The Health Coach program is one of the initiatives of the new Model of Care (MoC) in the Al-Qassim Region, linked within the programs of the Keep Well system. It aims to equip health coaches with the necessary skills to guide and advise community members endeavoring to improve their lifestyle, helping them to better control their health. This is through the standard licensing for Health Coaches in the Kingdom. This will enhance the optimum level implementation of MDTs treatment plans, heightening the motivation of the target population to adopt a healthy lifestyle, which is aggrandized when engaging in sports and other lifestyle programs that amplify their optimal level of functioning, whether spiritually, physically, psychologically, or socially.

                  The Health Coaching Program will be applied in healthcare facilities to cover all levels of healthcare. It will be mainly applied at primary care levels such as in PHCs (as part of TBC teams) and virtual platforms. It can also be applied at healthcare institutions offering secondary and tertiary care services such as specialized centers and hospitals.

                    With this, MoC Al-Qassim has designed a standard pathway that has specific and clear coverage (Target Population) of patients' engagements in Health Coaching in the Al-Qassim Region. This will not be biased based on the density of subjects from the point of enrollment until completion (number of enrollees in virtual and physical visits in every catchment area).

                    In addition, it standardizes all the Health Coaching durations and frequencies given to each beneficiary to improve the total successful completions of subjects in the whole pathway.

                    Furthermore, the Health Coach Program notes the total trained health coaches versus the target population in order to improve the pathway’s services.

• Direct access to health coaching service:
  • If an individual desires to enhance their lifestyle and wellbeing, they can:
    • Book an appointment via "MAWID" and "SEHHATY."
    • Visit the PHC directly and ask for a HC appointment (Walk-In appointment).
  • Referral process to the health coach:
    • Based on the initial patient's assessment, those identified to be at a higher risk of developing chronic diseases or worsening their current health status are recommended to be referred to the health coach.
    • Can be referred to the HC Clinic by the PHC physician in the same center.
    • PHC physicians and/or nurses assess individuals seeking medical care at PHCs and Hospitals to identify patients and individuals at risk of various diseases and in need of counseling.
    • PHC physicians and/or nurses identify individuals who need counseling.
    • PHC physicians and/or case-coordinators refer individuals who need counseling to the HC.
    • Patient information is documented in the Health Coach Referral Form.

• HC starts the training session with an assessment of the individual's needs using predetermined criteria: 

• • Views the results of the vital signs examination including blood pressure and body mass index (BMI).

• • Reviews the results of laboratory tests such as glycated hemoglobin, HbA1c, etc.

• • Keeps track of physician's notes and the medications prescribed.

• • Asks basic questions related to the state of health, such as smoking and the medications the patient is taking at the present time.

• • A customized plan is developed by HC for each individual based on their needs, health status, and preferences. Including:
    • The preferred educational method.
    • The goal to be achieved.
    • The duration and actions needed to achieve the goal.
    • The date of the next planned visit..

• • After a discussion with the client, the health coach will set a goal to be achieved in a predefined duration using the goal-setting form.

• • The goal should be measurable, agreed-upon, realistic, and time-bound. Clarify if the support of someone else, such as family members, is needed to achieve this goal.

• Assess all patients using the (OR Record Forms-Raqeem):

  • Readiness to change
    • Determine the patient's stage of change then act accordingly (Please indicate this neumerical assessments in Raqeem system):
      • (0-1) Precontemplative, discuss the possible benefits of change.
      • (2-4) Contemplative, discuss the possible benefits of change and explore what would need to happen to start preparing for change.
      • (4-6) Preparation, define the problem and set goals.
      • (6-10) Action and maintenance, congratulate the patient for taking control of their own health. Assess their actions to ensure appropriate weight change methods. Suggest further changes if necessary.

• Assess physical activity level:
  • Assess and record current physical activity level (Low, Moderate, High).
  • Establish whether the patient can increase their physical activity level due to contraindications (low physical activity level, medical history) and whether they need clearance.

• Weight history
  • Current weight
  • Previous weight
  • Reasons for weight loss or gain
  • Duration of weight loss or gain
  • Previous weight loss or gain attempts and what has worked before

• Barriers to weight change (Indicate in the Assessment Form all the Barriers inorder to Adress)
  • Poor understanding of overweight health risks and outcomes
  • Sedentary lifestyle
  • Dislike of exercise
  • Financial limitations
  • Pain
  • Mental illness
  • Disability issues
  • Limited nutrition knowledge
  • Limited literacy or education background
  • Social and family influences
  • Beliefs and attitudes

• Risk Factors
  • Smoking
  • Sedentary lifestyle
  • Family history of obesity
  • Reduced mobility

• Check medications being taking by the patient (Identify those that often increase weight)
  • Antipsychotics
  • Oral steroids
  • Insulin
  • Antiepileptics
  • Antidepressants
  • Mood stabilisers
  • Contraceptives.

• Obtain baseline anthropometric measures if the patient consents. These are used to monitor changes in weight and body fat distribution over a period of time. Each practice  should have a set of bariatric scales.
• Waist circumference is taken at the midpoint between rib and iliac crest or, if not obvious,  at the narrowest point when looking from the front. If locating the waist is still diGcult using  these methods, the waist circumference can also be taken at the position at which the  patient believes their waist to be.

• Calculate Body mass index
  • Body mass index = Kg/m²
  • See Obesity, Ideal Body Weight, and Saudi Online BMI Calculator.

• Criteria (Who to coach?):
  • Newly diagnosed HTN patients.
  • Uncontrolled HTN (Grade 1&2)
  • White Coat HTN.

• Identify risk factors such as:
  • smoking, unhealthy dietary habits, and stress, and guide them on how to mitigate these risks.

• Keeping blood pressure in check is crucial to avoid complications and adverse health outcomes.

• Assessment for HTN:

• • Assess the patient’s understanding of hypertension.
  • Assess barriers to learning.
  • Determine the patient’s risk factors for hypertension.
  • Assess for signs and symptoms.
  • Regularly measure the patient’s blood pressure.
  • Screen for secondary causes of hypertension.
  • Assess for peripheral edema and weight gain.
  • Assess lab values.
  • Assess diet and fluid intake.
  • Assess caffeine consumption.
  • Review the patient’s treatment list.
  • Assess their history and interests.
  • Ensure the patient is safe for activity.

• Criteria (Who to coach?):
  • Newly diagnosed DM patients.
  • Uncontrolled DM type 1 & 2.
  • During annual assessment.

• DM Assessment by HC:
  • History
    • Onset of diabetes
    • Compliance
    • Medications
    • Diabetic complications
    • Glycaemic control – HbA1c
  • Examination
    • Height, weight, BMI
    • Blood pressure, heart rate

• For The Following Assesments, please use (OR Form-Raqeem):
  • Diet Habits Assessment.
  • Smoking Assessment.
  • Mental Health Assessment.

• Health Coaches should follow the 5A's framework when assessing a patient: 

• • Ask:
    • Ask permission to discuss patient's concern, and explore readiness to change.
  • Assess:
    • Assess the stage of patient's condition (Obesity, HTN, DM... etc) for co-morbidities, drivers, complications and barriers.
  • Advise:
    • Discuss the benefit of the intervention (e.g. losing weight, quitting smoking, physical activity... etc)
  • Agree:
    • Agree on realistic goals, and management plan.
  • Assist:
    • Assist the patient in addressing drivers and barriers, assest in accessing resources, refer prn / arrange follow up.

• To manage hypertension effectively, it’s essential to adopt certain lifestyle modifications, ensure consistent monitoring, and, if needed, take prescribed medications.

• Lifestyle modifications:
  • Healthy Diet:
    • A balanced diet can contribute to reducing blood pressure levels.
    • Consider referral to a dietitian for therapeutic diet.
  • Exercise:
    • Engaging in regular physical activity is beneficial for lowering blood pressure and maintaining an optimal weight.
  • Quitting Smoking:
    • Quitting smoking is critical as it can elevate blood pressure and harm blood vessels, thus increasing heart disease risk.
  • Regular Monitoring:
    • Keeping track patient's blood pressure is vital due to the often-asymptomatic nature of hypertension. Blood pressure can be measured at home using a personal monitor or checked by a medical professional in the PHC or hospital.
  • Medications Compliance:
    • Encouraging adherence to the prescribed regimen and communication with your patient about any adverse effects are crucial.
• Referral:
  • Follow referral procedures below.

• Referral:
  • See referral procedures below.

• According to Obesity pathway segmentation
  • Without co-morbidities:
    • Level 0 : BMI = 25 - 29.9
    • Level 1 : BMI = 30 - 34.9
    • Level 2 : BMI = 35 - 39.9
    • Level 3 : BMI = ≥ 40
  • With Co-morbidities:
    • Level 1 : BMI = 25 - 29.9
    • Level 2 : BMI = 30 - 34.9
    • Level 3 : BMI = 35 - 39.9
    • Level 3 : BMI = ≥ 40

• Level 0 and Level 1 mentioned above are to be followed and be managed by the health coach.

• In case of resistance (Patient who did not achieve at least 5% reduction in weight within 6 months), Level 0 and Level 1 shall be referred to the Obesity pathway (essential plus/bariatric clinic) for further consultation and managment.

• Level 2 & 3 regardless of co-morbidites are to be referred to Obesity pathway (essential plus/bariatric clinic).

• Referral is done through:
  • Raqeem (internally if a bariatric clinic is available in the same PHC)
  • Mawid (Externally if no bariatric clinic is available in the same PHC).

• For more detailes on the managment of Overweight and Obesity use the following links:
  • Obesity and Overweight. 
  • Saudi Guidelines on the prevention and management of Obesity.

• Referral of Patients to Specialized Healthcare Providers:

  • If the health coach discovers something important regarding the patient's health (whether it's urgent or not), they should refer them to the specialized healthcare provider.

     

  • Referral of Patients with Critical Conditions:

    • If the patient reports a health issue that is considered urgent, the health coach should express concern by saying: "This matter is somewhat concerning to me. I will contact your doctor and explain your situation. If the doctor shares my concern, you may need to speak to him or visit him soon. Can you do that? And if you're feeling unwell right now, you can go to the emergency room." The health coach will then contact the specialized healthcare provider to alert them about the case, which includes urgent situations such as:

      • Blood sugar levels (when measured) are less than 80 or higher than 400 mg/dL.
      • Blood pressure (when measured) is less than 90/50 or higher than 200/120 mmHg.
      • Symptoms of hypoglycemia without blood sugar measurement include sweating, shaking, dizziness, etc.
      • Other symptoms such as chest pain, loss of consciousness, sudden shortness of breath, weakness on one side of the body, sudden vision loss, or severe pain.

       

  • Referral of Patients with Non-Critical Conditions:

    • If the patient reports something important but not urgent, the coach should express concern by saying, 'It could be important for your doctor to know this. I will send him your report. If you're feeling unwell, you should make an appointment with the specialist doctor.' The health coach should then notify the specialized healthcare provider about the case and the important signs observed. Important non-urgent issues include:

      • The patient is not taking medications as prescribed.
      • Problems in obtaining the prescription.
      • Serious side effects of medications.
      • Visiting the emergency department or hospitalization.
      • Fasting blood sugar levels equal to or higher than 160 mg/dL for several days despite taking medications.
      • Postprandial blood sugar levels equal to or higher than 250 mg/dL for several days despite taking medications.
      • Glycated hemoglobin (HbA1c) levels equal to or higher than 12%.
      • Systolic blood pressure equal to or higher than 150 mmHg for several days.
      • Low-density lipoprotein (LDL) cholesterol levels equal to or higher than 130 mg/dL.