Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE
Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated.
To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy).
Secondary analysis of a randomized controlled trial.
Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly.
A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy.
The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI − 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI − 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (− 4.6; 95% CI − 9.1, − 0.15; p = 0.04).
We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention.
KEY WORDStelephone coaching health risk assessment health literacy health numeracy
We are grateful to the leadership and staff of the VA’s National Center of Health Promotion and Disease Prevention (NCP) for the constant support throughout this project, including Dr. Jane Kim, Chief Consultant (NCP) and Ms. Kathleen Pitman. We also acknowledge the dedication and professionalism of our two health coaches, Ms. Karen Juntilla and Ms. Courtney White-Clark.
This project was funded by the Department of Veterans Affairs, Health Services Research and Development Service (CRE 12-288) and by a fellowship training grant by the National Research Service Award (NRSA) T32HP19025.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 13.Hibbard JH and Cunningham PJ. How engaged are consumers in their health and health care, and why does it matter? Res Brief. 2009;8:1–9.Google Scholar
- 18.Institute of Medicine (US) Committee on Health Literacy. Health literacy: a prescription to end confusion. Washington, D.C: National Academies Press; 2004.Google Scholar
- 19.Kirsch IS, Jungeblut A, Jenkins L, Kolstad A. Adult literacy in America: a first look at the findings of the National Adult Literacy Survey (NALS). Washington, DC: U.S. Department of Education, National Center for Education Statistics; 1993.Google Scholar
- 20.Kutner M, Greenberg E, Baer J. A first look at the literacy of America’s adults in the 21st century. Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2005.Google Scholar
- 21.Goodman M, Finnegan R, Mohadjer L, Krenzke T, Hogan J. Literacy, numeracy, and problem solving in technology-rich environments among U.S. adults: Results from the program for the international assessment of adult compe- tencies 2012: First look (NCES 2014-008). Washington, DC: U.S. Department of Education, National Center for Education Statistics; 2013.Google Scholar
- 22.OECD. OECD skills outlook 2013: first results from the survey of adult skills. OECD Publishing; 2013, http://www.oecd-ilibrary.org/education/oecd-skills-outlook-2013_9789264204256-en. Accessed May 2017.
- 31.Oddone EZ, Damschroder LJ, Gierisch JM, et.al. A Coaching by Telephone Intervention on Engaging Patients to Address Modifiable Cardiovascular Risk Factors: A Randomized Controlled Trial. J Gen Intern Med, 2018 (in press).Google Scholar
- 33.Veterans Health Administration. MyHealtheVet: HealtheLiving Assessment <https://www.myhealth.va.gov/mhv-portal-web/web/myhealthevet/ss20170509-birds-eye-view-of-your-wellness-and-your-health-risks>. Accessed May 2017.
- 38.Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med 2004;36(8):588–94.Google Scholar
- 42.Fitzmaurice, GM, Laird NM, and Ware JH. Applied longitudinal analysis. Vol. 998. Hoboken NJ: John Wiley & Sons, 2012.Google Scholar