A personal health coach for those living with chronic diseases Priscilla Pemu
When I first became a doctor
in Benin City, Nigeria,
some 30-odd years ago,
I was drawn to help
people live full lives.
But often, I found myself
feeling impotent.
Here I was, a brand-new doctor
with all these skills,
but I couldn’t cure my patients
who had chronic diseases –
illnesses like heart disease,
asthma, diabetes –
and needed more than just
handing them a prescription
or providing grief counseling
in the office to get the job done.
Fast-forward 15 years later:
I’m in Atlanta, Georgia;
it’s a different world,
but it was déjà vu all over again.
As doctors, we see our patients
who have chronic illnesses
in an episodic way.
In between,
the patients have to learn how to make
a lot of decisions for themselves.
I’ll give you examples.
If you have medications
you’re supposed to take every day,
what do you do when you’re sick?
Are you still supposed to take it?
How do you recognize
a complication when it happens?
How do you recognize
a side effect when it happens?
What do you do with it?
In addition to all of this,
they’re dealing with the inevitable
loneliness, isolation and anxiety
that people who have
chronic illnesses deal with.
In the US alone, six in 10 adults
have a chronic illness.
That’s 125 million people.
A recent report from
the Robert Wood Johnson Foundation
showed that health habits
account for 50 percent
of the health outcomes
that people experience,
while medical care
only accounts for 20 percent.
In fact, the Centers for Disease Control
says that if we could eliminate smoking,
physical inactivity and poor nutrition,
that we can prevent
80 percent of heart disease,
80 percent of type 2 diabetes
and 40 percent of cancer.
But we also know
that changing health behaviors
is very difficult.
So we asked the question:
What if we could create a resource
that could motivate people
to change health behavior?
The truth is, there are a lot
of these resources out there
that help people acquire
these so-called self-management skills.
But many a time, they’re not
easily accessible or relatable,
particularly to individuals within
minority and underserved communities,
who face bias in addition to barriers
like language and culture
and inadequate health insurance coverage.
And so in the last 12 years,
my colleagues and I
at Morehouse School of Medicine
have created a
technology-based application
to assist with chronic illness care.
It’s freely available on the web
and as an app.
And what we do is get people
to track variables –
blood pressure, blood sugar –
and then report it back to them
in a color-coded format.
So green would indicate a healthy range,
and red would indicate a problem
that needs something done about it.
We link these stats to a curriculum.
The curriculum helps the individual
learn about their health condition,
whatever the chronic illness is.
They also work with a health coach
to learn self-management skills,
skills that’ll help them prevent
complications of their illness.
In order for the coach to be successful,
they have to be able to gain the trust
of the individual
that they’re working with.
We tested this application
in clinics, where the health coaches
were medical assistants,
and in a large urban church,
where the health coaches were volunteers
from the health ministry.
A year later, a third of the participants
were able to acquire
three new self-management skills
and maintain them to the extent
that it was able to improve
their blood pressures, their blood sugar
and their exercise.
Now, what was simple yet fascinating to us
was that the group from the church
did just as well or even better
than the group that were
under purely medical care.
And we wanted to learn why that was.
So we looked a little further
into the research –
400 hours of recorded conversation –
and what we learned was that
the coaches from the church
did have more time to spend
with the patients,
they had access to the patients' families,
and so they could figure out
what people needed
and provide those resources for them.
My team and I call this
“culturally congruent coaching.”
To illustrate this concept
of culturally congruent coaching,
I want to tell you about
one of our patients.
I’ll call her Ms. Bertha.
So Ms. Bertha is an 83-year-old lady
with diabetes and hypertension.
She was assigned to Anne,
her health coach in the church.
Anne also happened to be a family friend
to Ms. Bertha for many years,
and they were fellow congregants.
Anne observed after the first few visits
that even though Ms. Bertha
faithfully recorded her stats,
they were all showing up as red.
So she probed a little deeper
to try to understand
what was going on with Ms. Bertha,
and Ms. Bertha gave her the real-real.
(Laughter)
She told her that there were times
when her medications made her feel weird,
and she wouldn’t take them
the way they were prescribed,
because she thought
it was due to the medicines
but she didn’t tell her doctor that.
She also skipped out
on some doctor appointments
for a variety of reasons,
but one of them was
she wasn’t doing better
and she didn’t want
to make her doctor mad,
so she just didn’t go.
So Anne talked to Ms. Bertha
and asked her to bring her daughter
in for the next visit, which she did.
And at that visit,
Anne was able to print out
a log of all these stats
that Ms. Bertha had been collecting,
gave them to her and encouraged them
to go see the doctor together,
which they did.
With that information,
the doctor was able to make changes
to Ms. Bertha’s treatment.
Within three months, Ms. Bertha’s numbers
were all in the green.
No one was more excited
or surprised than Ms. Bertha herself.
Now, Anne was successful as a health coach
because she cared enough
to go below the surface
and probe Ms. Bertha’s deep culture
and was able to reach her at that level.
She knew how to listen,
and she knew how to ask
the right questions
to get to what was needed.
We all have deep unconscious rules
that drive the way we make
our health decisions.
That’s our culture.
The relationship and the conversation
between Anne and Ms. Bertha
illustrates what’s possible
when we have conversations
with our patients,
our friends and our neighbors
on a deep cultural level.
And personally, I’m beyond excited
to think that with this simple concept
of culturally congruent coaching,
we could change the lives
of 125 million Americans
and many others across the world
that are living with chronic diseases.
Thank you.
(Applause)