The HCA Model of Health Change

With the ever-increasing realisation that education alone is not effective in influencing long-term behaviour change, the HCA Model of Health Change introduces evidence-based change protocols in a structured 10 step format that makes it easy for health practitioners to apply.

Key documents

• Gale, J (2012). A Practical Guide to Health Behaviour Change Using the HCA Approach. Click here to download an excerpt of the Guide.
• Gale, J (2010). The HCA Model: An integrated model of health behaviour change for chronic disease prevention and chronic disease self-management. Click here to download a theoretical overview of the approach.

What is Health Coaching?

'Health Coaching,' is a patient-friendly term for health behaviour change assistance, it is typically conducted as part of usual professional practice for health professionals. Health coaching health practitioners combine their usual assessment, treatment and lifestyle recommendations and patient education with health change principles so that patients are better able to adhere to recommendations.

Health Coaching is typically conducted in the context of disease prevention and/or chronic condition self-management within public and private sector health services. It is suitable for interdisciplinary teams of health professionals within chronic disease prevention, early intervention, rehabilitation and other chronic condition self-management programs. The model is being used successfully in other contexts such as disability and aged care services, general practice and allied health services.

As health coaching can also be used as stand-alone health behaviour change intervention, there is also a growing tendency for health organisations to use dedicated health coaching consultations as part of their chronic disease management programs. These are delivered by health coaching-trained Key Workers, Case Managers or Health Coaches.

HCA health coaching techniques enable efficient use of consultation time by focusing on what patients can actively do to improve their health. The Model promotes patients' responsibility for their own health management. Consultations can be face-to-face or telephone-based.

In summary – health coaching health professionals motivate patients toward readiness to change, assist them to change unhelpful thinking patterns, promote behaviour change and empower patients to achieve better health outcomes.

What Is The HCA Model All About?

The HCA Model of Health Change was designed to meet WHO (2003) recommendations for addressing adherence to long term (health) therapies. Health coaching acknowledges the difficulties inherent in making lifestyle changes for all human beings.

The model is based on a 'readiness to change framework.' The health coaching processes explicitly identify and target individual barriers to changing behaviours at a particular point in time, for a particular person, given his or her unique life circumstances. These barriers are behavioural, emotional, situational and cognitive in nature. They include habitual behaviours, emotional reactions to behaviour change attempts, physical and social environmental factors, beliefs, attitudes, expectations and everyday thinking patterns that undermine health enhancing behaviour change intentions. The model guides health professionals regarding which behaviour change intervention/s to match to the patient's state of readiness, importance and confidence in making particular changes. Readiness is viewed as being in a constant state of flux, depending upon the patient's perceptions of barriers and facilitators for change.

The communication style and techniques used in health coaching interventions incorporate elements of motivational interviewing and solution-focused coaching. These are combined with critical cognitive change techniques to enhance the effectiveness of motivational interviewing and solution-focused interventions.

Click here for more documentation information the HCA Model

How Do You Implement The HCA Model?

Many organisations in Australia are combining health coaching techniques with other chronic disease prevention and self management (CCPSM) models such as the Flinders and Stanford models. These models are complementary and the use of multiple models can enhance intervention effectiveness.

There are a number of options available for integrating the HCA Model and intervention framework into clinical practice. These are:

1. Use the entire framework as a standalone intervention for health behaviour change for CCPSM.
2. Use the framework in conjunction with other models of CCPSM such as the Stanford group education model
3. Use of single components of the model within short consultations (e.g., use of a cognitive change intervention technique to address cognitive barriers to carrying out an action plan, or use of MI techniques to encourage a client to seek assistance regarding a psychosocial problem acting as a barrier to self-management).

The HCA training, structural framework and tools provide health practitioners with micro skills that may augment the effectiveness of other CCPSM interventions. Feedback from organisations that use a combination of models suggest that this is the case.