Health Coaching for Family Caregivers Improves Patient Activation

Offering health coaching to family caregivers might be key to improving patient activation and chronic disease management for patients with diabetes, according to a new study published in JAMA Network Open. 

Currently, 75 percent of US adults with diabetes are not meeting glycemic, blood pressure, and lipid treatment, signaling barriers to chronic disease management and the patient and family activation that support disease management.

“These patients often need more intensive monitoring and support than health systems can provide. One potentially powerful source of support is patients’ family and friends (family supporters),” Ann-Marie Rosland, MD, associated professor at the University of Pittsburgh School of Medicine, and colleagues, wrote in the study. “Family involvement plays a key role in diabetes management, with nearly 50 percent to 75 percent of adults with diabetes reporting having a member who is regularly involved in their diabetes management.

“Support for diabetes care from family and friends is associated with better self-management behaviors and risk factor control and is associated with decreased risk of hospitalization and death. However, healthcare teams do not have structured programs or tools to deliver these promising approaches to patient-supporter pairs.”

The Caring Others Increasing Engagement in Patient Aligned Care Team (CO-IMPACT) intervention tapped into this key source for diabetes support and provided tools to adult patient-supporter dyads to help improve patient activation, diabetes management, and outcomes compared with standard care.

During the study intervention, over 230 patient caregivers completed a health coaching session regarding dyadic information sharing and positive support techniques. Proceeding the session, caregivers also received 12 months of biweekly automated monitoring telephone calls to ensure patients meet diabetes goals and coaching calls to prepare for patient care visits.

By the end of the study, the low-intensity coaching and monitoring program had a significant impact on patient activation. Additionally, self-efficacy and healthy eating behavior improved for patients who participated in the study.

“Increases in patient activation and the related concept of self-efficacy are key patient-centered diabetes outcomes,” the study authors stated. “Moreover, each provides an essential foundation for patients to make healthy behavior changes and engage in medical care.”

“Our findings from this randomized clinical trial indicate that increasing family caregivers’ engagement in the care of adults with diabetes is feasible and may improve key behavioral determinants,” the study authors continued. “Future studies should investigate whether interacting more directly with patients’ supporters and targeting patients with higher needs for support would help translate the observed benefits into physiological improvements.”

The study comes as the role of family caregivers and supporters is increasingly recognized. While family caregivers are instrumental in helping their loved ones, there is a lack of support for them throughout the healthcare system.

In September 2022, the Department of Health and Human Services (HHS) unveiled a national strategy to provide better support to family caregivers. The strategy includes nearly 350 actions that 15 federal agencies will take to support family caregivers. The document also outlines 150 actions that others at the state and local government, plus the private sector, can take.

HHS said there are around 350 million people who assume the role of family caregiver, and it is usually a low- or no-wage job. Providing this level of support will be essential to helping to achieve patient activation and support better outcomes for chronic disease.

“Supporting family caregivers is commonsense, since most people will at some point in their lives be a family caregiver, need a family caregiver, or both. Caregivers are sacrificing for their loved ones and often are standing in the health care gap by providing that care,” CMS Administrator Chiquita Brooks-LaSure said in the HHS announcement.

“Many of the more than 150 million people who receive health care coverage through Medicare, Medicaid, and the Health Insurance Marketplaces® rely on trusted friends and family for care,” Brooks-LaSure added. “CMS is committed to advancing home and community-based services and other forms of caregiver support across the lifespan to give caregivers the recognition and resources they need and deserve.”