The latest research on Health Coaching from the pioneering project of Assistant Professor Ms. Ayse Basak Cinar in partnership with Danish Institute of Coaching. Our first article for magazines in english. Academic articles for journals can be requested: cd@danskcaochinginstitut.dk

1. PATIENT FOCU
COACHING
T A N D P L E J E R E N J U N I 2 0 1 438
GROW
New Insight, consiousness about
Myself, my goals, values & beliefs
KNOW
Recieve knowledge about what you
want to improve, change and learns
ACT
Optimizing skills & capabilities
by doing, learning and experience
Figure 1. Schematic representation
of coaching for behavioral change.
Modified from the Learning Model
by Danish Coaching Institute, 2011.
OW ACT
ou Op
Figure 1. Schematic representation
of coaching for behavioral change.
Modified from the Learning Model
by Danish Coaching Institute, 2011.
Transition &
Development
Action learning,
recieving feed-
back. Building
skills and
competence
Transformation
& New behavior
Relearning into
new personal
& social
Competencies
This process is ongoing for us all throughout our lives.
You can call it a universe of learning. This is important
in order for a patient to learn, unlearn and relearn
new skills, competencies and habits to secure an in-
creased positive level of orral health and quality
of life. The dental team is in the coaching role
creating a space and fram for learning in
order to secure a greater level of rap-
port, compliance and self efficacy.
Understand & Learn from exercising,
observation, trial and error
The Development and Learning Triangle is based on
DavidKolbLearningTheories.Thismodelillustratethe
theory of experience based learning - action learning.
This way of learning and growing take you through
an iterative proces of learning, we know this as
transition. - A Proces of experience leading
into self reflection and thoughtfulness
for then to exchange perspectives and
recieve feedback. When you have
reached a level of self recognition
and conceptualization, you are
able to engage in activities
and experiement and gain
new experience.
Unlocking the Human PotentialUnlocking the Human Potential
Danish
Coaching
Institute
Danish
Coaching
Institute

2. ››
USED HEALTH
Health Coaching (HC) is a new patient-centered behavi-
oral/lifestyle intervention. It facilitates individuals in
establishing and a aining health promoting goals in
order to change lifestyle-related behaviors. The intent is
to reduce health risks, improve self-management of chro-
nic-conditions and in-
crease health-related
quality of life1
. HC, in
principal, focuses on
transformation and
maintenance of positi-
ve health behaviors by
empowerment of patients. HC, one of the most effective
behavioral techniques, is directly associated with positive
lifestyle outcomes (smoking cessation, management of
obesity and diabetes)2-6
. An assessment of the effect of HC
on multiple chronic disease management as a common
approach has been a neglected issue. Ayse Basak Cinar
and Lone Schou and the research group, the first to their
knowledge, run an international project that aims to
evaluate the impact of a HC on oral health and diabetes
management among patients with diabetes type 2 (DM2),
by comparing HC intervention to health education.
DM2 and oral diseases
Promoting good oral health is essential to prevent and
reduce the negative consequences of DM2 and to maintain
good health, as proposed by the WHO 7
. Periodontal disea-
se may significantly contribute to the risk of dying from
DM8
. Periodontal inflammation in early old age tends to be
associated with mortality in older age8
and DM2 patients
are more likely to have periodontal disease than people
In the last issue of the Dental Hygienist Magazine (May 2014), Dental Hygi-
enist Ms. Azita Negahban explains her contribution to the research project
headed by assistant professor Ms. Ayse Basak Cinar at the Faculty of Odon-
tology at Copenhagen University.The research focuses on the benefits and
impact of empowerment and coaching on diabetes patients.
It is vital that patients learn to
connect their health goals and
lifestyle to a vision of health
in a greater picture (...)
without DM29
. DM2 and oral diseases, so
called lifestyle diseases, share common bio-
logical mechanisms10, 11
and the same lifesty-
le related risk factors (poor dietary habits,
smoking)12, 13
. Be er management of these
diseases requires good
self-care practices and
adherence to regular
daily regimes. Howe-
ver, many patients find
themselves unable to
follow recommended
lifestyles (a healthy diet, regular physical
exercise, no smoking, tooth brushing twi-
ce daily), which makes them more prone to
DM2-related complications and poor oral
health, leading to a poor quality of life.
Therefore, a common-risk factor approach
to promote be er oral health and successful
DM2 management are proposed as an urgent
need by WHO14
and IDF15
. Behavioral inter-
ventions are highly recommended to meet
this need16
. In line with this recommenda-
tion, studies by Cinar and colleagues (2013,
2014), has found that HC, compared to tra-
ditional health education, significantly im-
proves HbA1c (clinical parameter reflecting
the average blood glucose level over the past
three months time), periodontal health and
psychosocial measures (self-efficacy, diabe-
tes coping skills) among DM2 patients17, 18
.
By Ms. Ayse Basak Cinar, assistant professor, and Ms. Lone Skou, head of section, Faculty of Odontology
at Copenhagen University
J U N I 2 0 1 4 T A N D P L E J E R E N 39

3. What makes HC different from other health
promotion approaches?
The HC approach in the present study:
1. originally stems from coaching that is international-
ly accredited and uses specific psychological tech-
niques19
including motivational interviewing 20
, neu-
ro-linguistic programming (NLP)21
and self-efficacy22
.
Health Education and promotion is integrated to the
HC,withacontinuousfocusonpatientempowerment.
2. tackles health-related psychological blocks to change
by empowering and motivating the patient.
3. is a collaborative process between medical professio-
nal and patients/people. It is not a communication
between an expert and an obeying patient. It is desig-
ned to motivate people to a ain specific goals which
can improve their performance and enhance their
quality of life.
4. may work for promotion of multiple health behaviors
based on patient-centered choice.
5. functions in terms of empowering, applauding, sup-
porting, motivating, providing feedback, and helping
the patient to remain commi ed to achieving goals
and accountable for choices he/ she makes.
6. explores multiple interaction, not unilateral,
pathways between emotional and cognitive compo-
nents of patient’s health behavior, and differentiates
from health education (table 1).
7. targets the continuous personal growth of the
patient to adopt and maintain healthy lifestyles
and to improve quality of life. The initial point is to
createawarenessofowncapacityandvalues-beliefsand
therea er to set up a health-related goal based on
these.
HC as an interventional method in the clinical
settings
The primary method is that patients themselves set up
the goal and an action plan, focusing on improvement of
lifestyle and clinical measures, under the supervision of
the coach. Each coaching session is used for subsequent
monitoring of patients’ progress towards the achieve-
ment of the target goal. The time frame for face to face
coaching sessions is 20-60 minutes, determined by
needs, expectations, hindrances, and progress of patient.
Figure 1 on page 14 is a schematic representation of coa-
ching for behavioral change, modified from the Learning
Model by Danish Coaching Institute, 2011.
A Wheel of Health (figure 2) is administered during
the initial HC session visits to explore values, establish
priorities, and set goals: Participants define their prio-
rity areas in health to improve, on the wheel of health
where each pie represents an health area such as diet,
physical activity etc (figure 2). Then they rate how sa-
tisfied they are in each area ranging from 0% to 100%
A erwards they define how satisfied they would like to
be in each area. Wheel of Health is specific for participant
identifying his/her priorities, needs and expectations
COMPARISON OF HEALTH EDUCATION
MODEL AND PATIENT FOCUSED
APPROACH-HEALTH COACHING
T A N D P L E J E R E N J U N I 2 0 1 440
Traditional Care Model
• Health professional as expert
• Client told what to do
• One size fits all solutions
• Extrinsic motivators
• Client required to facilitate change
• Ignores barriers to change
• Resistance to change
• Goal setting overload
Health Coaching Model
• Client as expert in own life
• Client offered information but chooses own
solutions
• Individually tailored solutions
• Intrinsic motivators
• Collaboration and assistance in facilitation
change
• Adresses barriers to change
• Magnitude of goals to suit client
Tabel 1. Comparison of Health Education Model and Patient Focused Approach-Health Coaching modified from Health
Coaching Australia, http://www.healthchange.com.

4. referring to health (figure 2). Participants choose one do-
main and set up a specific goal and action plan during
each face-face session. The progress of the patient is sup-
ported by telephone calls.
HC as a new effective dental professional-patient commu-
nication tool can be used at daily clinical practice. HC has
seven master bones structure an effective and successful
communication:
1. Building Trust and Rapport (1+1=3, asking permis-
sion, empathy, being in the moment)
2. Unconditional Positive Regard (acceptance and re-
spect)
3. Patient-Focused Approach
4. Empathy
5. Active Listening and Empowerment (words and tone
of voice, body language and behavior)
6. ASK, Don`t Tell
7 Feedback and summarising (mirroring).
Figure 2. The wheel of health is a great tool to create ovierview, clarity and conciousness for the patient. This
assessment for a focused dialogue support the HP and the patient in moving in on what is most important, what create
most value for the patient and reflect where the inner drive of the fokusperson is. The fokusperson always leave with a
task defined by the fokusperson itself in order to motivate for continous and future compliance and most importantly
building ressources and skills for self efficacy.
››
WHEEL OF HEALTH
Assessment of the patients own level of statisfaction with state of health
Level of statisfaction – present state on a level from 0% to 100% in this area
Level of satifaction – future state on a level from 0% to 100% in this area
Oral health
behaviour,
(mostly
brushing
twice a day)
Sleeping
habits
Stress &
emotional
Management
Physical
activity
Self & Life
Management
Diet
Mindfulness
& meditation
Weight (BMI)
Oral health
behaviour,
(mostly
brushing
twice a day)
Sleeping
habits
Stress &
emotional
Management
Physical
activity
Self & Life
Management
Diet
Mindfulness
& meditation
Weight (BMI)
Goal setting for Focus Points: What action to take
in order to close the gap bewteen present and fu-
ture state of statisfaction and then reach goal for
excellent oral health and quality of life: I will...
I want to...(positive formulated, specific,
concrete, measurable, attractive and
timed).
Focus Points: Patient
choose the areas (max.
3) to work with right
now in order to
close a gap in a
wheel of health
area of great
importance
and value.
0%
J U N I 2 0 1 4 T A N D P L E J E R E N 41

5. T A N D P L E J E R E N J U N I 2 0 1 442
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(2005) Metabolic control, self-manage-
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195-203.
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M (2004) A nurse-coaching intervention for
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Christiansen N, Holm-Pedersen P (2009)
Effect of inflammation in the periodontium
in early old age on mortality at 21-year
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Wikblad KF (2000). Type 2 diabetes and oral
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and non-diabetic subjects. Diabetes Res
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Murayama Y (2005) A proposed model
linking inflammation to obesity, diabetes,
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76 (11 Suppl):2075-2084.
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on diabetes mellitus. J Int Acad Periodontol
2:49-55.
12. Santacroce L, Carlaio RG, Bottalico L
(2010) Does it Make Sense that Diabetes is
Reciprocally Associated with Periodontal
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Drug Targets 10:57-70.
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Welfare (2012) Risk factors contributing
to chronic disease 2012. http://www.
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aspx?id=10737421546. Accessed April 29,
2013
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Report 2003: continuous improvement
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Programme. Community Dent Oral Epide-
miol 31 Suppl 1:3-23.
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www.idf.org/oral-health-
vital-component-wellbeing. Accessed
March 2014.
16. WHO (2013) Non-communicable diseases.
http://www.who.int/mediacentre/factshe-
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ahead of print]
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for Patients with Diabetes: Health
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ge. New York: The Guilford Press, pp. 428.
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ro-Linguistic Programming Surrey., UK:
Centre for Management Learning and
Development, School of
Management, University of Surrey, 2006.
Available from: http://www.som.surrey.
ac.uk/NLP/Resources/ IntroducingNLP.pdf.
[Accessed April 29 2013].
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of Control. New York: W.H. Freeman and
Company; 1997. p. 604.
22. Wolever RQ, Dreusicke M, Fikkan J et al
(2010) Integrative health coaching for pa-
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clinical trial. Diabetes Educ 36:629-639.
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24. Donovan JE, Jessor R, Costa FM (1993)
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25. SW Butterworth, et al. Health Coaching as
an Intervention in Health Management
Programs. Dis Manage Health Outcomes
2007; 15: 299-307.
26. Cinar AB, Schou L. Impact of Empowerment
on Toothbrushing and Diabetes Manage-
ment. Accepted for publication to Oral
Health Prev Dent April 2014.
While dentists, physicians and diabetes educators un-
dergo extensive education and training to learn ’what is
best’ for patients, the education/training mostly misses
’how’ to achieve that best. ’How’ is implied in the patient’s
motivation and patient’s needs to find out his/her moti-
vators with support and encouragement of health care
providers who can put on HC ’shoes’ .
It is vital that patients learn to connect their health goals
and lifestyle to a vision of health in a greater picture,
which is a critical step in developing the best strategies
for lasting behaviour change22
, thereby to maintain
be er oral health and diabetes management. Therefore,
dentists, physicians and diabetes educators need to en-
gage patients under the ’umbrella’ of health behaviours
considering that health behaviors including oral health
co-occur as separate clusters as either health-enhancing
or health-detrimental behaviors in the same individual23
.
Engagement either in health-enhancing or in health-
detrimental behaviors is proposed to represent an
individual’s health-related lifestyle24
. HC provides a
holistic communication approach to motivating and
supporting patients for se ing up health goals connected
to each other.
HC is being increasingly incorporated into health
management programs, implemented in a variety of
se ings, from individual health behavioral change to
disease management/health at population se ings25
.HC
in dentistry can take a lead role at management of be er
oral health and diabetes management considering dental
professionals have more time to communicate with/treat
their patients compared to other medical health care pro-
fessionals. Besides, toothbrushing can be a practical start
point for empowerment of other healthy behaviors, in
line with earlier publication26
.Dental professional-patient
communication, from simple consultations to complex
treatment, can be more effective by integration of HC
’bones’.
Acknowledgements
We express our deepest thanks to Christian Dinesen,
Danish Coaching Institute for his collaboration. Many
thanks are due to our patients for their participation and
cooperation.