Health Coach Assistant (Peer Health Coach)
Summary: Peer influence is often more powerful than professional advice. The MHS can use the power of peer influence to improve healthy lifestyle behavior by recruiting military spouses, educating them, and employing them as "health coach assistants" (HCA). These HCAs will conduct healthy lifestyle education in family support group circles, spouse clubs, and serve as a member of the patient-centered medical home primary care teams. Using activity monitoring technology like a Fitbit, HCAs can monitor and encourage patient activity. For example, as a member of the PCMH team, the HCA can send a congratulatory note on achieving your execise plan or call and encourage if not. Such a strategy reaches into the "lifespace" of the military family by not only employing the benficiary population, but using social connections and technology to promote a healthy lifestyle through peers.
The following innovation idea is designed to influence military beneficiaries' “ lifespace” while both increasing access to care, reducing obesity, increasing activity, engaging spouses and providing transferable skills and increased employment opportunities. It also uses connected activity technology to enhance the peer and/or social influence on healthier lifestyles.
The challenge as the Army Surgeon General has stated is to influence the family “whitespace” or the “lifespace” – that is, the time when family members are not visiting their healthcare provider.
The military health system needs to focus not just on the Soldier, but on "moms" or spouses. Mothers have the greatest influence on family health. For example, men are 2.4-2.7x more likely to seek healthcare if influenced by a woman. An informal survey of colleagues revealed that even in dual-income households, "mom" still does more than 50% of grocery shopping and cooking. The jury is out, however, on who makes more decisions about whether children go out to exercise or sit and play video games. However, since male Soldiers outnumber females, it is typically mom who is farthest removed from military command influence. Thus, if we are to influence a soldier's "lifespace" we must effectively influence the behaviors and habits of their spouses as well.
In the book, Reverse Innovation by Vijay Govindarajan, peer health coaches were effectively employed in Haiti where physicians are very scarce to improve basic health practices. A similar experiment was conducted in Roxbury, MA in an attempt to reduce the community rates of HIV. After 2 years, using peer coaches selected and trained from the community, HIV costs in the community were nearly cut in half . The program managers attributed most of the success to having peers coach healthier habits - not "white coats" telling patients what to do.
We have a similar opportunity in the military.
Concept of the Operation:
The military could select and train "peer health coaches" or "health coach assistants" (HCA) from the pool of available military spouses. These peers could then serve in two important roles:
First, they could do both formal and informal healthy lifestyle education and training at family support groups, spouse clubs, or anywhere military spouses gather.
Second; they could be employed as part of the PCMH team. In this role, they could serve as an assistant to a primary care provider (PCM), nurse case manager (NCM), nutritionist, fitness coach, etc to monitor the activity of patients using web-connected activity trackers such as FitBit, Jawbone UP, Nike Fuel Band, etc. For example; the PCM could prescribe exercise and refer the patient to a fitness coach, the HCA (depending on training level), or allow the patient to build their own exercise plan with the help of the HCA. That plan would then be built into a web site that is linked to the patient's activity tracker. The HCA’s job is then to check up on the patient's activity and contact them with an encouraging message if they are achieving their planned goals or to find out why they may not be achieving them. Automated flags could be easily established to assist in monitoring activity. For example, Dr. Robert Salis, a family medicine physician at Kaiser Permanente, recommends at least 150min/week for adults and 420/min week for children. Similarly, in the first role, the HCA could introduce activity monitors at social events in order to create groups of spouses who exercise together and/or share their activity – thus spurring friendly competition or encouragement. Several websites exist to promote social health like www.neufit.com, www.livewellchallenge.com, www.nikeplus.com, and www.digifit.com, just to name a few.
This function would be relatively low-cost, yet an important healthy-lifestyle influencer and potentially one with the most frequent contact with targeted patients such as those with obesity who need more frequent, positive support. Also, because they may detect inactivity, they serve as an early warning in case other problems for the patient arises. Because of their predominately peer-encouragement role, they would also support mental health and well-being by showing that the health system cares individually.
The skills developed in this role would not only directly impact that individual's family, but all families they are connected to whether personally or professionally. Since this job function would be prolific across the DoD, the spouse would have a high chance of similar employment no matter where stationed.
The HCA role could be developed in one of four ways: A new role for Red Cross Volunteers; a separate volunteer force; a contracted force; or GS employee. The Multi-Service Market Office could be the place to hire a trained health and wellness coach who then act as the principle trainer and coordinator so that such efforts reaches all services in a uniform manner.
The initial model would require potentially one peer coach assistant for every PCM - that is a basis of 1200 patients for a typical family practice setting. The formula estimate is based on the average American overweight percentage of 70%. At that rate, HCAs would monitor 840 patients or 21/hr during a 40-hr week. The ratio of HCA to PCM may be reduced for internal medicine PCMHs with more complicated patients. It should not be necessary for SCMH since unit leadership should monitor a Soldier’s activity. However, inclusion at SCMH in the future may be considered. Pilot studies may reveal that more HCAs are needed in order to promote and keep people active who are not overweight, but perhaps at risk. However, if pilots prove effective for overweight and obese populations, it is likely they will prove cost-effective in a prevention role.
Activity Monitors: The MHS should work through AAFES to sell activity monitors on site at the PCMH center. This way, HCA can work with the patient immediately to get them set up with the device. Alternatively, this should be arranged at fitness centers on military facilities whereby a fitness center employee and/or health coach on site can teach a patient how to use it and link the data with the PCMH team.