Competencies and training of health professionals engaged in health coaching: A systematic review

Abstract

Objective:
A systematic review was undertaken in order to evaluate the competencies of primary healthcare professionals who are engaged with health coaching patients with chronic health conditions.

Methods:
The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched to identify peer reviewed papers referring to competencies of health professionals engaged in health coaching.

Results:
Nine key competencies that health professionals met and which resulted in successful patient outcomes from health coaching were identified. Comparisons of the core health coaching competencies to the competencies for coaches established by the International Coaching Federation and European Mentoring and Coaching Council showed considerable overlap. However, the comparison also reiterated the need for competencies specific to health coaches to be made explicit.

Discussion:
Health coaching has been shown to improve the health outcomes in patients with chronic health conditions. As such, there is a need to build an evidenced-based competency framework specific to health coaches. At present, the lack of a competency framework on which to base health coach training could significantly impact the outcomes of patients receiving health coaching. Practical implications include improving regulation and quality of health coaching, and more importantly, the health outcomes of patients receiving the service.

Full text

Article
Competencies and training of
health professionals engaged
in health coaching:
A systematic review
Harjit K Singh , Gerard A Kennedy and
Ieva Stupans
Abstract
Objective: A systematic review was undertaken in order to evaluate the competencies of
primary healthcare professionals who are engaged with health coaching patients with chronic
health conditions.
Methods: The databases CINHAL, EMBASE, PubMed, PsychINFO and SCOPUS were searched
to identify peer reviewed papers referring to competencies of health professionals engaged in
health coaching.
Results: Nine key competencies that health professionals met and which resulted in successful
patient outcomes from health coaching were identified. Comparisons of the core health coaching
competencies to the competencies for coaches established by the International Coaching
Federation and European Mentoring and Coaching Council showed considerable overlap.
However, the comparison also reiterated the need for competencies specific to health coaches
to be made explicit.
Discussion: Health coaching has been shown to improve the health outcomes in patients with
chronic health conditions. As such, there is a need to build an evidenced-based competency
framework specific to health coaches. At present, the lack of a competency framework on which
to base health coach training could significantly impact the outcomes of patients receiving health
coaching. Practical implications include improving regulation and quality of health coaching, and
more importantly, the health outcomes of patients receiving the service.
Keywords
Health coaching, competencies, healthcare professionals, chronic health conditions, behaviour
change
Received 22 May 2019; accepted 19 November 2019
The School of Health and Biomedical Sciences, RMIT
University, VIC, Australia
Corresponding author:
Harjit K Singh, Discipline of Pharmacy, School of Health
and Biomedical Sciences, RMIT University, Bundoora, VIC
3083, Australia.
Email: s3200840@student.rmit.edu.au
Chronic Illness
0(0) 1–28
!The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/1742395319899466
journals.sagepub.com/home/chi

Introduction
Coaching is an emerging concept with
established roots in sports, psychology,
and business.
1
Coaches help clients apply
their own personal resources and overcome
obstacles in the pursuit of a mutually
agreed upon goal.
2
Recently, coaching has
gained attention in the healthcare industry
in the form of health coaching. Studies have
shown that health coaching can help
patients adopt healthy behaviors that can
help prevent and manage a number of
chronic health conditions.
3–6
Chronic illnesses are health conditions
that are prolonged in nature, and although
treated are lifelong. However, if detected
and managed early, the health outcomes
of people with chronic health conditions
can be improved.
7
Most people with chron-
ic illnesses can find it difficult to manage
their health condition as they lack under-
standing about disease progression and
self-management.
8
Health coaching has
resulted in an improvement in the health
outcomes of patients with chronic diseases
such as diabetes, hypertension, depression
and high cholesterol, as it assists their
understanding of their health condition as
well as their management through positive
behavior change.
6
Health coaching differs from other life-
style improvement services. Typically, the
counselling undertaken by healthcare pro-
fessionals such as pharmacists, physical
therapists, medical practitioners and
nurses is fast paced. It customarily involves
“advice giving” about clinical targets and
expectations. This type of counselling has
been described as having a rigid approach
to health education and disease manage-
ment, as it involves the healthcare provider
instructing the patient what to do, taking
little consideration of the patient’s personal
goals and capacity for change.
6,9–12
Although these healthcare professionals
have the skills and sensitivity to discuss
complex treatment and care issues with
the patient, time constraints often impact
the counselling that can be provided. In
contrast, counselling provided by therapists
and psychologists can be focused on the
needs of the patient as these professionals
not only have training and qualifications
within their field, but their practice is
better equipped for this purpose.
13
In contrast, health coaching provided by
heath care professionals takes a patient-
centered and collaborative approach to
patients’ management of their chronic
health conditions. The health coach is a
partner in the change process who actively
listens while empowering the coachee in a
non-judgmental manner based on the
coachee’s, rather than the health coaches’
concerns.
9
It is postulated that this switch-
ing between the health coach and health
professional can violate the coaching agree-
ment.
9
However, the underlying concept of
health coaching is that it is the role of the
health coach is to ensure that patients are
educated about their health and guided
towards setting realistic health goals.
6,14
It
is the role of the health coach to improve
patient health literacy through patient-
centered communication, educational mate-
rials, and reinforcement, towards realistic
goal setting.
15
Therefore, it would be imper-
ative for a health professional to practice
both roles concurrently. There have been a
number of descriptions of health coaching
reported in the literature, which has made it
difficult to compare studies and evaluate
the outcomes of health coaching interven-
tions, but a recent paper has provided a
grounded definition. Health coaching has
been defined as a service that is provided
to patients by healthcare professionals for
the purpose of managing health. It involves
a collaborative interaction between the
patient and the coach for the purpose of a
behavioral change. This involves the patient
setting self-centered goals and regular
follow-up with the health coach. In this
2Chronic Illness 0(0)

relationship, both the coach and patient are
held accountable for the patient’s health
outcomes. It is the role of the coach to pro-
vide guidance, expert information, and
facilitate motivation of the patient in
order to achieve their goals.
6
The theoretical foundation of coaching is
based on psychological concepts.
5
There are
several types of models and theories that
form the basis of behavioural change in
coaching. Those most frequently referred
to in the literature include the transtheoret-
ical model of change (TTM) and Social cog-
nitive theory (SCT). Each theory is distinct;
however, coaching recognizes that individ-
uals intrinsically learn in different ways,
and thus the process could involve one or
a combination of models or theories which
may complement one another.
16,17
The
behavior change process can also be sup-
ported through techniques such as motiva-
tional interviewing (MI), which involves
facilitating a patient’s underlying motiva-
tion towards a positive behavior change.
18
Health coaching has been shown to
improve the health outcomes of patients
with chronic health conditions.
19–25
A key
question is – what are the competencies
required for a professional to undertake
health coaching? Competencies in this con-
text are multifaceted and dynamic concepts,
encompassing skills, knowledge, attitudes,
and attributes for the comprehensive prac-
tice of clinical care by primary healthcare
professionals.
26
Competency frameworks
define expectations of accrediting boards
and colleges and function to maintain the
social contract between the public and prac-
titioners.
27
Derived from the competencies
are enabling competencies. These are state-
ments that describe what a person needs to
be able to do in order to successfully per-
form their job. In order to meet a compe-
tency, an individual may need to integrate a
number of enabling competencies.
28,29
Several coaching organizations have
been established with the remit to regulate
and accredit coaches; the organizations
have developed a standardized competency
framework that applies to all coaching pro-
fessions.
30,31
However, these organizations
do not consider the differences in the exper-
tise required amongst the various profes-
sions that undertake coaching, such as
sports and business coaching, as opposed
to health coaching.
32
The Association for Coaching (AC) is an
independent and not-for-profit body dedi-
cated to promoting best practice and raising
the awareness of coaching standards glob-
ally. The AC competency framework con-
tains nine competencies which include
establishing the coaching agreement and
outcomes, and a trust-based relationship
with the client, and designing strategies
and actions.
33
The International Coaching Federation
(ICF) represents its member coaches and
aims to advance the profession by offering
credentialing paths and guidelines for self-
governance. ICF defines 11 core competen-
cies critical to the practice of professional
coaching including a cluster of competen-
cies which facilitate learning and results.
34
The European Mentoring and Coaching
Council’s (EMCC) purpose is to develop,
promote, and set expectations for best prac-
tice in mentoring and supervising a coach.
It has defined eight competencies for
coaches and mentors. These include manag-
ing the contract and building the
relationship.
35
With respect to health coaching, the
United States-based National Society of
Health Coaches (NSHC) provides health
coach training and certification for clinical
healthcare practitioners and allied health-
care professionals.
36
The society provides
evidence-based education and core compe-
tencies specifically for health coaches in the
United States (US). There are 11 core com-
petencies for health coaches, which include
the use of evidence-based practice interven-
tions and MI.
37
Singh et al. 3

The National Board for Health and
Wellness Coaching (NBHWC) endeavors
to standardize coaching certification inter-
nationally. While this organization has pro-
vided a job task analysis for health and
wellness coaches, it has not provided a com-
petency framework.
29,38
Coaching accreditation by many of the
organizations often involves variations in
brief and inconsistent training programs.
30
The larger organizations, such as the
EMCC and ICF have strived to standardize
the credentialing process for coaches as well
as developing baseline coaching competen-
cies.
39
Notably, the outcomes from the
health coach training and certifications pro-
vided by each of the organizations have not
been reported in peer reviewed literature.
32
The aim of this paper is to identify the
skills, knowledge, attitudes, and attributes
associated with health coaching interven-
tions and to compare these to the
competencies established by the larger
international coaching organizations – the
EMCC and ICF for coaches. This will pave
the way for training programs tailored spe-
cifically to health professionals as health
coaches.
Methods
Search strategy
The literature review followed the Preferred
Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guidelines.
Figure 1 shows the PRISMA-based article
review process and illustrates each step of
the literature search and study selection pro-
cess. The electronic databases (CINHAL,
EMBASE, PubMed, PsychINFO, and
SCOPUS) were extensively and systemati-
cally searched to identify the scholarly sour-
ces related to health coaching involving
Eligibility
Databases (n=235)
•CINAHL (n=37)
•EMBASE(n=6)
•PubMed(n=52)
•PsycINFO (n=123)
•SCOPUS (n=17)
Titles and abstracts screened
(n=218)
Duplicates removed
(n=17)
IdentificationScreening
Included
Full- text articles reviewed (n=81)
Studies included in review (n=18)
Excluded (n=66)
No relevant, no definition, not
within context of health
coaching by primary care health
professionals
Excluded: not
relevant (n=137)
Identified through
reference lists and
hand searching (n=4)
Duplicates removed (n=1)
Figure 1. PRISMA flow chart of the literature search and study selection.
4Chronic Illness 0(0)

primary care health professionals. Other
references were also identified by examining
the bibliographies of studies that met the
eligibility criteria, and via searching by
hand. The database searches involved two
stages (Table 1). In the first stage, the
search strings focused on the skills, knowl-
edge, attitudes, and training of primary care
health coaches. The second stage focused
only on the attributes of the primary care
health coaches. The database searches cap-
tured 218 non-duplicate citations, with a
total of 18 papers meeting the eligibility cri-
teria for inclusion in the systematic review.
The outcomes of both search stages were
collectively evaluated.
Selection criteria
Papers were included in the literature
review if they were: (1) published sources;
(2) peer-reviewed; (3) contained text that
stated the skills, knowledge, attitudes,
attributes, or training of a primary care
health professional as a health coach;
defined by the grounded definition of
health coaching; primary healthcare profes-
sionals included general practitioners,
nurses, nurse practitioners, midwives, phar-
macists, dentists, allied health professionals;
(4) published between 1950 and 2018 (pre-
sent). The start date for the search aligned
with the emergence of the concept of
“health coaching” in the early 1950s.
6,40
Sources were excluded if they were (1)
published in a language other than
English; (2) any source other than a peer
reviewed journal article; (3) did contain
the skills, attitudes, knowledge, or training
required of a primary care health coach; (4)
did not describe health coaching within the
role of a primary healthcare professional;
(5) did not include the word “health coach-
ing”; (5) the full text could not be found; (6)
grey literature.
Data extraction and analysis
The studies found from the databases were
downloaded, and a single researcher initial-
ly screened the titles and abstracts.
Subsequently, the full-text copies of articles
that passed the initial screening process
were independently reviewed by two
researchers. The third researcher was con-
sulted when a consensus decision about the
eligibility of a paper could not be reached
by the first two researchers.
Each paper was read to extract the fol-
lowing information about the health coach
mentioned in the piece; profession, skills,
knowledge, attitudes, attributes, and train-
ing information. This information was com-
piled into a table using Microsoft Word
(Table 2). The table provides a clear view
of the common themes and characteristics
as well as a review of other unexpected find-
ings. Once extracted, the information was
grouped based on the profession of the
health coach. The data fields are in line
with the aims of this review and included:
(1) the profession of the health coach
referred to in the paper; (2) the skills,
knowledge and attributes of the health
coach; and (3) the training of the health
coach. Subsequently, qualitative analysis
of the information in Table 2 was used to
investigate each of the data fields to explore
the emergence of recurring concepts among
and between the health professions. All
papers showed that health coaching led to
positive health outcomes for patients. This
allowed the development of key competen-
cies classified under the main headings of
knowledge, skills, attitudes, attributes
(Table 3). Comparisons were made between
the competencies of each health profession-
al group as health coaches. The health
coaching competencies were also compared
to the competencies established by the
EMCC and ICF for coaches. Although
the purpose of the review was not to evalu-
ate the outcomes of health coaching, as part
Singh et al. 5

Table 1. Search strings for two-stage search.
Date of search
April 2018 CINAHL search strategy
#1. Search (health AND coaching)
#2. Search (skills OR knowledge OR attitudes OR training)
#3. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#4. Search (#1 AND #2 AND #3) filters: English; Peer Reviewed; Journal Article;
Published Date 19500–2018
#5. Search (health AND coaching)
#6. Search (attitudes)
#7. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#8. Search (#5 AND #6 AND #7) filters: English; Peer Reviewed; Journal Article;
Published Date: 19500–2018
#9. Search #4 AND #8
EMBASE search strategy
#1. Search (health AND coaching)
#2. Search (skills OR knowledge OR attitudes OR training)
#3. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#4. Search (#1 AND #2 AND #3) filters: English; embase OR medline; <1966–2018
#5. Search (health AND coaching)
#6. Search (attitudes)
#7. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#8. Search (#5 AND #6 AND #7) filters: English; English; embase OR medline;
<1966–2018
#.9. Search #4 AND #8
April 2018 PubMed search strategy
#1. Search (health AND coaching)
#2. Search (skills OR knowledge OR attitudes OR training)
#3. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#4. Search (#1 AND #2 AND #3) filters: Full text, Publication Date: 1950–20181;
Humans, English
#5. Search (health AND coaching)
#6. Search (attitudes)
#7. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#8. Search (#5 AND #6 AND #7) filters: Full text, Publication Date: 1950–20181;
Humans, English
#9. Search #4 AND #8
April 2018 PsychINFO search strategy
#1. Search (health AND coaching)
#2. Search (skills OR knowledge OR attitudes OR training)
#3.
(continued)
6Chronic Illness 0(0)

Table 1. Continued.
Date of search
Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#4. Search (#1 AND #2 AND #3) filters: Peer Reviewed; Humans; NOT (Home Care &
Hospice AND Curriculum & Programs & Teaching Methods AND Developmental
Disorders & Autism AND Personnel Management & Selection & Training AND
Artificial Intelligence & Expert Systems AND Childrearing & Child Care AND
Criminal Behavior & Juvenile Delinquency AND Educational/Vocational Counseling
& Student Services AND Group & Family Therapy AND Interpersonal & Client
Centered & Humanistic Therapy AND Occupational & Employment Testing AND
Rehabilitation AND Special & Remedial Education)Occupational & Employment
Testing AND Physical & Somatoform & Psychogenic Disorders AND Community &
Social Services AND Developmental Disorders & Autism) NOT Animal NOT
(Interview AND
#5. Search (health AND coaching)
#6. Search (attitudes)
#7. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#8. Search (#5 AND #6 AND #7) filters: Peer Reviewed; Humans; NOT (Home Care &
Hospice AND Curriculum & Programs & Teaching Methods AND Developmental
Disorders & Autism AND Personnel Management & Selection & Training AND
Artificial Intelligence & Expert Systems AND Childrearing & Child Care AND
Criminal Behavior & Juvenile Delinquency AND Educational/Vocational Counseling
& Student Services AND Group & Family Therapy AND Interpersonal & Client
Centered & Humanistic Therapy AND Occupational & Employment Testing AND
Rehabilitation AND Special & Remedial Education)Occupational & Employment
Testing AND Physical & Somatoform & Psychogenic Disorders AND Community &
Social Services AND Developmental Disorders & Autism) NOT Animal NOT
(Interview AND
#9. Search #4 AND #8
April 2018 SCOPUS search strategy
#1. Search (health AND coaching)
#2. Search (skills OR knowledge OR attitudes OR training)
#3. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#4. Search (#1 AND #2 AND #3) filters: Published (All years to Present), Document type
(Article), Access type (All)
#5. Search (health AND coaching)
#6. Search (attitudes)
#7. Search (general practitioner OR nurse, OR nurse practitioner OR allied health
professional OR pharmacist OR dentist OR aboriginal health worker OR health
professional OR primary health care)
#8. Search (#5 AND #6 AND #7) filters: Published (All years to Present), Document type
(Article), Access type (All)
#9. Search #4 AND #8
Singh et al. 7

of our analysis we noted that all studies
reported a successful health coaching inter-
vention in a chronic health condition.
Assessment of study quality
Given the diverse study designs included in
this review, the quality assessment methods
traditionally used to assess effectiveness
would not be suitable. However, the quality
assessment of the papers included in the lit-
erature review was considered according to
the Cochrane Review Handbook for
Systematic Review of Interventions.
41
Considering that study outcomes were not
an initial selection strategy we considered
the risk of bias of each paper as low.
Furthermore, given that the concept of
health coaching is growing, we regarded
the inclusion of all papers in our systematic
review as important.
Results
Search results and study characteristics
The database searches captured 218 non-
duplicate citations (Figure 1). After review-
ing the titles and abstracts, 81 papers were
considered potentially relevant, and the full
text of each of these was then reviewed. The
reference list of the full-text articles were
also reviewed for other relevant sources,
three papers were found in this way and
one from hand searching. Of these, 66
were not relevant or did not mention
health coaching undertaken by a primary
care health professional and one was a
duplicate. A total of 18 papers met the eli-
gibility criteria and were thus included in
the systematic review and are summarized
in Table 2.
Characteristics of study samples
Eight of the 18 health coaching studies
were undertaken by nurses. These studies
were further classified as involving,
specialized
1,42–46
and non-specialized
nurses.
12,40,47–50
Specialized nurses were
those that had undergone extensive train-
ing, had greater expertise than the non-
specialized nurses, and included nurse prac-
titioners, advanced practice nurses, forensic
nurses, pediatric nurses, and neonatal
nurses. Non-specialized nurses included
registered nurses, graduate nursing students
and nurse practitioner students.
Pharmacists as health coaches
24,40,51
were
referenced in three papers, while only one
paper referred to physical therapists.
52
Two
papers made a broad reference to primary
health professionals as health coaches.
4,53
Key findings in health coaching by primary
care health professionals
The summary of characteristics and find-
ings from the research papers included in
this systematic review is given in Table 2.
Comparisons of these findings allowed
inferences to be made between and within
the professions captured in the literature.
This allowed characteristics to be grouped
and classified as being captured within
domains.
A representation of this is shown in
Table 3; it displays the individual profes-
sions of the health coaches and their char-
acteristics, with a focus on domains,
capturing these as core competencies that
incorporate the skills, knowledge, attitudes,
and attributes of a health coach.
Skills of a health coach
All 18 articles included in the review were
identified as having extractable data on
health coaching skills and knowledge
(Table 2). The characteristics under which
they have been classified include: (1)
“communicates effectively for the delivery
of patient centered care”; (2) “demonstrates
team and leadership skills to optimize
health care” and (3) “demonstrates an
8Chronic Illness 0(0)

Table 2. Characteristics and findings of studies included in the review.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
Hayes and
Kalmakis
1
Nurse
practitioner
•Help patient identity goals
meaningful to them
•Empower patients
•Support patient
•Patient focused
•Facilitates learning in client
•Encourages
•Accountability in decisions
making towards goal
attainment
•Inspire belief
•Communication strategies
•Coaching is a
NP education-
al competency
of the
National
Organization
of Nurse
Practitioner
Faculties
(NONPF)
•Warm
•Empathetic
•Optimistic
•Genuinely love
people
•desire to help
people reach goals
•Responsible
•Accepts client
unconditionally
•Avoids judgment
and imposing his/
her own beliefs
•States that previous
studies do not
describe coach
training or provide
examples of coach-
ing communication
Neuner-Jehle
et al.
54
General practi-
tioner (GP)
•Good Communication skills
•Good questioning technique
•Adapt to patient needs
•Shared responsi-
bility of patient’s
health with the
patients them-
selves made GPs
feel relieved
•Health coaching
empowers GPs
•Communication
training is a manda-
tory part of the
programme
•Training is stepwise:
a. sensitization
workshops, b. skills
training course, c.
feedback sessions
to share
experiences
Lonie et al.
51
Pharmacist •Provide support, education
and feedback
•Enhance client self-aware-
ness, motivation, account-
ability and self-efficacy
•Encourage patients
•Build partnership with patient
•Health
knowledge •Responsible
•Respectful
•Connects with
patients
•Display empathy
•Comfortable
during silence
•Pharmacists have
significant experi-
ence and expertise
and that the role of
an educator is not
foreign to
pharmacists
(continued)
Singh et al. 9

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
•Identify patient needs, values
and interests
•Adapt health coaching to suit
individuals
•Provide continued care
•Provide emotional and social
support
•Link health coaching to clini-
cal care
•Listen to patient
•Questioning skills
•Puts aside per-
sonal issues to
focus on patient
•Commitment to
personal
development
•Pharmacists can be
trained in health
coaching using a
combination of
didactic and inter-
active learning
methods
Ammentorp and
Kofoed
42
Neonatal nurse •Anticipate patient reactions
•Recognize and respond to
patient cues
•Reflect on the thoughts feel-
ings and behaviours of
patients
•Assess patient performance
•Understand the perspective
of others
•Ability to encourage clients
•Ability to listen
empathetically
•Ability to express under-
standing and support
•Able to explore the experi-
ences, feelings and expecta-
tions of the parents
•Nurses have
greater self-effica-
cy after having
participated in the
coaching course
and were better
able to meet the
needs of the
parents
•Active listener
•Share perceptions
•Appropriate
questioning
•Self-reflection
•Non-judgment
•Empathy
•Exemplary com-
munication skills
•A three-day health
coach training.
course which con-
sisted of short lec-
tures, dialogue and
reflection and role
plays
Vale et al.
12
Dietician
Nurses
•Individualize coaching to
patient
•Experience in
working with
cardiovascular
•Part-time training
program provided
for two weeks by a
trained coach
(continued)
10 Chronic Illness 0(0)

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
disease
patients
Hayes et al.
43
Nurse practition-
er (NP) •Motivate patients
•Encourage patients
•Guide patients to plan and
achieve their health goals
•Builds collaborative relation-
ship with patient
•Strong communication skills
•Assess patients stage of
change
•Promote patient self-care
•Recognize patient autonomy
•Recognize patient differences
and is able to adapt coaching
accordingly
•Provide feedback to patients
on progress
•
•Measure biological parame-
ters (e.g. HbA1c) to assess
coaching outcomes
•Clinical prac-
tice guidelines
of diabetes
•Coaching is a
competency
of the
National
Organisation
of Nurse
Practitioner
Faculties
•Good patient/
provider
communication
•Being empathetic
•Encouraging of
patients
•Supportive
•Some nurses may
practice coaching
intuitively
•Respectful
•Trustworthy
•Proposes that nurse
practitioners (NP)
and NP students
could be trained to
be a diabetes health
coach. Training
would be provided
by a certified coach,
a diabetes educator,
NP faculty
researchers, and
endocrinologists
•Traning could
include recent dia-
betes research, cur-
rent approaches to
diabetes manage-
ment, evaluation of
diabetes guidelines
and introduction to
the theories of
behavior change
•Group discussion
would be valuable
during the training
•Continuing educa-
tion could lead to
coaching
certification
Brook et al.
24
Pharmacist •Adequate communication
skills
•Medication
monitoring
•Suggests that the
pharmacists could
be concerned
•Communication
skills
•Pharmacists are
already well
equipped with
(continued)
Singh et al. 11

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
•Drug/medica-
tion knowl-
edge/
information
about the time
that coaching
could take away
from other roles/
responsibilities/
duties
communication skill;
they do not require
further training
Kaplan et al.
50
Medical student
Nurse practi-
tioner student
•Set short- and long-term
health goals for patients
•Ability to motivate patients
•Work collaboratively with
other members of the
patients healthcare team
•Complete health coaching
phone calls
•Oral presentation skills
•Develop team-based care
plans
•Follow-up with patient
weekly
•Professionalism
•Negotiation skills
•Communication
skills
•Students attended a
2 h training session.
Training included
motivational inter-
viewing skills and
scripts for scenarios
involving chronic
illness
•Students in the
second period of
the study shadowed
the students from
the first period as
means of refreshing
training and obser-
vational learning
Nessen et al.
52
Physical therapists
•Provide guidance for goal
setting
•Switch between health pro-
fessional role and health
coach role
•Tailor coaching to individual
needs
•Organize meetings with the
client
•Knowledge on
the mainte-
nance and
treatment of
arthritis
•The physical
therapists initially
felt stressed when
providing the
coaching. This
diminished with
time as they
gained experience
•Coaching brought
forward a number
•Cope in stressful/
demanding
situations
•Confidence
•Organized
•A six-day training
course was provid-
ed to physical
therapists. Training
included:
Coaching skills
Strategies to support
health-enhancing
behavior
Practice coaching
(continued)
12 Chronic Illness 0(0)

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
•Promote health enhancing
physical activity
•Adapt skills from training
program to real life situations
of challenges and
experiences
•The physical
therapists
expressed
experiencing
increased confi-
dence which indi-
cated professional
growth
Bennett et al.
47
Nurses •Guide coaching sessions with
client
•Individualize coaching
•Support participant progress
toward their chosen goal
•Follow-up with client
•Knowledge of
an array of
medical condi-
tions experi-
enced by
older persons
•Communication
skills
•Nurses were pro-
vided with 24 h of
motivational inter-
view coach training
by two registered
nurses
Fahey et al.
48
Nurse
•Provide encouragement to
patients
•Facilitate goal setting in
patients
•Use motivational
interviewing
•Recognize stage of the trans-
theoretical model (TTM) of
change a patient is in
•Support patient self-efficacy
•Rephrase questions or infor-
mation to assist patients
understanding
•Cancer pain
management
knowledge
•Empathetic
•Assertive commu-
nication skills
•Active listening
•An advanced prac-
tice oncology nurse
with expertise in
cancer pain man-
agement was
trained in TTM and
MI
•Training included
supervision, prac-
tice, review of calls
and feedback
Walker et al.
44
Practice nurse •Practice
guidelines for
•Personable
•Approachable
•Practice nurses
were trained over
(continued)
Singh et al. 13

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
•Motivate patients to make
lifestyle changes and adhere
to medications
•Empower patients
•Monitor patients’ biochemi-
cal targets
•Build professional coaching
relationship with patient
•Provide personalized care
•Negotiate goals and targets
with patients
type 2
diabetes
•Easy going two days to deliver
telephone coaching
sessions
•Training included
didactic information
on nutrition exer-
cise testing proto-
cols, medication
adherence and
optimal risk factor
testing protocols
and target levels
Romain-Glassey
et al.
45
Advance practice
nurses
•Promote effective learning
•Empower patient
•Form a partnership with the
client
•Help a patient develop
knowledge and skills needed
to overcome fear
•Build shared understanding
circumstances
•Provide patient-centered
coaching
•Refer to relevant resources
when necessary
•Use a family perspective
•Professional
experience
•Commitment
to continuing
education
•Understanding
of the profes-
sional codes of
conduct and
standards
from the gen-
eral discipline
•Emotional
maturity
•Interpersonal
skills
•Communication
skills
•Reflective practice
•Self confidence
•Respect for per-
sons
dignity and
integrity
Lawn and Schoo
4
Health professio-
nals
•Tailor coaching to individual
needs
•Use the skills of motivational
interviewing and other cog-
nitive behavioural approaches
•Understanding
of motivation-
al interviewing
and other
cognitive
•Takes an interac-
tive role towards
patient care
•Training could
involve a workshop
run over one to two
days
(continued)
14 Chronic Illness 0(0)

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
behavioural
approaches
Leung et al.
40
Nurse practition-
er students
Medical stu-
dents
Pharmacy
students
•Follow-up with client
regularly
•Follow a standardized coach-
ing protocol
•Be able to rate patients
achievements
•Strong interest in
patient interaction
•Coaches reported
“never” or
“sometimes” get-
ting frustrated
during coaching
study
•Counselling skills
•Clinical
experience
•Ability to com-
municate with the
patient:
speaks slowly and
simply
asks open-ended
questions
asks patient to
summarize
speaks in lay terms
focuses on patient-
relevant concerns
in hypertension
•Ability to explain
difficult concepts
patient in innova-
tive ways, e.g.
Drawing pictures
•Focus on patient-
centered goals
•Two hours of inter-
active training from
multidisciplinary
team of physicians,
nurses and
psychologists
•Training includes
concepts of motiva-
tion interviewing,
idiographic goal-set-
ting, cultural con-
siderations and
hypertension
terminology.
Nesbitt et al.
49
Graduate nursing
students
•Perform motivational
interviewing
•Ask open-ended questions
•Reflect on own practices
•Undertake continuing
education
•Core compe-
tencies for
nurses include
coaching
•All of the nursing
students reported
that they valued
learning MI and
that it was useful
•Standard nursing
skills
•Nursing students
undertook a health
promotion/clinical
prevention course.
Involved exposure
to MI via class
(continued)
Singh et al. 15

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
lecture, discussion,
video-taped prac-
tice, experiential
application and
independent
readings.
•Nurses were
required to partici-
pate in online dis-
cussions, video tape
themselves and
present findings
•The students were
encouraged to
practice MI at home
and at work
Swerczek et al.
46
Paediatric nurses •Communicate effectively with
children
•Provide advice and guides
client
•Provide non directive
support
•Commitment to ongoing
education
•Follow a protocol
•Follow-up with client
•Move from a directive care
approach to a non-directive
counselling approach
•Guide client on decision
making rather than providing
own reasons and solutions
•Paediatric
telephone
triage experi-
ence and abili-
ty to manage
patients
during an
acute asthma
exacerbation
•Commitments to
patient care and
follow-up with the
parents at odd
hours
•Coach training
composed of two
90 min group ses-
sions. Course con-
tent included
introduction to
asthma coaching
and the conceptual
model as well as a
review of docu-
mentation
expectations
•Simulated phone
interviews were
conducted for
practice
(continued)
16 Chronic Illness 0(0)

Table 2. Continued.
References Profession Skills of health coach
Knowledge of
health coach
Attitudes of
health coach
Attributes of health
coach Training of health coach
•Partner with healthcare
providers
•Establish shared decision
making with the client and
sets mutual goals
•Empower client
•Motivate client
Miller
53
Health
professionals
•Support individuals readiness
to change
•Assess where the patient lies
on the continuum of change
•Help individual set goals that
are specific measurable, and
achievable within a defined
period
•Ask open-ended questions
•Guide individuals to self-
monitor their performance
•Follow-up with the client
through email, telephone or
face-to-face.
•Assist individual to reformu-
late goals when unmet
•Identify barriers to change
•Offer additional information
about the behavior and clari-
fies misconceptions
•Help individual find relevant
resources
•Educate individuals about
how to undertake problem-
solving approach
•Anticipate challenging or dis-
tressing situations
•Help individual plan for diffi-
cult times
•Understanding
of motivation-
al interviewing
and how to do
it
•Are a credible
source of
information
Singh et al. 17

Table 3. Comparison of desirable characteristics of primary care health coaches.
Knowledge and skills of a health coach Attributes of health coach
Profession
(1)
Communicates
effectively for
the delivery
patient-centered
care
(2)
Demonstrates
team and
leadership
skills to
optimize
healthcare
(3)
Demonstrates
an understanding
of relevant,
fundamental
and evidence-based
knowledge and
undertakes lifelong
learning to
improve
professional
practice
(4)
Demonstrates
tolerance and
respect for
individuals and
groups from
diverse
backgrounds
(5)
Demonstrates
professional
behavior and
accountability
(6)
Demonstrate the
ability to utilize
empathy when
communicating
with patients
(7)
Demonstrates
confidence
(8)
Identifies areas
for development
to improve
competency
(9)
Works
systematically
and coordinates
activities
Pharmacist
24,40,51
  
Physical therapist
52
 
Medical practitioners
40,50,54
 
Specialized nurses
1,42–46
  
Non-specialized nurses
12,40,47–50
 
Health professionals
4,53
 

understanding of relevant, fundamental and
evidence-based knowledge and undertakes
lifelong learning to improve professional
practice” all which are outlined in Table 3.
The first competency includes skills that
include listening, questioning, motivating
and encouraging the patient, providing sup-
port and feedback as well as having regular
follow up with the patient to monitor their
progress. Demonstrating team and leader-
ship skills as the second competency, entails
the ability of the primary healthcare
professional health coach, to collaborate
with other members of the patient’s
multidisciplinary care team and with the
patient individually to facilitate the patient
setting self-centered goals. The third compe-
tency includes a health professional’s com-
mitment to ongoing education, the ability to
find relevant resources, as well as the ability
to practice previously learned knowledge.
Comparisons made between the individ-
ual professional groups showed that to be a
competent health coach the first and second
competency were imperative as they were
discussed in all papers, yet the third compe-
tency skills set were not. The skills charac-
terized under this competency were only
mentioned in the articles that included med-
ical practitioners, specialized nurses and
non-specialized nurses and health professio-
nals in general as the health coach.
Attributes of the health coach
The attributes embodied by the health
coaches were extracted from the papers.
Analysis revealed six desirable attributes;
these were categorized within the following
competencies: (4) “demonstrates tolerance
and respect for individuals and groups
from diverse backgrounds”; (5)
“demonstrates professional behavior and
accountability”; (6) “demonstrates the abil-
ity to utilize empathy when communicating
with patients”; (7) “demonstrates con-
fidence”; (8) “identifies areas for
development to improve competency” and
(9) “works systematically and coordinates
activities” (Table 3).
The fourth competency, referred to only
for pharmacists and specialized nurses and
included attributes of the health coach such
as; being respectful by putting aside person-
al differences, and not imposing their own
beliefs and values on the patient, but rather
acknowledging and respecting theirs.
The fifth competency “demonstrates pro-
fessional behavior and accountability” is
the sum of two parts. Firstly, it includes
attributes that were defined as behaviors
and skills that enabled the health coach to
do their job well, and achieve satisfactory
outcomes for the patient. Secondly, it also
includes the health coach being accountable
to the patient. The first part of this attribute
appeared to be autogenous to pharmacists,
medical practitioners, and non-specialized
nurses as health coaches, while the second
part, that is, being accountable, was solely
quoted in an article that examined pharma-
cists as the health coach.
51
The sixth competency “ability to utilize
empathy when communicating with
patients” included attributes describing
emotive communication, such as being;
comfortable during silence; focusing on
patient concerns; speaking slowly and
simply and being empathetic. This attribute
appeared within all professional
groups,
12,24,40,47–51,54
excluding physical
therapists.
52
The seventh competency, cited only for
physical therapist health coaches,
52
“demonstrates confidence”; included desir-
able attributes that involved having faith in
one’s self, including the ability to cope in
stressful situations. The ability to identify
areas for development in order to improve
practice, the eighth competency, included
attributes that involved being able to reflect
on one’s coaching skills and practice, as a
means of improving them. From the litera-
ture, only two health profession groups as
Singh et al. 19

coaches were found to include this compe-
tency: pharmacists,
51
and specialized
nurses.
42,45
The ninth competency, only ref-
erenced in the paper referring to physical
therapists as health coaches,
52
involves
demonstrating the ability to pre-arrange
coaching and materials prior to sessions,
to ensure that contacts are at ease during
the intervention.
Training of health coaches
The extent and duration of health coach
training provided to the primary health
professionals differed. Of the 18 articles
reviewed, none made any reference to the
competency frameworks established by the
international coaching bodies when training
health professionals to health coach.
Fourteen papers referred to training of the
primary health professional or the potential
thereof in order to health coach,
4,12,40,42–
44,46–52,54
while two papers
45,53
made no
mention of training. Health coaching was
mentioned only once as domain within the
competency framework of a health profes-
sional discipline i.e. nurse practitioner edu-
cational competency of the United States
National Organisation of Nurse
Practitioner Faculties (NONPF).
Comparisons amongst the health coach-
ing articles showed that the training periods
were highly variable. Some studies referred
to a health coach training period as short as
two hours,
40,50
while the longest training
period reported was four weeks.
49
Training
for early career primary health professional
student health coaches which included phar-
macy, medical, nursing and nurse practi-
tioner students referred to communication
skills training which covered the concepts
and processes of MI. Education and guid-
ance on the principles and techniques of MI
was also provided in three additional
articles
40,47,48
while one other assumed that
the health professionals already had an
understanding of the skills of MI.
53
Education regarding the psychological con-
cepts of behavior change was provided in
five papers; three referred to the transtheor-
etical model of change (TTM)
43,47,54
while
two referred to the social cognitive theory
(SCT) of behavior change.
43,52
The assump-
tion that the health professionals already
had competency in the theories of change
was made by one article.
43
Another dis-
cussed that cognitive-behavioral theories of
change have a clear evidence base and that
their use in health coaching would be advan-
tageous, but made no mentioning of the
training necessary to educate health profes-
sionals about this.
4
Comparison of ICF core
competencies to health coaching
competencies
Although none of the papers made refer-
ence to the ICF core competencies, compar-
isons made between the health coaching
competencies and the ICF core competen-
cies showed significant similarity (Table 4),
though ICF core competencies made no
mention of leadership skills or the need to
work collaboratively as a team to improve
client outcomes. They also did not mention
confidence or the need to respect and treat
clients from all backgrounds equally.
Comparison of EMCC
competence framework to health
coaching competencies
Even though the EMCC framework was
not mentioned in the reviewed articles,
analysis showed an overlap between the
health coaching and EMCC competencies
(Table 5). However, the EMCC framework
made no mention of the need for profes-
sional behavior or accountability of the
coach or the demonstration of confidence
during the coaching relationship.
20 Chronic Illness 0(0)

Table 4. Comparison of ICF core competencies to health coaching competencies.
Domain Knowledge and skills required to health coach Attributes required to health coach
Competency
(1)
Communicates
effectively for
the delivery
patient-centered
care
(2)
Demonstrates
team and
leadership
skills to
optimize
healthcare
(3)
Demonstrates
an understanding
of relevant,
fundamental and
evidence-based
knowledge and
undertakes
lifelong learning
to improve
professional
practice
(4)
Demonstrates
tolerance and
respect for
individuals and
groups from
diverse
backgrounds
(5)
Demonstrates
professional
behavior and
accountability
(6)
Demonstrate
the ability
to utilize
empathy when
communicating
with patients
(7)
Demonstrates
confidence
(8)
Identifies areas
for development
to improve
competency
(9)
Works
systematically
and coordinates
activities
Setting the foundation
1. Meeting ethical
guidelines and profes-
sional standards

2. Establishing the
coaching agreement
 
Co-creating the relationship
3. Establishing trust and
intimacy with the client
 
4. Coaching presence 
Communicating effectively
5. Active listening  
6. Powerful questioning 
7. Direct
communication
 
Facilitating learning and results
8. Creating awareness 
9. Designing actions 
10. Planning and goal
setting

11. Managing progress
and accountability


Discussion
Chronic health conditions are a leading
cause of morbidity and mortality, unless
they are appropriately managed by patients
and health professionals.
7
Services such as
heath coaching can assist patients to better
understand and manage their chronic
health conditions through positive behavior
change.
6
Establishing competencies specific
to the practice of health coaching which are
associated with successful patient outcomes
is imperative. The following competencies
for health professionals as health coaches
were identified from this review: (1) com-
municates effectively for the delivery
patient centered care; (2) demonstrates
team and leadership skills to optimize
healthcare; (3) demonstrates an understand-
ing of relevant, fundamental and evidence
based knowledge and undertakes lifelong
learning to improve professional practice;
(4) demonstrates tolerance and respect for
individuals and groups from diverse back-
grounds; (5) demonstrates professional
behavior and accountability; (6) demon-
strates the ability to utilize empathy when
communicating with patients; (7) demon-
strates confidence; (8) identifies areas for
development to improve competency; (9)
works systematically and coordinates
activities.
Although the majority of papers includ-
ed in this systematic review mentioned some
degree of training provided to the primary
health professionals in order to perform
health coaching, not one referred to the
competencies established by the interna-
tional coaching organizations.
From the literature, the concepts, techni-
ques, and information covered during the
training sessions differed. Despite this, the
most important skills gained from the health
coach training were underpinned by the first
“communicates effectively for the delivery
of patient-centered care” and second
“demonstrated team and leadership skills
to optimize health care” competencies.
Surprisingly, some of the articles includ-
ed in this review made no mention of the
training provided to the health professio-
nals in order to be a health coach.
45,53
However, all the papers revealed that
health coaches met the first two competen-
cies. This suggests that these skills must be
an essential part of a health professional’s
educational training and that inclusion of
these specific competencies within a training
course is redundant though could be
recapped. Although the purpose of this
review was not to evaluate the outcomes
of health coaching, we noted that all studies
reported successful health coaching inter-
ventions. As such, we are confident that
each of the health coaches were able to
demonstrate these skills in order to improve
the patients’ health outcomes. There was
not one paper that included all the compe-
tencies of health coaches, and no single
paper discussed all the attributes encom-
passed within the fourth to ninth competen-
cies. Notably, the attributes of the fourth
competency; “demonstrates tolerance and
respect for individuals and groups from
diverse backgrounds”, were only cited in
the papers that referred to pharmacists
and specialized nurses as the health coach.
However, these attributes are fundamental
to all health professionals. As such, under
the assumption that health professionals
are expected to possess these attributes,
they may have been less frequently men-
tioned throughout the literature and thus
absent from many of the health profession-
al groups in Table 3.
We saw the emergence of two communi-
cation types, these were exemplified in the
first and the sixth competency;
“communicates effectively for the delivery
of patient-centered care” and “demonstrates
the ability to utilize empathy while commu-
nicating with patients/clients”, respectively.
The first competency involved

communication skills that were inherent and
recapped during training; these skills were
displayed by all health professional groups,
while the sixth competency involved com-
munication that was emotionally driven.
Several studies alluded to a proforma or
protocol which the health professionals
could use to guide health coaching both
during and at the completion of train-
ing.
1,12,24,40,44,46–48,51–54
This suggests that
even in papers that made no mention of
training
45
the health professional coach
was still able to indirectly refresh these com-
munication skills while being guided
through their health coaching sessions.
Professionalism was captured within the
fifth competency. Considering that only
one health profession per se failed to men-
tion this competency, it could be that pro-
fessionalism too is considered an
underpinning attribute and thus was not
explicitly mentioned. Furthermore, this
attribute need only be briefly referred to
during health coach training to reiterate its
importance. An additional component of
the fifth competency was the health
coach’s ability to “demonstrate
accountability” to the patient. Considering
this competency was only referred to once in
the cited papers
51
it may not be considered
as an essential competency for health coach-
ing, though more fittingly could be synergis-
tic, that involves a partnership between the
patient and health coach, whereby both are
accountable for the patient’s outcomes.
The remaining competencies: confidence
and being organized, were mentioned only
in the paper referring to physical therapists
as health coaches.
52
The ability of a health
coach to portray confidence to patients/cli-
ents can make some individuals feel at ease
knowing they are in competent hands. On
the contrary, however, a health professio-
nal’s confidence can occasionally depict
them as unapproachable and arrogant.
Furthermore, health professionals should
be advised to have an organized yet fluid
approach to health coaching to maintain a
predictable structure to health coaching ses-
sions allowing clients to feel comfortable
and safe yet also allow them to bring up
other points of discussion.
The nine competencies for health
coaches were compared to the ICF and
EMCC competencies for coaches, showing
a considerable overlap. Both coaching
organizations, however, did not refer to
the need for confidence within their coach-
ing competencies. This suggests, demon-
strating confidence is a competency
specific to health coaches; reiterating the
need for competencies specific to the prac-
tice of health coaching.
The ICF competencies did not refer to
the team or leadership skills required to
coach as well as the tolerance and respect
for individual’s from diverse backgrounds.
There was no association between the
EMCC core competencies and the fifth
health coaching competency;
“demonstrates professional behaviour and
accountability”. Surprisingly, though both
accountability and professionalism are the
foundation of coaching interventions,
55
the
absence of this heath coaching competency
proposes that it is specific to health coaches.
Demonstrating team and leadership skills is
important to achieve centered patient care
and an improvement in health, but may not
be necessary with other types of coaching.
This research has yielded nine competen-
cies that health professionals met and which
resulted in successful patient outcomes
from health coaching. These are the skills,
knowledge, attitudes, and attributes which
ideally should be met by a health coach.
This research has also demonstrated a
need for competencies specific to the prac-
tice of health coaching and the lack of evi-
dence and skepticism towards the
certifications and training provided by the
larger international coaching bodies.
However, a correlation between the health
coaching competencies and those from the
Singh et al. 23

Table 5. Comparison of EMCC competence categories to health coaching competencies.
Domain Knowledge and skills required to health coach Attributes required to health coach
Competency
(1)
Communicates
effectively for
the
delivery
patient-
centered
care
(2)
Demonstrates
team and
leadership
skills to
optimize
healthcare
(3)
Demonstrates
an understanding
of relevant,
fundamental
and evidence-
based
knowledge and
undertakes lifelong
learning to improve
professional
practice
(4)
Demonstrates
tolerance and
respect for
individuals and
groups from
diverse
backgrounds
(5)
Demonstrates
professional
behavior and
accountability
(6)
Demonstrate
the ability to
utilize empathy
when
communicating
with patients
(7)
Demonstrates
confidence
(8)
Identifies
areas for
development
to improve
competency
(9)
Works
systematically
and
coordinates
activities
1. Understanding self 
2. Commitment to self-
development

3. Managing the contract  
4. Building the
relationship

5. Enabling insight and
learning

6. Outcome and action
orientation

7. Use of models and
techniques

8. Evaluation  

larger international coaching organizations
has been observed, and confirms that there
are similarities between practices of both
services. It has also reiterated the existence
and requirement of competencies specific to
the practice of health coaching.
Strengths and limitations
This literature review was conducted using
a systematic approach. Several databases
were searched to capture all the relevant
papers. Furthermore, a narrow range of
search strings and terms that were decided
upon in discussion with the research team
made finding articles specific to the area of
interest manageable. Since some may con-
sider this a limitation, where vital informa-
tion may have been missed, the search
string has been included in full, allowing
for replication. Although efforts were
made to minimize bias and appraise quality
by having the final review and selection of
papers carried out by two independent
reviewers, the lack of a defined quality rat-
ings scale was a limitation and could have
limited the analysis. The inclusion of only
peer-reviewed research resulted in the exclu-
sion of grey literature and unpublished
materials which may have resulted in some
relevant information being missed, though
this was considered negligible. Lastly, many
of the papers within this review did not
explicitly state the skills, knowledge, atti-
tudes and attributes of the health professio-
nals as the health coach and had to be
inferred, although this brings with it the
risk of bias since this review did not evalu-
ate the outcomes of health coaching inter-
ventions it is unlikely that this would be of
concern.
Conclusions
This research has derived nine key compe-
tencies specific to the practice of health
coaching and is interchangeable amongst
the health professional groups. The com-
petencies identified align with the compe-
tencies for coaches established by the
larger coaching organizations: ICF and
EMCC. Four competencies were found to
be specific to the practice of health coach-
ing; (2) demonstrates team and leadership
skills to optimize healthcare; (4) demon-
strates tolerance and respect for individual
and groups from diverse backgrounds; (5)
demonstrates professional behavior and
accountability; (7) demonstrates confi-
dence. Unlike the coaching competencies
established by the coaching bodies and
organizations, the health coaching compe-
tencies identified as part of this systematic
review are interdisciplinary. The compara-
tive analysis has confirmed these findings.
The identification of competencies specific
to health coaches paves the way for train-
ing programs tailored specifically to health
professionals as health coaches. This
would improve the regulation and quality
of health coaching and more importantly,
the health outcomes of patients with
chronic health conditions that are receiving
the coaching service.
Acknowledgements
None
Contributorship
HS and IS screened the titles and abstracts of all
remaining papers and the full text of all articles
remaining were obtained and reviewed by two
researchers HS and IS. GK reviewed articles
when consensus could not be reached. All
authors participated in drafting the article. All
authors read and approved the final version of
the article.
Declaration of conflicting interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship,
and/or publication of this article.
Singh et al. 25

Ethical approval
Ethical approval was not sought for this article
because this review did not require human or
animal participation.
Funding
The author(s) received no financial support for
the research, authorship, and/or publication of
this article.
Guarantor
HS.
Informed consent
Informed consent was not sought for this article
because this review did not require any partici-
pant involvement.
ORCID iD
Harjit K Singh https://orcid.org/0000-0002-
1070-5448
References
1. Hayes E and Kalmakis KA. From the side-
lines: coaching as a nurse practitioner strat-
egy for improving health outcomes. JAm
Acad Nurse Pract 2007; 19: 555–562.
2. Biswas-Diener R. Personal coaching as a
positive intervention. J Clin Psychol 2009;
65: 544–553.
3. Olsen JM and Nesbitt BJ. Health coaching
to improve healthy lifestyle behaviors: an
integrative review. Am J Health Promot
2010; 25: e1–e12.
4. Lawn S and Schoo A. Supporting self-
management of chronic health conditions:
common approaches. Patient Educ Couns
2010; 80: 205–211.
5. Kivel€
a K, Elo S, Kyng€
as H, et al. The effects
of health coaching on adult patients with
chronic diseases: a systematic review.
Patient Educ Couns 2014; 97: 147–157.
6. Singh HK, Kennedy GA and Stupans I. A
systematic review of pharmacy health coach-
ing and an evaluation of patient outcomes.
Res Social Adm Pharm 2019; 15: 244–251.
7. Dowrick C, Dixon-Woods M, Holman H,
et al. What is chronic illness? London,
England: Sage Publications Sage UK, 2005.
8. Jerant AF, Friederichs-Fitzwater MMv and
Moore M. Patients’ perceived barriers to
active self-management of chronic condi-
tions. Patient Educ Couns 2005; 57: 300–307.
9. David OA and Bernard ME. Coaching for
rational living: rational-emotive, cognitive-
behavioral perspectives. Coaching for rational
living. Berlin: Springer, 2018, pp. 3–24.
10. McNeilly RB. Coaching for solutions: a new
world of opportunity. Psychotherapy in
Australia 2003; 9: 70.
11. Griffiths K and Campbell MA. Semantics or
substance? Preliminary evidence in the
debate between life coaching and counsel-
ling. Coaching 2008; 1: 164–175.
12. Vale MJ, Jelinek MV and Best JD. Impact
of coaching patients on coronary risk fac-
tors: lessons from The COACH Program.
Dis Manage Health Outcomes 2005; 13:
225–244.
13. Bor R, Miller R, Gill S, et al. Counselling in
health care settings: a handbook for practi-
tioners. London: Palgrave Macmillan, 2008.
14. Wolever RQ, Caldwell KL, Wakefield JP,
et al. Integrative health coaching: an organi-
zational case study. Explore (NY) 2011; 7:
30–36.
15. Sudore RL and Schillinger D. Interventions
to improve care for patients with limited
health literacy. J Clin Outcomes Manage
2009; 16: 20–29.
16. Shearer M, Kelly J, Lindner H, et al.
Coaching for behaviour change in chronic
disease: a review of the literature and the
implications for coaching as a self-
management intervention. [Special Issue:
The Management of Chronic Disease in
Primary Care Settings.]. Aust J Prim
Health 2003; 9: 177.
17. Rosenstock IM, Strecher VJ and Becker
MH. Social learning theory and the Health
Belief Model. Health Educ Q 1988; 15:
175–183.
18. Simmons LA and Wolever RQ. Integrative
health coaching and motivational interview-
ing: synergistic approaches to behavior
change in healthcare. Glob Adv Health Med
2013; 2: 28–35.
26 Chronic Illness 0(0)

19. Luder H, Frede S, Kirby J, et al. Health
beliefs describing patients enrolling in com-
munity pharmacy disease management pro-
grams. J Pharm Pract 2016; 29: 374–381.
20. Herborg H, Haugølle LS, Sørensen L, et al.
Developing a generic, individualised adher-
ence programme for chronic medication
users. Pharmacy Pract 2008; 6: 148–157.
21. DiDonato KL, May JR and Lindsey CC.
Impact of wellness coaching and monitoring
services provided in a community pharmacy.
J Am Pharm Assoc (2003) 2013; 53: 14–21.
22. Wertz D, Hou L, DeVries A, et al. Clinical
and economic outcomes of the Cincinnati
Pharmacy Coaching Program for diabetes
and hypertension. Managed Care
(Langhorne, PA) 2012; 21: 44–54.
23. Bosmans JE, Brook OH, van Hout HP, et al.
Cost effectiveness of a pharmacy-based
coaching programme to improve adherence
to antidepressants. Pharmacoeconomics
2007; 25: 25–37.
24. Brook O, Van Hout H, Nieuwenhuyse H,
et al. Impact of coaching by community
pharmacists on drug attitude of depressive
primary care patients and acceptability to
patients; a randomized controlled trial. Eur
Neuropsychopharmacol 2003; 13: 1–9.
25. Brook OH, Van Hout HPJ, Nieuwenhuysea
H, et al. Effects of coaching by community
pharmacists on psychological symptoms of
antidepressant users: a randomised con-
trolled trial. Eur Neuropsychopharmacol
2003; 13: 347–354.
26. Axley L. Competency: a concept analysis.
Nurs Forum 2008; 43: 214–222.
27. Verma S, Paterson M and Medves J. Core
competencies for health care professionals:
what medicine, nursing, occupational thera-
py, and physiotherapy share. Journal of
Allied Health 2006; 35: 109–115.
28. Pharmaceutical Society of Australia. nation-
al competency standards framework for phar-
macists in Australia 2010. Australia:
Pharmaceutical Society of Australia, 2010.
29. Woodruffe C. What is meant by a compe-
tency? Leadership Org Development J 1993;
14: 29–36.
30. Payne K. Coaching competencies decon-
structed. Pennsylvania: University of
Pennsylvania, 2017.
31. Jordan M, Wolever RQ, Lawson K, et al.
National training and education standards
for health and wellness coaching: the path to
national certification. Los Angeles, CA:
SAGE Publications, 2015.
32. Mittelman M. Health coaching: an update
on the national consortium for credentialing
of health & wellness coaches. Glob Adv
Health Med 2015; 4: 68–75.
33. Coaching Af. Become a member, www.asso
ciationforcoaching.com/page/MemBecome
Member (2019, accessed 8 March 2019).
34. ICF. Coaching, https://coachfederation.
org/ (2019, accessed 8 March 2019).
35. EMCC. European mentoring & coaching
council, www.emccouncil.org/ (2019,
accessed 8 March 2019).
36. Huffman M. National Society of Health
Coaches, www.nshcoa.com (2019, accessed
29April 2019).
37. NSHC. NSHC history & founders, www.
nshcoa.com/about (2019, accessed 8 March
2019).
38. Wolever RQ, Jordan M, Lawson K, et al.
Advancing a new evidence-based profession-
al in health care: job task analysis for health
and wellness coaches. BMC Health Serv Res
2016; 16: 205.
39. Grant AM, Passmore J, Cavanagh MJ, et al.
The state of play in coaching today: A com-
prehensive review of the field. Int Rev Ind
Organ Psychol 2010; 25: 125–167.
40. Leung LB, Busch AM, Nottage SL, et al.
Approach to antihypertensive adherence: a
feasibility study on the use of student
health coaches for uninsured hypertensive
adults. Behav Med 2012; 38: 19–27.
41. Higgins JP and Green S. Cochrane hand-
book for systematic reviews of interventions.
John Wiley & Sons, 2011.
42. Ammentorp J and Kofoed P-E. Coach train-
ing can improve the self-efficacy of neonatal
nurses. A pilot study. Patient Educ Couns
2010; 79: 258–261.
43. Hayes E, McCahon C, Panahi MR, et al.
Alliance not compliance: coaching strategies
to improve type 2 diabetes outcomes. JAm
Acad Nurse Pract 2008; 20: 155–162.
44. Walker C, Furler J, Blackberry I, et al. The
delivery of a telephone coaching programme
to people with type 2 diabetes by practice
Singh et al. 27

nurses in Victoria, Australia: a qualitative
evaluation. J Nurs Healthc Chronic Illn
2011; 3: 419–426.
45. Romain-Glassey N, Ninane F, Jd P, et al.
The emergence of forensic nursing and
advanced nursing practice in Switzerland:
an innovative case study consultation.
J Forensic Nurs 2014; 10: 144–152.
46. Swerczek LM, Banister C, Bloomberg GR,
et al. A telephone coaching intervention to
improve asthma self-management behaviors.
Pediatr Nurs 2013; 39: 125–145.
47. Bennett JA, Perrin NA, Hanson G, et al.
Healthy aging demonstration project: nurse
coaching for behavior change in older
adults. Res Nurs Health 2005; 28: 187–197.
48. Fahey KF, Rao SM, Douglas MK, et al.
Nurse coaching to explore and modify
patient attitudinal barriers interfering with
effective cancer pain management. Oncol
Nurs Forum 2008; 35: 233–240.
49. Nesbitt BJ, Murray DA and Mensink AR.
Teaching motivational interviewing to nurse
practitioner students: a pilot study. JAm
Assoc Nurs Pract 2014; 26: 131–135.
50. Kaplan JA, Brinson Z, Hofer R, et al. Early
learners as health coaches for older adults
preparing for surgery. J Surg Res 2017;
209: 184–190.
51. Lonie JM, Austin Z, Nguyen R, et al.
Pharmacist-based health coaching: a new
model of pharmacist-patient care. Res
Social Adm Pharm 2017; 13: 644–652.
52. Nessen T, Opava CH, Martin C, et al. From
clinical expert to guide: experiences from
coaching people with rheumatoid arthritis
to increased physical activity. Phys Ther
2014; 94: 644–653.
53. Miller NH. Motivational interviewing as a
prelude to coaching in healthcare settings.
J Cardiovasc Nurs 2010; 25: 247–251.
54. Neuner-Jehle S, Schmid M and Gru
¨ninger
U. The “Health Coaching” programme: a
new patient-centred and visually supported
approach for health behaviour change in pri-
mary care. BMC Fam Pract 2013; 14: 100.
55. Huffman MH. Advancing the practice of
health coaching: differentiation from well-
ness coaching. Workplace Health Saf 2016;
64: 400–403.
56. Nelson LJ, Cushion CJ and Potrac P.
Formal, nonformal and informal coach
learning: a holistic conceptualisation. Int J
Sports Sci Coach 2006; 1: 247–259.
28 Chronic Illness 0(0)