Date Presented 04/13/21
Informal caregivers are at risk for experiencing stress, anxiety, and other concerns that influence quality of life and that have a direct effect on the care recipient. Preliminary evidence suggests that Health Coaching in Context may help address the needs of mothers who are caring for a child with spinal cord injury. Using this client-centered and solution-focused approach, OTs develop a partnership that is connected by authenticity and trust through the use of skillful, constructive dialogue.
Primary Author and Speaker: Bernadette Alpajora
Additional Authors and Speakers: Rochelle Mendonca
INTRODUCTION: Mothers of children with spinal cord injury (SCI) often assume the role of informal caregiver and are at a high risk for experiencing stress, anxiety, and other health concerns that can impede participation in daily life (Bourke-Taylor et al., 2010). Health Coaching in Context is a skillful, constructive dialogue that involves client-centeredness, coach presence, active listening, and use of powerful questioning to create awareness, action plans, and solutions to everyday challenges (Stewart, 2017). It is grounded by positive psychology, appreciative inquiry, and health coaching to support optimal health, wellness, and participation in required and desired daily activities. The purpose of this pilot study was to examine the outcomes of Health Coaching in Context with caregivers of children with SCI.
METHODS: Nine female caregivers consented and enrolled in the study from four pediatric spinal cord injury (SCI) practices across the United States. Each caregiver participated in up to 10 coaching sessions over a 10-week period, via face-to-face (N = 4) or phone (N = 5), by one of four trained coaches. The Canadian Occupational Performance Measure (COPM) (Law et al., 2004) was administered at baseline and after the coaching program. The COPM is a self-reported measure administered using a semi-structured interview to prompt discussion about challenges in activities related to self-care, productivity, and leisure. Each participant identified 3-5 goals that were rated on a scale ranging from 1 to 10 (1 = ‘cannot perform’, ‘very unsatisfied’; 10 = ‘performs well’, ‘very satisfied’). Frequency distributions were calculated for sample characteristics. Changed performance and satisfaction scores were calculated for each COPM goal (N = 31). A 2-point change in COPM scores reflects clinically meaningful change (Law et al., 2004). A Wilcoxon signed-rank test was used to determine if there was a statistically significant change between baseline and post-coaching performance and satisfaction scores.
RESULTS: Caregivers were 38.5 (r = 32-45) years of age with children, ages 7-13 years (mean=9.5) who had paraplegia (N = 5) and tetraplegia (N = 4) due to SCI sustained an average of 5.9 years (r = 1-13) prior to the study. Two of nine caregivers dropped out for unspecified reasons before completing follow up assessments. Six caregivers completed 7-10 coaching sessions, and one completed three sessions. Each COPM goal was associated with one of three domains: leisure (N = 11), self-care (N = 4), and productivity (N = 16). Improvements in performance and satisfaction were clinically meaningful and statistically significant. Mean performance scores increased by 2.48 (SD = 2.01) and mean satisfaction scores increased by 2.81 (SD = 1.33). Leisure-related goals demonstrated greatest improvements where mean performance scores increased by 3.27 and mean satisfaction scores increased by 2.91. Statistically significant improvements were evidenced by higher post-coaching median performance (Z = -4.057 =, p < 0.001) and satisfaction (Z = -4.812, p < 0.001) scores.
CONCLUSIONS: This study shows preliminary evidence in support of Health Coaching in Context as an approach that has potential to support caregivers of children with SCI. Further work is needed to examine coaching fidelity, to determine optimal number of coaching sessions, and to evaluate how positive changes due to coaching are sustained over time. This study was funded by the Craig H. Neilsen Foundation.
References
Bourke-Taylor H, et al. (2010). Impact of caring for a school-aged child with a disability: Understanding mothers’ perspectives. Australian Occupational Therapy Journal, 57(2), 127–136. https://doi.org/10.1111/j.1440-1630.2009.00817.x
Stewart, J. (2017). How to coach with positive psychology and emotional intelligence. Retrieved from https://coachfederation.org/blog/how-to-coach-with-positive-psychology-and-emotional-intelligence.
Law, M., Baptiste, S., Carswell, A., et al. (2004). Canadian Occupational Performance Measure (4th ed.). Ottawa, ON: CAOT Publications ACE. https://doi.org/10.1177/000841740407100406
Portney, L. G. & Watkins, M. P. (2015). Foundations of clinical research: Applications to practice. (3rd ed.). F.A. Davis.
