Effect of Health Coaching on Adults with Type 2 Diabetes a Descriptive

FACULTY OF HEALTH AND OCCUPATIONAL STUDIES NURSING DEPARTMENT, Department of Health and Caring Sciences MEDICINE AND HEALTH COLLEGE Lishui University, China

Effect of Health Coaching on adults with type 2 diabetes

A descriptive review

Zhang Jieru (Lvy) Ye Chenglin (Brian)

2021

Student thesis, Bachelor degree, 15 credits Nursing Degree Thesis in Nursing

Supervisor: Xu Linyan (Alisa)

Examiner: Britt-Marie Sjölund

Contents

1.Introduction ...... 1 1.1 Background ...... 1 1.2 Health Coaching – definition ...... 1 1.3 Type 2 Diabetes – definition ...... 2 1.4 Nurses’ role ...... 2 1.5 Self-Care Deficit Theory of Nursing ...... 2 1.6 Earlier review...... 3 1.7 Problem description ...... 3 1.8 Aim and research questions ...... 4 2. Method ...... 4 2.1 Design ...... 4 2.2 Search strategy ...... 4 2.3 Selection criteria ...... 5 2.4 Selection process and outcome of potential articles ...... 5 2.5 Data analysis ...... 6 2.6 Ethical considerations ...... 7 3. Results ...... 7 3.1 Organize information of articles ...... 7 3.2 Health coaching intervention ...... 9 3.2.1 The intervention ways from intervention group ...... 9 3.3 The effects of health coaching ...... 10 3.3.1 Physiological change ...... 10 3.3.1.1 HbA1c ...... 10 3.3.1.2 Weight...... 11 3.3.1.3 Waist circumference ...... 12 3.3.2 Psychological change ...... 12 3.3.2.1 Self-efficacy ...... 12 3.3.2.2 Life satisfaction ...... 13 3.3.2.3 Anxiety and depression ...... 13 4. Disscusion ...... 14 4.1 Main results ...... 14 4.2 Results discussion ...... 14 4.2.1 The need of health coaching………………………………………………………….13 4.2.1 Physiological change ...... 16 4.2.2 Psychological change ...... 17

4.3 Methods discussion ...... 18 4.4 Clincal implications ...... 19 4.5 Suggestions for further research ...... 19 4.6 Conclusion ...... 20 5. References ...... 20 Appendix ...... i

Abstract

Background: Type 2 diabetes, which has a bad effect on people’s life in both mental and physical aspects, has become global health concern, whose prevalence has been increasing exponentially. Some studies have showed that health coaching can improve the health condition of type 2 diabetics. Aim: To describe health coaching and the effect of health coaching on adults with type 2 diabetes. Design: A descriptive review of quantitative studies. Method: Search for quantitative articles in such databases as PubMed and EBSCO. Suitable articles were selected after being carefully read. Then all results were compared. Finally, similarities and differences were categorized accordingly. Results: A total of 10 articles were included in the review. The review finds that health coaching has a positive effect on treating type 2 diabetes. The health coaching intervention was effective in reducing HbA1c and waist circumference. It also improved participants’ self-efficacy, enhanced their life satisfaction as well as reduced their anxiety and depression. However, the effect of health coaching on weight was not significant. Conclusions: This review assessed the effect of health coaching on patients with type 2 diabetes through 10 eligible studies with a total of 2753 participants. The results showed that health coaching could not only improve the psychological health of patients and effectively reduce the HbA1c of patients, but also reduce the waist circumference of patients in the short term. However, health coaching seems to lack a persistent effect on waist circumference, so more research was needed to support this conclusion. In addition, future studies should consider distinguishing the effects of health coaching on participants of different ages. Key words: adult, health coaching, type 2 diabetes.

背景: 2 型糖尿病在生理和心理上都对人们的生活产生了不良影响，已成为一个明显的全球性公共卫生问题，并且其发病率呈指数增长趋势。一些研究表明，

健康指导可以改善 2 型糖尿病的健康状况。

目的: 描述健康指导及其对成年 2 型糖尿病患者的影响。

设计: 定量研究的描述性综述。

方法: 检索 PubMed 和 EBSCO 数据库中的定量文献。仔细阅读后选择合适的文

章，比较所有结果，并进行异同分类。

结果: 共纳入 10 篇文献。研究发现，健康指导对 2 型糖尿病有积极的影响。健康指导干预在降低糖化血红蛋白和腰围方面效果显著，并且能够提升参与者的自我效能感、生活满意度并减少焦虑和抑郁。然而，健康指导对体重的影响并

不显著。

结论: 本综述纳入了 10 篇相关的研究，共 2753 名参与者，评估了健康指导对 2 型糖尿病患者的有效性。结果表明，健康指导不仅能改善患者的心理健康，还能有效降低患者的糖化血红蛋白，并且在短期内降低患者的腰围。然而，健康训练似乎对腰围缺乏持久的影响，因此需要更多的研究来进一步阐明这些结果。

此外，未来的研究应考虑区分健康指导对不同年龄参与者的影响。

关键词: 成人，健康指导，2 型糖尿病。

1. Introduction 1.1 Background Over the past few years, diabetes, especially type 2 diabetes, has become a serious health problem worldwide, with its incidence increasing exponentially (Wu, Ding, Tanaka & Zhang 2014). It has a high prevalence rate in the population of developing countries and some developed countries as well (Wild et al. 2004). 90% - 95% of diabetic patients are type 2 diabetic patients (Tripathi & Srivastava 2006), and the patients are usually adults (Alabama Department of Public Health, 2017). It is necessary to find some tools to manage the conditions (Miyamoto et al. 2019). One of the most important interventions is health coaching whose performer is called health coaches. Health coaches were initially found in the United States (Miller & Rose 2009; Eliopoulos 1997; Eliopoulos 2014). In the United States, with the increasing demand for healthy life, health coaches have gradually appeared in great numbers (Wolever et al. 2013). Although health coaching is used to treat many chronic diseases, the effect of health coaching techniques on type 2 diabetes remains to be explored.

1.2 Health Coaching – definition Someone shows that health coaching is a kind of health intervention in patients’ behaviours, which encourages clients to establish and attain target to improve health condition. It will change patients’ unhealthy behaviors, thereby reducing health risks, improving individuals' ability to manage chronic diseases, and improving their quality of life (Van & Heaney 1997). There are other people who define health coach as a kind of medical professionals with different backgrounds. on the basis of behavior change theory and in the practice of seeing patients as the center, the health coach promoted patients to set goals by themselves and helped them to form healthy behaviors by integrating a variety of mechanisms. (Wolver et al. 2013). In addition, health coaching is also a client-centered treatment approach, which is target-oriented. It focuses on health and plays its role through encouraging patients to make changes and empowering them (Olsen 2014). Our review agrees with the view of Van and Heaney (1997) who believe health coaching is a way to significantly improve individual’s management ability and quality of life by encouraging patients to change their lifestyle via setting health goals.

1.3 Type 2 Diabetes – definition Diabetes occurs when someone suffers a complete or partial lack of insulin secretion, which can cause disorders in lipid and protein metabolism featured by persistent hyperglycemia and impaired carbohydrates (Wu et al. 2014). Inadequate insulin leads to type 2 diabetes, a multisystem syndrome of metabolism. The risk factors of type 2 diabetes are age, weight, sex, nation, family and medical history (Sullivan et al. 2019). Diabetes has many complications, such as cardiovascular disease, kidney failure, stroke, or poor circulation. It significantly decreases the quality of life, limits normal activities and productivity of patients, and imposes huge economic and social burdens (Zhao et al. 2011).

1.4 Nurses’ role Nurses, as health coaches, can teach people what healthy lifestyles are and help people change their lifestyles. For example, they can help people identify healthy behaviors, set life goals and decide how much they would like to make adjustments so as to manage to arouse people’s awareness to make changes or help them become more determined to change their behaviors (Normand & Bober 2020). Nurses may also play a role helping people pay more attention to control their blood sugar. By helping patients to contact other healthcare professionals and seeking advice from the healthcare team, nurses emphasize the importance of blood sugar control and normal level of HbA1c while deepening people’s understanding of HbA1c. It is well known that increasing communicating time with nurses will provide other support and useful advice to patients. Nurses can also provide training in terms of self-monitoring blood glucose. The special skills nurses have can enhance the efficacy of therapy and thus improve type 2 diabetics’ ability of blood glucose control. (Nesbeth et al. 2015). Nurse coaching is a practice framework supplementing patient education and supportive treatment to enhance self-management behavior and self-care ability of client and their family members (Lewis & Zahlis 1997). Therefore, the role of nurses in the prognosis and treatment of diabetes is significant.

1.5 Self-Care Deficit Theory of Nursing This review uses Orem's theory as theoretical basis. In terms of human nature, human beings are dynamic. They collectively live in their environment. As they are continually

developing, they acquire free will and other basic human qualities (Banfield 1998). The theory is involved in the following three parts, including Self-Care, Self-Care Deficit and dependent care (Orem 2011). Self-care theory shows what person’s needs are and how to meet these needs (Orem 2001). Dependent care theory shows how the self-care system is adjusted to help a socially dependent person and to meet self-care needs (Taylor & Renpenning 2011). Self-care deficits theory shows the limitation involved in realizing the effects on the health and wellbeing of the person or meeting dependency need for ongoing nursing (Orem 2011). The theory can describe why and how patients with type 2 diabetes care for themselves. It also explains how to provide dependent- care for a socially dependent patient by families or friends, and why patient can be helped through nursing (Orem 2001).

1.6 Earlier review Some reviews have researched the effects of health coaches on chronic diseases in the previous years. In Barakat et al. (2018) article, they find that health coaching can enhance the quality of life in cancer patients and enhance patients’ capacity by several mechanisms (Barakat et al. 2018). Kennel (2018) finds that health coaching is a potentially effective tool to change patients' nutrition-related behaviors. And it is an effective strategy for the restraining and therapy of some chronic diseases like obesity (Kennel 2018). What’s more, Smartphone-based health coaching can reduce blood pressure and increase medication compliance in patients with hypertension. It will significantly reduce the incidence of stroke and coronary heart disease (Xu & Long 2020). 1.7 Problem description Diabetes, as a global disease, is on the rise year by year. The advent of health coaching techniques has been a boon for type 2 diabetics. Techniques of health coaching are already being used to help patients with chronic diseases. Good results have been yielded, including improving patients’ quality of daily life, and playing an active role in disease management and treatment compliance. However, the results of the health coaching intervention for type 2 diabetics have not been reviewed in detail. Describing the effect of health instruction on type 2 diabetes can indicate whether health coach is suitable for long term care intervention of type 2 diabetics or it can contribute to its development as strong evidence.

1.8 Aim and research questions The aim of this literature review was to describe health coaching and the effect of health coaching on adults with type 2 diabetes.

-What kind of the health coaching was used? - What was the effect of health coaching on adults with type 2 diabetes?

2. Method 2.1 Design This research was a descriptive literature review (Polit & Beck 2017).

2.2 Search strategy The articles were searched in two databases and they are PubMed and EBSCO (Polit & Beck 2017). In PubMed, the search terms were “Coach*”, “Diabetes Mellitus, type 2”, “health coaching” and “mentoring”. In EBSCO, the terms of “Type 2 diabetes” and “Coach*” were searched. The limitations of articles are that those English articles were published ten years ago. Boolean terms “AND” and “OR” were combined when searching terms (Polit & Beck 2017). The first step to select articles was to read titles and abstracts. In this step, 406 articles were skimmed, and 23 articles were selected as qualified articles.

Table 1. Results of preliminary database searches.

Database Limits and Search terms Number of Possible articles search date hits (excluding doubles)

Medline via 10 years, “Diabetes Mellitus, type 70476 PubMed English 2” [MeSH] 2020-4-22

Medline via 10 years, “Mentoring” [MeSH] 1591 PubMed English

2020-4-22

Medline via 10 years, “Coach*” 10671 PubMed English 2020-4-22

Medline via 10 years, “health coaching” 6388 PubMed English 2020-4-22

Medline via 10 years, “Diabetes Mellitus, type 171 13 PubMed English 2” [MeSH] AND 2020-4-30 (“Mentoring” [MeSH] OR “Coach*” OR “health coaching”)

Ebsco 10 years, “Type 2 diabetes” AND 258 10 English “coach*” 2020-5-3

Total 23

2.3 Selection criteria The inclusion criteria for the articles in the review were (1) the articles should answer the aim and the research question; (2) Quantitative literature; (3) The study had to use the health coaching intervention; (4) The target population is adult (>18 years old); The exclusion criteria for articles in the degree program are: (1) Literature review and qualitative literature; (2) Data for type 2 diabetes in the study were mixed with data for other diseases;

2.4 Selection process and outcome of potential articles To begin with, among 429 studies, 398 of them were excluded preliminarily according to the title and abstract out of 5 reasons. Firstly, there were 125 studies that did not include a target population. Secondly, 103 studies’ intervention was not health coaching Thirdly, with regard to 73 literature reviews, 67 studies of them did not describe the

impact of a health coach. Fourthly, 30 studies were not related to type 2 diabetes. Fifthly, 31 studies were left out after being screened according their titles and abstracts, for 8 of them were duplicate articles, 23 remaining articles. Then the author read the full text carefully, and screened out 13 articles according to the exclusion criteria., 5 of them were the protocols which did not have the data, and 8 of them did not have the clear diabetes’ data in results. Therefore the remaining 10 articles were included in this article. (see Figure1)

Records identified through database searching (n =429) Records excluded after title and abstract screened:(n=398) (Ebsco: 258; PubMed: 171) -Did not include target population (n=125) -The intervention was not health coaching (n=103) -Literature review (n=73) -It did not describe health coaching’s effect (n=67) -Did not type 2 diabetes (n=30) Records included after title and abstract screened (n = 31)

Papers duplicates (n=8)

Papers after duplicates removed (n=23) Papers excluded after full-text examination (n=13) -Did not have data (n=5)

-Type 2 diabetes’ results were mixed with other diseases’ result (n =8) Records included after full- text screened (n=10)

Studies included in the review (n=10)

Figure1. Flow chart of the literature search

2.5 Data analysis All information of the selected articles must be analyzed and integrated (Polit & Beck 2017). The articles were read carefully by the authors, then analyzed and abstracted

their titles, design, participants, data collection methods, analysis methods, objectives and results. According to the aim, the results of these articles were extracted by the author after being read for many times, and their similarities and differences were identified, analyzed and compared. In the end, authors made a category in tabular form (Polit & Beck 2017).

2.6 Ethical considerations Articles were read and commented objectively by the authors, but such comments were not influenced by the author's own views and attitudes. The results of the article were presented authentically and were not changed at the author's discretion. None of the content of this degree project was plagiarized, and all citations have been noted.

3. Results

The results were based on 10 quantitative studies. Most of the articles used randomized controlled trials. These studies were from 8 countries, and 2753 participants joined in these studies totally. The participants’ average age was from 50 to 70. All the articles used two intervention forms: by callings or using app. The intervention period for most articles was six months, but the frequency of intervention was different based on different articles. After the results of 10 articles were synthesized, what was found was that health coaching had a positive effect on treating type 2 diabetes. The health coaching intervention was effective in reducing HbA1c and waist circumference. It also improved participants' self-efficacy and life satisfaction as well as reduced their anxiety and depression. However, the effect of health coaching on weight was not significant.

3.1 Organize information of articles Half of the articles used randomized controlled trials (Karhula et al. 2015; Odnoletkova et al. 2016; Varney, Weiland, Inder & Jelinek 2014; Wayne, Perez, Kaplan & Ritvo 2015; Wolever et al. 2010; Young, Miyamoto, Dharmar & Tang-Feldman 2020). And other articles used single-arm interventional study (Berman et al. 2018), longitudinal mixed method (McGloin, Timmins, Coates & Boore 2015), 1-group longitudinal trial (McGowan, Lynch & Hensen 2019), and open-label cluster-randomized parallel groups trial (Patja et al. 2012). These 10 studies were from 8 countries: America (Berman et al. 2018; Wayne et al.

2015), Finnish (Karhula et al. 2015; Patja et al. 2012), Ireland (McGloin et al. 2015), Canada (McGowan, Lynch & Hensen 2019; Varney et al. 2014), Belgium (Odnoletkova et al. 2016), and Australia (Varney et al. 2014).

A total of 2,753 participants were recruited, including 1,394 males and 1,359 females. Generally speaking, there are three ways to recruit patients. The recruitment method used in most articles is to directly select eligible patients from medical institutions and then send out invitations for them to participate in research projects (McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Patja et al. 2012; Varney et al. 2014; Wayne et al. 2015; Young et al. 2020). In two articles, patients were drawn by online advertising (Berman et al. 2018; Wolever et al. 2010). The remaining two articles used offline advertising to recruit participants (Karhula et al. 2015; McGloin et al. 2015). The average age of the patients was aged between 50 and 70 . The average age of participants in six articles was aged between 50 and 60 (Berman et al. 2018; McGloin et al. 2015; Odnoletkova et al. 2016; Wayne et al. 2015; Wolever et al. 2010; Young et al. 2020), and the average age of participants in four articles was aged between 60 and 70 (Karhula et al. 2015; McGowan, Lynch & Hensen 2019; Patja et al. 2012; Varney et al. 2014). Among all the participants, the mean age of the oldest and youngest were 65.0 (Karhula et al. 2015) and 50.4 (Berman et al. 2018), respectively.

The 10 articles assessed changes in the participants' conditions from both physical and psychological perspectives. In terms of physiology, all of the articles measured HbA1c. In addition, some of them also measured blood pressure, weight, waist circumference, and BMI (Karhula et al. 2015; McGloin et al. 2015; Odnoletkova et al. 2016; Patja et al. 2012; Varney et al. 2014). In terms of psychology, the following scales were mainly used in these articles: Short Form Health Survey (Karhula et al. 2015; Wayne et al. 2015; Wolever et al. 2010), Diabetes Empowerment Scale (McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Young et al. 2020), Patient activation measure (McGowan, Lynch & Hensen 2019; Wolever et al. 2010), and Hospital Anxiety and Depression Scale (Wayne et al. 2015; Young et al. 2020).

3.2 Health coaching intervention 3.2.1 The intervention form All the articles used two intervention forms. The first one was to call the participants regularly and had a conversation with the patients, which included assessing the patient's condition, instructing them to adopt a good lifestyle, and helping them set goals and plans for recovery (McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Patja et al. 2012; Varney et al. 2014; Wolever et al. 2010). The second intervention form combined smartphone app with portable monitoring device to monitor the patient's disease-related physiological information, and then provided feedback to the patient via software (Wayne et al. 2015; Young et al. 2020). Berman et al. (2018) and Karhula et al. (2015) used both of these two interventions methods.

3.2.2 The frequency of the intervention The frequency of intervention varies almost from article to article. In four of the articles, intervention time was on a regular basis, such as once a week (McGowan, Lynch & Hensen 2019), once every two weeks (Berman et al. 2018), once every 4-6 weeks (Karhula et al. 2015), or once a month (Varney et al. 2014). But four of the articles had irregular frequency of intervention. McGloin, Timmins, Coates and Boore (2015) and Patja et al. (2012) showed that the frequency of intervention was once a week for the previous month and was then carried out every two weeks for the next two months. But Wolever et al. (2010) showed that the frequency of intervention was once a week for the previous 2 months and then the intervention was carried out every two weeks for the next two months and had a final call 1 month later. The remaining two articles continued to conduct intervention during the intervention period (Wayne et al. 2015; Young et al. 2020).

3.2.3 The time of the intervention

The intervention period for most articles was six months (McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Varney et al. 2014; Wayne et al. 2015; Wolever et al. 2010). Three of the articles had an intervention duration of 3 months (Berman et al. 2018; McGloin et al. 2015; Patja et al. 2012). The longest intervention period was 12

months (Karhula et al. 2015). Young, Miyamoto, Dharmar and Tang-Feldman (2020) set 9 months as the intervention period.

3.3 The effects of health coaching In our review, we evaluated the effects of health coaching on patients from both physiological and psychological aspects, in which the physiological evaluation includes four indicators of HbA1c, weight, waist circumference and the psychological evaluation includes three indicators of self-efficacy, life satisfaction, and anxiety and depression. And the results of studies were measured in 3 different terms according to their effects. Less than 3 months was called short term, 4-6 months was called mid- term and longer than 6 months was called long term.

3.2.1 Physiological change 3.3.1.1 HbA1c

Three articles have mentioned the short-term effect of health coaching on HbA1c, and the results of the three papers all showed that HbA1c experienced a significant decrease in the short term (Berman et al. 2018; McGloin et al. 2015; Wayne et al. 2015). Among three articles, Berman et al. (2018) and McGloin et al. (2015) adopted self-controlled trials, while Wayne, Perez, Kaplan and Ritvo (2015) adopted a randomized controlled trial. In Wayne et al. (2015), intervention group and control group accepted the same health guidance., While intervention group got health coaching through the mobile phone, the control group got health coaching without mobile phone, and HbA1c of both groups of type 2 diabetics decreased. It was notable to point out that the decrease in the intervention group was more obvious.

There were 6 articles that mentioned the mid-term impact of health coaching on HbA1c, and all of them showed a decrease in HbA1c in the mid-term (McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Varney et al. 2014; Wayne et al. 2015; Wolever et al. 2010). The studies of Odnoletkova et al. (2016), Varney, Weiland, Inder and Jelinek (2014) and Wolever et al. (2010) set up the control groups without any intervention., HbA1c values were not changed in these groups, but in the study of Wayne et al. (2015), in terms of the reduced variation of control group with

regular medical intervention in controlled, HbA1c data was less than the intervention group with health coaching, which suggested that a health coaching was also beneficial for type 2 diabetics with medical support.

Six groups conducted long term experiments (Karhula et al. 2015; McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Patja et al. 2012; Varney et al. 2014). McGloin et al. (2015) showed that long term health coaching led to a further decline in HbA1c over the mid-term, while Varney et al. (2014) showed the long-term health coaching was not so effective as a mid-term health coaching. Although the long-term data in the studies of Karhula et al. (2015) and Patja et al. (2012) maintained the validity of the mid-term period, there was not any further decline in these studies. The long-term effect in Odnoletkova et al. (2016) and McGowan, Lynch and Hensen (2019) was shown in the interview, without any health coaching that time, and they showed that long term outcomes for HbA1c were unchanged from the baseline.

3.3.1.2 Weight

Two studies mentioned the changes of body weight in the short term (McGloin et al. 2015; Wayne et al. 2015). In McGloin et al. (2015), type 2 diabetics received regular telephone coaching., There were 10 people included in the intervention group, five of whom lost weight, while four of whom gained weight, and one of whom had no changes in weight during the three months. In Wayne et al. (2015), the participants in intervention group lost weight, while the participants in control group did not.

Varney et al. (2014), Wayne et al. (2015) and Odnoletkova et al. (2016) involved mid- term effect of body weight. Varney et al. (2014) showed no change in body weight at 6th month from baseline in either the intervention or control group. But Wayne et al. (2015) showed a significant change in weight in the intervention group. The result of Odnoletkova et al. (2016) showed patients’ BMI were reduced in the 6th month, according to the calculation method of BMI, and the authors grouped the data of BMI into weight data, which meant that patients’ weight was reduced in the 6th month in the study of Odnoletkova et al. (2016).

The studies of Karhula et al. (2015) and Varney et al. (2014) mentioned long term weight change. Karhula et al. (2015) showed that intervention group lost weight significantly while control group had no change in weight. The results of Varney et al. (2014) showed both intervention and control groups had no significant change in BMI or weight in the long term.

3.3.1.3 Waist circumference

Two studies involved waist circumference in the short term, and both of them showed the waist circumference had the significant reduction in the 3rd month (McGloin et al. 2015; Wayne et al. 2015). The study of McGloin et al. (2015) also showed that it had no more effect on physiological changes after the intervention was stopped.

The study of Varney et al. (2014) and Wayne et al. (2015) recorded mid- and long- term waist circumference data. Varney et al. (2014) showed no significant change in waist circumference in the intervention group, while Wayne et al. (2015) discovered that waist circumference had a significant reduction in the intervention group in the mid and long term. Patja et al. (2012) recorded long term waist circumference data, but the data were not statistically significant (p = 0.08).

3.3.2 Psychological change 3.3.2.1 Self-efficacy In the short term, 3 researches mentioned self-efficacy, and all of them utilized Diabetes Empowerment Scale (Berman et al. 2018; McGloin et al. 2015; Young et al. 2020). The study of Young et al. (2020) showed that patients’ self-efficacy in the intervention group with health coaching improved significantly at the third month and was significantly different from the control group. The study of Berman et al. (2018) and McGloin et al. (2015) showed that patients who got regular health coaching had significant improvement in self-efficacy in the short term. In the mid-term, McGloin et al. (2015) and McGowan, Lynch and Hensen (2019) did not establish a control group, and all participants received the health coaching through

telephone communication. The result showed that the self-efficacy had a significant improvement. In the long term, the result of McGowan, Lynch and Hensen (2019) and Young et al. (2020) showed an improvement in self-efficacy, all of them researched the effect in the long term in the following up interview, without any health coaching during that period of time.

3.3.2.2 Life satisfaction Two studies showed the intervention group’s life satisfaction had been elevated in the short term (McGloin et al. 2015; Wayne et al. 2015). The group of McGloin et al. (2015) used the Diabetes Distress Score, which showed patients’ life satisfaction had been increased. In the result of Wayne et al. (2015), the participants of intervention group received health coaching through software while the participants of control group were restricted to access disease-related information through telephone or software., Both of the two groups became more satisfied to life. In the mid-term, the studies of McGowan, Lynch and Hensen (2019) and Wayne et al. (2015) showed an increase of patients’ life satisfaction. About life satisfaction’s data in the long term, the studies of McGowan, Lynch and Hensen (2019) and McGloin et al. (2015) had the same result, indicating health coaching was beneficial to patients’ life satisfaction. In the study of Karhula et al. (2015), the intervention group had health coaching through telephone and communicated every 4-6 weeks, lasting 30 minutes approximately., The control group could get any information from books or other health care., However, it did not show any difference of patients’ life satisfaction between intervention group and control group.

3.3.2.3 Anxiety and depression Two studies showed the health coaching could reduce patients’ anxiety and depression in the short term (Wayne et al. 2015; Young et al. 2020). Wayne et al. (2015) used Hospital Anxiety and Depression Scale (HADS) to evaluate patients’ emotion. Young et al. (2020) used Patient Health Questionnaire and presented whether health coaching took any positive impact on patients’ anxiety and depression.

In the mid-term, McGloin et al. (2015) showed patients’ anxiety and depression had been decreased. In the study of Wayne et al. (2015), both the intervention group and control group were become better than baseline. Varney et al. (2014) and Young et al. (2020) did not find patients’ anxiety and depression undergo any changes in the long term.

4. Discussion 4.1 Main results This review aimed to summarize the impact of health coaching on treating type 2 diabetes over the past 10 years. A total of 10 studies that met the criteria were included through a comprehensive search. In this review, it finds that health coaching mostly intervened participants through APP or telephone, and health coaching has obvious positive effects in terms of the participants' HbA1c, waist circumference, self-efficacy, life satisfaction, and anxiety and depression, but their influence on body weight is still unclear.

4.2 Results discussion 4.2.1 The need of health coaching In this review, the authors conducted health coaching interventions through either telephone (McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Odnoletkova et al. 2016; Patja et al. 2012; Varney et al. 2014; Wolever et al. 2010) or APP (Wayne et al. 2015; Young et al. 2020). In those interventions, telephone communication was the most widely used approach in this review. By talking to patients on the phone, health coaches could assess the patient's condition, instruct them to adopt a good lifestyle, and help them set goals and plans for recovery, while patients were able to learn to build a healthy lifestyle, resulting in significant improvements in their physiological and psychological health condition. This was similar results with Chen et al. (2019), who found that telephone health coaching had a good effect on mitigating the factors of cardiovascular risk such as HbA1c, systolic blood pressure, and physical activity., And they considered that it was convenient, for it required neither technical knowledge with T2DM nor Internet. Using smart phone to deliver patient coaching was an easy yet feasible and sustainable choice (Chen et al. 2019). According to Orem's self-care theory,

individuals were responsible for healthy related self-care, and external interventions were designed to improve patient care ability (Orem 2011). If people with type 2 diabetes could be taught health coaching which could encourage them to develop healthy habits to improve their ability of self-care, the progression of the disease would be positively affected (Wu et al. 2014). Health coaching required health professionals from different backgrounds to be patient-centered in practice, to motivate patients to set goals for themselves and to encourage self-discovery in addition to health education (Wolver et al. 2013). Through telephone coaching with patients, health workers were able to continuously provide health advice in time that is relevant to their daily lives and effectively help patients set goals for recovery. The role of nurses in chronic disease management was expanding (Chen et al. 2019). Lewis and Zahlis (1997)suggested nurse could provide a practice framework as a method for improving self-care and self- management behavior for patient and their kinsfolk which would replenish patient coaching and serve as a part of supportive treatment. Telephone communications could be organized by nurses for type 2 diabetes to improve their health condition. Using smartphone app was another intervention in this review (Wayne et al. 2015; Young et al. 2020). The intervention results showed that using app could also decrease patient's HbA1c and improve psychological condition, but the intervention effect continued for a short time. Kumar, Moseson, Uppal and Juusola (2018) mentioned that the use of APP was a kind of remote intervention, so it may be an effective way to spread evidence-based Diabetes self-management coaching and support widely, increase access to the programs of self-management and enhance glycemic control for type 2 diabetics (Kumar, Moseson, Uppal & Juusola 2018). But the Shan, Sarkar and Martin (2019) showed that different APPs had different effects on patients, and further research was needed to assess the impact of individual factors on app use (Shan, Sarkar & Martin 2019). The special skills of nurses can enhance the effectiveness of therapy and thus improve blood glucose control ability of type 2 diabetics (Nesbeth, Ørskov & Rosenthall 2015). Through interactive platform of app, the special skills of nurses could be better applied. The duration of intervention also played a vital role in health coaching. In this review, the authors confirmed that interventions with a duration of less than 3 months may have the best impact on patients with type 2 diabetes. And with the extension of intervention time, the intervention effect decreased. This was different with Kivelä, Kyngäs and Kääriäinen (2014), who showed that it had an active effect after 3 weeks but not after

12 months. When the interventions lasted for 6 to 8 months, the outcomes of health coaching were consolidated. It is not clear whether the duration of intervention could influence the results (Kivelä, Kyngäs & Kääriäinen 2014). Therefore, it is necessary to do further research to explore the best intervention time.

4.2.2 Physiological changes This review showed that health coaching could decrease HbA1c in type 2 diabetics both in the short and mid-term (Berman et al. 2018; McGloin et al. 2015; Odnoletkova et al. 2016; Varney et al. 2014; Wayne et al. 2015; Wolever et al. 2010; McGowan, Lynch & Hensen 2019), but the long-term effect of health coaching on HbA1c was controversial. Most studies showed that health coaching reduced HbA1c in the long term (Karhula et al. 2015; McGloin et al. 2015; Patja et al. 2012; Varney et al. 2014), but some studies showed that health coaching had no significant effect on HbA1c in the long term (Odnoletkova et al. 2016; McGowan, Lynch & Hensen 2019). This result was similar to Sherifali, Viscardi, Bai and Ali (2016), who found that health coaching could reduce HbA1c in the mid-and-long term, and the effect built up over the duration of the intervention. These showed that nurses could effectively control the development of type 2 diabetes by carrying out health coaching on patients' lifestyle. Nevertheless, Carpenter, DiChiacchio and Barker (2018) had an integrative review describing the effect of self-management of type 2 diabetes.,It was designed to summarize and criticize the intervention measures to support diabetes self-management in patients with type 2 diabetes. The results stated that the reduction in HbA1c were mixed in all terms (Carpenter, DiChiacchio & Barker (2018)). The reason might include the difference of intervention population., Actually, the decrease of HbA1c was closely related to living habits., What’s more, different population had different religious beliefs and living habits. Nurses could only encourage and guide patients to improve their self- management ability, but could not force patients to choose what kind of life. Therefore, health coaching conduct could not avoid the influence of religious beliefs and customs to patients. Generally speaking, the effect of health coaching on HbA1c still needs more experiments to prove. According to the structure of self-care defects in Orem's self-care theory, when individuals have self-care defects, they need the help of nursing (Orem 2011). Health

coaching provides guidance to help type 2 diabetics who lack the ability to take care of themselves, in line with Orem's structure of self-care defects in Orem's self-care theory. The impact of health coaching on patient's weight is controversial in this review. It is different from the results of Olsen & Nesbitt (2010) which showed that the health coaching could effectively reduce the weight of intervention group. The reason why the results were different might be that there existed different health coaching contents and different number of samples. If health coaching could incorporate nutritional diet and health exercise intervention, the weight loss of patients would be very significant (Olsen & Nesbitt 2010). If patients wanted to lose weight, nurses could add nutritional diet and health exercise intervention into health coaching, and help the patients to reach their goals.

4.2.3 Psychological change This review showed that health coaching could effectively improve patients' self- efficacy in all terms (Berman et al. 2018; McGloin et al. 2015; McGowan, Lynch & Hensen 2019; Young et al. 2020), which is similar to the result of Carpenter, DiChiacchio and Barker (2018), believing that health coaching can improve chronic patients' self-efficacy. Pirbaglou et al. (2018) had similar results, with patients’ self- efficacy significantly improved after receiving health coaching. The reason why health coaching could improve patients’ self-efficacy was that it had a direct connection with the benefit of health coaching (Chen et al. 2019). Tully, Shneider, Monaghan, Hilliard and Streisand (2017) summarized the development of peer coaching, including the intervention of chronic disease coaching programs for children and adults, and application results of peer coaching intervention in adult patients with diabetes or parents, it showed that the health coaching was beneficial to patients’ self-efficacy, which was conform to the result of this review. Health coaching was an intervention measure to encourage and motivate patients to improve their self-management ability in various ways. In this process, nurses could provide various kinds of help for patients as coaches, such as encouraging patients through communication, and setting goals or plans for patients to motivate patients to improve their self-management ability. According to Orem's self-care theory, the self- management ability of patients with type 2 diabetes was less than the management ability required by the disease, while the health coaching just made up for the lack of

management ability (Orem 2011). Nurses providing health coaching for patients could improve and make up for the lack of self-management ability of patients. As a result, these efforts increased the self-efficacy of patients. All studies had consistent results in the short and mid-term, supporting the idea that health coaching can effectively reduce anxiety and depression in patients (McGloin et al. 2015; Wayne et al. 2015; Young et al. 2020). The results of health coaching in all studies were indicating that long term’s health coaching has no significant effect on anxiety and depression in patients (Varney et al. 2014; Young et al. 2020). Tully et al. (2017) showed the health coaching was beneficial to adult patients’ anxiety and depression, which was similar with the result of this review. However, the result of this review was different to Pirbaglou et al. (2018), who concluded that the health coaching had no significant effects on reducing anxiety and depression in all terms. One explanation for these findings might be that the personal health coaching program explicitly emphasizes the management of T2DM to prevent further metabolic progression, considering the relative success of metabolic effects., In addition to focusing on lifestyle and behavior change, the influence of emotion or quality of life might require more psychological intervention (Pirbaglou et al. 2018). It is safe to conclude that nurses need to give more care to patients, give psychological comfort timely when patients are in bad mood, patiently listen when patients want to talk, and give encouragement and provide positive information related to the disease when patients lose hope and confidence in the disease. This review showed that health coaching could effectively improve patients' life satisfaction in all terms (Karhula et al. 2015; McGloin et al. 2015; Wayne et al. 2015). Nevertheless, Pirbaglou et al. (2018) concluded that the health coaching had no significant effects on improving patients’ life satisfaction. One reason might be that controlling the development of diabetes required strict control of lifestyle and lifelong medication according to the doctor's advice, which had a great negative impact on the life of patients, for they could not eat the food they want to eat like normal people.

4.3 Methods discussion The authors chose a literature review, which can collect a large amount of information related to the topic, and organize and perfect the current topic on the basis of predecessors (Polit & Beck 2017).

This review had some advantages. Firstly, the authors searched articles in PubMed and Ebsco which are professional and reliable. Secondly, MeSH and Boolean terms were used to search articles which can narrow the search scope of the article and improve the credibility of the article (Polit & Beck 2017). After retrieving many articles, the authors had chosen appropriate inclusion and exclusion methods. First of all, the selected articles were the latest articles published in the past ten years, so that the subject matter of the article was novel and in line with the current situation. Secondly, the articles were all quantitative research, allowing the author to analyze, reason, and modify hypotheses based on objective data (Polit & Beck 2017). In addition, participants must be patients with type 2 diabetes over the age of 18, which makes the data source more accurate and reliable. The authors of the included articles were from 7 different countries, which will increase reliability and exert global influence. However, there were also two points that need to be improved. Only two databases, Ebsco and PubMed, were obviously not enough. Thus, we need to cite articles from more databases to make the articles more accurate. In addition, only citing articles from the past ten years might make the article lack of generality and universality.

4.4 Clincal implications Diabetes mellitus, as a chronic disease afflicting a large number of middle-aged and elderly people around the world, not only made patients suffer from physical pain, but also brought great psychological pressure to them, which has seriously affected their mental health. In addition, it also has exerted a great impact on the prognosis of the disease and the quality of life of patients. In this review, the results showed significant short-term improvements in the physiological aspects of type 2 diabetes, especially HbA1c and waist circumference., The results also showed a more lasting positive effect on the psychological aspects of patients, so health coaching could be incorporated into clinical care measures. Therefore, the application of health coaching to nursing practice could not only significantly improve the physiological indicators of patients, but also effectively improved the mental state of patients, so as to indirectly promote their recovery and improve their quality of life.

4.5 Suggestions for further research Reviewing the literature of this study, it is suggested that health coaching could significantly reduce HbA1c and waist circumference in type 2 diabetics in the short term, and improve their psychological health. However, there is no significant long- term effect on waist circumference. In the future research, in order to strengthen the intervention effect, it is suggested to extend the intervention time. In addition, considering participants of different ages may have different level of technical know- how to use electronic products, which may affect the intervention effect of health coaching. Therefore, it is suggested to study the intervention effect of health coaching on patients of different ages with type 2 diabetes respectively.

5. Conclusion

This review assessed the effectiveness of health coaching in type 2 diabetes patients through 10 eligible studies with a total of 2753 participants. The results showed that health coaching could not only improve the psychological health of patients, effectively reduce the HbA1c of patients, but also reduce the waist circumference of patients in the short term. However, health coaching seems to lack a persistent effect on waist circumference, so further research was needed to support this conclusion. In addition, future researches should consider distinguishing the effects of health coaching on participants of different ages.

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Appendix

Author(s) ， Title Design/ sample Intervention Data Method of year, approach Intervention group Control group collection data analysis country method Berman, M. A., Change in A single-arm Numbers of Intervention: No control group Data collect t tests, Guthrie, N. L., Glycemic interventional participants: Consists of use of the time: chi-square tests, Edwards, K. L., Control With study 109 intervention app paired with McNemar test Appelbaum, K. Use of a Digital Male/Female ： specialized human support, At beginning

J., Therapeutic / (22/87) also delivered digitally. and the end of th Njike, V. Y., in Adults With A ①Use of the meal planning 12 weeks Eisenberg, D. M., Type 2 quantitative feature & Katz, D. L. . Diabetes: approach Age: means 50.4 ②Self-monitoring of weight 2018, Cohort Study years daily (via app) and the Measures: America option of reporting meals ① HbA1C Participants were made level recruited online ③Reviewing of educational ② Self- through materials Efficacy advertisements ④ Created an optional, listed on Facebook private Facebook and to a lesser extent community to Craigslist. provide support

. The app delivered reminders in the form of in-app notifications and an ability to message the participant’s health coach. The primary form of human support was delivered by 30- minute telephonic health coaching calls, scheduled at the participant’s convenience every 2 weeks via the study app. Duration:12 weeks Karhula, T., Telemonitoring a two-armed Number of type 2 Intervention: Standard Care: Data collect T test Vuorinen, A. L., and Mobile randomized diabetes patients: ①Health Coaching: coaches receive a disease time: Rääpysjärvi, K., Phone-Based controlled 250 management Before called them at regular chi-square test Pakanen, M., Health trial information program intervals—every 4 to 6 Itkonen, P., Coaching / Type 2 diabetes weeks, last for booklet, After program Tepponen, M., Among Finnish A patients concluded approximately 30 minutes, laboratory tests Junno, U. M., Diabetic and quantitative the end-point provided information, taken once a year, Measures: Jokinen, T., van Heart Disease approach assessments: 225 assistance, and support to 1 appointment or ① HbA1C

Gils, M., Patients: the patients phone call by a Levels Lähteenmäki, J., Randomized Numbers of ② Remote Patient nurse or doctor, ②Weight Kohtamäki, K., Controlled Intervention group: Monitoring: record blood can contact health ③ waist & Saranummi, Trial 180 pressure, body weight, care services any circumference N., ： time they feel Male/Female blood glucose level. The ④Short Form 2015, they need to. (99/81) health coaches give a self- (36) Health Finnish management guide to the Survey(SF- Numbers of Control patients through the data. 36) group: 70 Male/Female ： Duration: 12 months (40/30)

Age:≥18 years Intervention group mean 66.6 years Control croup mean 65.6 years

Participants from the South Karelia Social and Health Care District

iii

McGloin, H., A case study A Numbers of Intervention: No control group Data collect Friedman Timmins, F., approach to the longitudinal interventions:10 Coaching telephone calls time: analysis， Coates, V., & examination of mixed Male/Female:(5/5) were made to participants At beginning, Wilcoxon Boore, J., a telephone- method using Skype at baseline, the third Signed Ranks 2015, based health / Age:54.5±6.9 years weekly for four weeks and month, the test, Ireland coaching A every two weeks for a sixth month, thematic intervention in quantitative Recruit 10 patients further eight weeks. the twelfth analysis facilitating approach from the diabetes ① Each participant was month. behaviors management clinic at asked to formulate a Measures: change for a large regional Wellness Vision and set (1)Data adults with hospital. Participants three-month goals in the analysis： Type 2 diabetes were recruited by first phone call. ① HbA1C responding to a ② each participant was Levels poster advertisement coached to set weekly goals ② Weight, or through referral by which were reviewed and BMI and waist the diabetes nurse adapted each week circumference specialist team. ③ The final call (at 12 ③ The weeks) focused on diabetes reviewing the previous two empowerment weeks goals before moving score on to explore behavior change maintenance (2) Focus

group Duration:3 months interviews: Two focus group interviews were held with a total of five participants and two family members after the intervention was completed. McGowan, P., The Role and A 1-group The number of Intervention: No control group Data collect 1-way repeated- Lynch, S., & Effectiveness longitudinal coaches: 109 weekly 30-min telephone time: measures Hensen, F., of Telephone design Male/Female:(74/35) calls by coaches to patients Before analysis 2019, Peer Coaching / for a period of 6 months (26 program, Canada for Adult A The number of weeks) 6 month, 12 Patients With quantitative patients: 115 month Type 2 approach Male/Female:(73/42) Duration: 26 weeks

Diabetes Measures: Age: ①Hb1Ac Coaches’ group ② Self- mean 61.6 years, reported health Patients’ group mean ③ Self- 60.8 years efficacy Patient activation measure (PAM) Odnoletkova, I., Delivering A Numbers of Intervention ： The People with type Data collect T-test Ramaekers, D., Diabetes randomized Intervention group: COACH Program is a risk 2 diabetes are time: Before Nobels, F., Education controlled 287 factor target-driven treated by their program, 6 Goderis, G., through Nurse- trial telephone counselling GPs. When months, 18 Aertgeerts, B., & Led Tele / Numbers of Control intervention delivered by insulin therapy months Annemans, L. coaching. Cost- A group: 287 diabetes nurse educators, needs to be 2016, Effectiveness quantitative who have followed a one- initiated, the care Measures: Belgium Analysis approach Age:18-75 years week training course. It team is extended ①Changes of consists of five telephone by a certified HbA1c Patients were sessions of 30 minutes on diabetes educator ②Changes of selected from the average, spread over 6 and BMI

administrative months, focused on endocrinologist. database of the achieving guideline- Patients with sickness fund recommended diabetes advanced “Partena” treatment targets through diabetes, in need regular control of diabetes of three or more risk factors including self- insulin injections monitoring of blood per day, are glucose, appropriate usually treated by lifestyle adjustments and an intensification of endocrinologist- medication therapy upon a led hospital- consultation with the based diabetes patient’s GP. team.

Duration: Intervention for 6 months, and follow-up for 12 months. Patja, K., Absetz, Health An open- Numbers of Intervention: Usual care Data collect multilevel P., Auvinen, A., coaching by label cluster- Intervention group: ① Were called monthly, time: methods Tokola, K., Kytö, telephony to randomized 770 altogether 10–11 times. At beginning, (generalized J., Oksman, E., support self- parallel ② Go through a brief At the end of linear mixed Kuronen, R., care in chronic groups trial Numbers of Control engagement call, a broader 12 months’ models)

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Ovaska, T., diseases: / group: 359 needs assessment call, follow-up Harno, K., clinical A followed by monthly Measures: Nenonen, M., outcomes from quantitative Age:>45 years coaching calls and finally an ①Hb1Ac Wiklund, T., The TERVA approach Intervention group evaluation call. In between ② Waist Kettunen, R., & randomized mean 64.6 years the coaching calls there was circumference Talja, M, controlled trial Control croup mean an opportunity for brief 2012, 65.6 years follow-up calls, but these Finland were rarely used. Patients were ③ After the first two enrolled from Päijät- months, each coach selected Häme in the 2–3 calls randomly, call Southern Finland length typically up to 60 min. The call could have 8 topics: ④Know how and when to call help; Learn about the condition and set goals; Take medicines correctly; Get recommended tests and services; Act to help the condition well controlled; Make lifestyle changes and

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reduce risks; Build on strengths and overcome obstacles; Follow-up specialists and appointments. ⑤Each call could resolve no later than 3 topics in order to keep the quality.

Duration:12 months Varney, J. E., Effect of A Numbers of Intervention: Controls did not Data collect linear mixed Weiland, T. J., hospital-based randomized Intervention group: telephone coaching receive the time: models, Inder, W. J., & telephone controlled 47 Participants were telephone At the t-tests, Jelinek, G. A., coaching on trial Male/Female ： encouraged to follow a low coaching beginning, the Chi-squared , 2014， glycaemic / (34/13) saturated fat, high-fiber diet, intervention, or end of the 6th Fisher’s exact Australia control and A with 50% of energy from any contact from and the 12th tests, adherence to quantitative Numbers of Control carbohydrates, and were the researchers month Bivariate management approach group:47 encouraged to exercise for but also could Measures: correlations guidelines in Male/Female ： 150 min per week. For access STV usual ① HbA1C type 2 (30/17) treatment goals and risk care services, Levels diabetes, a factors not at target levels, including a ② Weight, randomised Age:56-66 the dietary, lifestyle and diabetes clinic BMI,

controlled trial years 4 medication changes staffed by Waist required to improve these endocrinologists, circumference participants was parameters were discussed. diabetes Physical recruited During subsequent coaching educators and activity over 13 months, from sessions, progress towards dietitians ③ Depression the Diabetes Clinic treatment goals, risk factor score of St Vincent’s status, adherence to self- Hospital Melbourne care and monitoring (STV), an Australian requirements were public teaching reassessed. If goals were not hospital achieved, barriers to goal attainment were identified, an action plan addressing these barriers was agreed and new goals were established. This process was repeated throughout the intervention

Duration:6 months

Wayne, N., Health Randomized Intervention group: Intervention： Received HC Data collect T tests， Perez, D. F., Coaching controlled 48 ① Provided with a mobile support in time: Before factorial Kaplan, D. M.& Reduces trial Male/Female:(17/31) phone with a user account of selecting and program, 3 repeated- Ritvo, P., HbA1c in Type / CWP progressing month, 6 measures 2015, 2 Diabetic A Control croup:49 toward goals month ② Participants track key analysis of Canada Patients From a quantitative Male/Female:(10/39) without access to Measures: metrics, notably blood variance Lower- approach a (study- ① HbA1c glucose levels , exercise Socioeconomic Age: provided) mobile frequency/duration/intensity levels Status Intervention group phone or the food intake and mood ② weight ， Community: A mean 53.1 years CWP software. ③ Can communicate with BMI, waist Randomized Control croup mean their health coach at any circumference Controlled 53.3 years time in the 24-hour cycle ③ Satisfaction Trial via secure messaging, with life Scale

scheduled phone contact, ④ Hospital Recruited from 2 and/or during in-person Anxiety and primary health meetings. Depression clinics in ④Health data feedback to Scale (HADS) Toronto and have an health coaches ⑤Positive and HbA1c ≥ 7.3% (56.3 Negative mmol/mol) Duration: 6 months Affect

Schedule ⑥Short Form

Health Survey-12 (SF-12)

Wolever, R. Q., Integrative A Numbers of Intervention: Usual care alone Data collect t tests, Dreusicke, M., Health Randomized Intervention ① Patients were guided in for 6 months time: Fisher exact, Fikkan, J., Coaching for Clinical group:30 creating a vision of health, Following the χ2 , Hawkins, T. V., Patients With Trial Male/Female ： and long term goals were 6-month Mann-Whitney Yeung, S., Type 2 / (8/22) discussed that aligned with intervention U tests Wakefield, J., Diabetes A that vision according to the phase, Duda, L., A Randomized quantitative Numbers of Control wheel of Health participants Flowers, P., Clinical Trial approach group:26 ② offered 30-minute attended a Cook, C., & Male/Female ： coaching sessions by follow-up visit Skinner, E. , (5/21) telephone (8 weekly calls, 4 2010, biweekly calls, and a final Measures: America Age:53 ± 7.9 call 1 month later) for a total ① Patient years of 14 sessions Activation ③Identifying areas in which Measure they felt less successful or (PAM-13) satisfied, participants then

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Participants were chose areas on which to ② exercise recruited from flyers, focus for coaching frequency newspaper ④ Over the remaining change and online coaching sessions, ③ Short-Form advertisements, participants revisited the Health Survey targeted mailings, Wheel of Health and were (SF-12) and prior encouraged to create ④ HbA1C study pools realistic goals in the context Levels of examining one s purpose in life, with these goals further broken down into small, realistic action steps Duration:6 months Young, H. M., Nurse A Number of all Intervention: Usual care Data collect T test Miyamoto, S., Coaching and randomized participants: 319 ①Usual care comprised time: Dharmar, M., & Mobile Health controlled Male/Female ： ② Nurse Health Coaching: standard health Before Wilcoxon Tang-Feldman, Compared trial (165/148) an in-person orientation care visits with program signed rank test Y., With Usual / with the nurse coach, providers and At 3rd month 2020, Care to A followed by telephone access to classes, at 9th month chi-square test United States Improve quantitative Numbers of sessions every 2 weeks for 3 resources, and Diabetes Self- approach Intervention months (6 contacts total) services (ie, Measures: Fisher exact test Efficacy for diabetes ① group:132 ③ Mobile Health Diabetes

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Persons With Technology, generated real- management and Empowerment mixed effect Type 2 Numbers of Control time information about steps weight loss Scale [DES] regression Diabetes: group:155 taken, distance walked, education, models Randomized active minutes, heart rate, electronic Controlled Age:≥18 years and hours of sleep at night learning videos, Trial and synced the data, allow and care Participants from 2 participants to log and track coordination) suburban and 1 urban nutritional consumption if primary care clinic they chose.(Have an within an academic unexpected recall of the health center in Basis Peak activity tracking Northern California. device, affected 79 participants, most of these participants received and were oriented to their new devices within 2 weeks of the recall) Duration: Intervention for 3 months, and follow-up for 6 months.

Author(s), year, Aim Result

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country

Berman, M. A., Guthrie, To investigates the effects of a ①Among participants who reported an end-study HbA1c, 80% had improvement of HbA1c, N. L., Edwards, K. L., novel digital therapeutic, with 59% having a decrease of 0.5% or more, 39% (38/97) having a decrease Appelbaum, K. J., FareWell, on hemoglobin A1c of 1% or more, and 23%having a follow-up HbA1c <6.5%. The mean change was –0.8% Njike, V. Y., Eisenberg, (HbA1c) (P<0.001) over a mean interval of 3.5months. There was a stepwise decrease in HbA1c as app D. M., and diabetes medication use. engagement level increased. & Katz, D. L. . ②Of the participants answering questions pertaining to selfefficacy, 92% of those responding 2018, reported greater confidence in their ability to manage their diabetes compared to before the America program, and 91% reported greater confidence in their ability to maintain a healthy dietary pattern Karhula, T., Vuorinen, The purpose of this 1-year ①On average, the HbA1c levels were 7.2%, showing that there was little room for A. L., Rääpysjärvi, K., trial was to study whether a improvement. Pakanen, M., Itkonen, structured mobile phone- ②In the intervention group, there was a significant decrease in weight (p=0.02). P., Tepponen, M., based health coaching ③There was a significant difference between the treatment arms in waist circumference Junno, U. M., Jokinen, program, which was (P=0.01). In the intervention group, there was a significant decrease in weight (P=0.02), T., van Gils, M., supported by a remote waist circumference (P<0.001). Lähteenmäki, J., monitoring system, could be ④There is no clearly difference in the Short Form (36) Health Survey(SF-36). Kohtamäki, K., & used to improve the health-

Saranummi, N., related quality of life

2015, (HRQL) and/or the clinical Finnish measures of type 2 diabetes and heart disease patients.

McGloin, H., Timmins, To examine the effectiveness ①The HbA1c reduced in six out of the ten participants. Several patients had clinically F., Coates, V., & Boore, of the use of telephone significant reductions in HbA1c at three months, but it did not have Statistical J. , empowerment-based health significance (p=0.12). 2015, coaching as a cost-effective ②Five participants lost weight at three months and started to regain it again after the Ireland alternative to changing health coaching intervention ended and had regained or exceeded the baseline weight at 12th behaviours of adults with month. Of the remaining participants, four increased weight and one remained unchanged Type 2 diabetes. at three months

③A significant change in waist circumference (WC) (p = 0.006) and a significant decrease in the group WC at 3rd month (p = 0.01) but also a significant increase between 3 months and 12 months (p = 0.004) ④The mean group change in the diabetes empowerment score increased from a baseline score of 3.8–4.28 at 3rd month (p = 0.03) and 4.28 (p = 0.27) at 6th month. The mean score at 12th month was 4.34 and the changes were not statistically significant ⑤The reduction in the diabetes distress score from baseline was significant at 3rd month (p = 0.015), 6th month (p = 0.024) and 12 months (p = 0.036) McGowan, P., Lynch, This pilot investigated the ①The A1C levels dropped from an average of 8.4% at baseline to 7.6% at 6th month and S., & Hensen, F., feasibility and viability of remained at 7.6% at 12th month. 2019, recruiting, training and ②Self-rated general health, fatigue, diabetes empowerment, self-efficacy, depression and Canada pairing peer coaches with communication with physician also improved significantly from baseline to 6th month patients with type 2 diabetes and remained at the improved levels at 12th month. and whether telephone ③Patient activation measure (PAM) scores showed that the transformed activation levels coaching enhances health

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outcomes. had increased from an average of 56.1 at baseline to 66.3 at 6th month, and they remained elevated at 64.4 at 12th month. ④The self-efficacy scores increased from 5.8 at baseline to 7.3 at 6 months and remained high at 7.1 at 12th month. ⑤In the study, 8 outcome measures improved from baseline to 6 months and were maintained at 12th month, namely, A1C levels (9%); general health (7%); fatigue (15%); patient activation (15%); diabetes empowerment (10%); self-efficacy (23%); depression (24%); and communication with physician (22%). In addition, these outcome measures were not influenced by covariates of sex, age, education level or the number of chronic health conditions patients were experiencing. Odnoletkova, I., The objective was to analyze ①HbA1c (%) difference between intervention group at 6th month was -0.2 (-0.3 to -0.1, Ramaekers, D., Nobels, the lifelong cost- P =0 .003) overall, at 18 months was sustained: -0.2 (-0.3 to -0.0, P = .046), BMI did not F., Goderis, G., effectiveness of “The have large difference. Aertgeerts, B., & COACH Program”. Annemans, L. 2016, ②BMI (kg/m2) differences between group at 6th month was -0.4 (-0.6 to -0.1, P = 0.003). Belgium Patja, K., Absetz, P., The aim was to evaluate the ①For patients with T2D,the goal for HbA1c there was no difference between intervention Auvinen, A., Tokola, effect of a 12-month and control group. K., Kytö, J., Oksman, individualized health ②For waist circumference, the target was below 100 cm for men and 90 cm for women. E., Kuronen, R., coaching intervention by The difference was not statistically significant (p = 0.08 combined, 0.07 for males and Ovaska, T., Harno, K., telephony on clinical 0.65 for females). Nenonen, M., Wiklund, outcomes.

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T., Kettunen, R., & Talja, M, 2012, Finland Varney, J. E., To measure the effect of a 6- ①A significant interaction effect was observed at 6th month for HbA1C (P = 0.03), Liew, D., month telephone coaching fasting glucose (P = 0.02), and physical activity (P = 0.02); however, these effects Weiland, T. J., intervention on glycemic disappeared by 12 months. Inder W. J., control, risk factor status and ② There has been no noticeable change in weight, BMI, Waist circumference and And Jelinek, G. A. , adherence to diabetes Depression score. 2016， management practices at the Australia intervention’s conclusion (6 months) and at 12th month. Wayne, N., To evaluate a health coach ①Significant HbA1c within-group Perez, D. F., Kaplan, D. intervention with and without reductions from baseline to 6 months (P=0.01) and significantly greater reduction at the M.& Ritvo, P., the use of mobile phones to 3-month follow-up (P=0.03). 2015, support health behavior ②Significant reductions in body weight (P=0.006) and waist circumference (P=0.01) in Canada change in patients with type 2 the intervention group diabetes. ③Life satisfaction were improved in the intervention (P=0.001) and control groups (P=0.003) ④Significantly reduced in HADS (P=0.02) and SF-12(P=0.03) Wolever, R. Q., To evaluate the effectiveness ①The time-by-group interaction for the PAM-13 was significant (P = 0.012), suggesting Dreusicke, M., Fikkan, of integrative health (IH) coaching facilitated patients’ knowledge, skills, and confidence for

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J., Hawkins, T. V., coaching on psychosocial self-management; patient engagement increased significantly in the IH coaching group Yeung, S., Wakefield, factors, behavior change, and (P <0 .001) with no change in the control group J., Duda, L., Flowers, P., glycemic control in patients ②a significant increase in exercise ( P = 0.026) Cook, C., & Skinner, with type 2 diabetes. ③Although the time-by-group interaction effect for the PSS-4 was not significant, E. , perceived stress decreased in IH coaching participants when analyzed 2010, alone (P = 0.013) but not among control participants America ④The SF-12 health survey revealed no significant time-by-group interaction effect;

however, there were increased scores for IH coaching participants (P =0 .027), whereas controls showed no change ⑤IH coaching participants with elevated baseline A1C significantly reduced their A1C by after 6 months of coaching (P = 0.030) Young, H. M., This study examined the ①The participants in the intervention group had significant improvements in diabetes Miyamoto, S., Dharmar, impact of a novel self-efficacy (Diabetes Empowerment Scale, 0.34; 95% CI –0.15,0.53; P<0.01). M., & Tang-Feldman, intervention using MI-based ②A decrease in depressive symptoms compared with usual care at 3rd month (Patient Y., nurse health coaching Health Questionnaire-9; 0.89; 95% CI 0.01-1.77; P=.05), with no differences in the other 2020, combined with wearable outcomes. The differences in self-efficacy and depression scores between the 2 arms at United States activity trackers that integrate 9th month were not sustained. patient-generated activity ③No difference. data into the patient’s electronic health record (EHR) to improve health among adults with type 2

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diabetes. We hypothesized that individuals randomized to the intervention group would show overall improved self-efficacy compared with individuals in the usual care group.