Title
BMC Public Health
Volume
25
Copyright Statement
© The Author(s) 2025. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.ss.
License URL
Publication Status
Published
Article Number
ARTN 2365