At Liva our approach to coaching is always person-first - this means that the coaching conversations are driven by what's important to the people we are working with and not our agenda for that person.

Our coaching approach is informed by behaviour change theories and relies on the use of Motivational Interviewing skills by coaches. The BMJ has a great short summary article and elearning module on Motivation Interviewing here, which you can access using your OpenAthens log in created for the NHS e-learning.

How do we educate people on health topics?

Everyone who joins a Liva programme will have their own reasons for taking part, and be driven by their own motivations and experiences so far. Giving people information or advice to change is largely ineffective and unrewarding for both parties.

We provide automated structured learning content on our programmes to meet the baseline information required (eg as outlined by a partner we are working with). This leaves the coaching space free to really focus on the individual's own goals and areas that are meaningful to that person.

Using MI skills

It’s not that we can’t provide further information with people in our coaching messages, but rather we need to remember to frame it in a way that is not overwhelming and is both relevant and meaningful to the individual's current goals and motivations.

The core skills of Motivation Interviewing focus on the language of change and the artful exchange of information. When thinking about providing information to people, the most relevant MI skill to consider is the O of OARS - Open Questions.

• Open questions draw out and explore the person’s experiences, perspectives, and ideas. Evocative questions guide the client to reflect on how change may be meaningful or possible. Information is often offered within a structure of open questions (Elicit-Provide-Elicit) that first explore what the person already knows, then seek permission to offer what the practitioner knows and then explore the person’s response.
• The exchange of information respects that both the coach and member have expertise in this situation. Sharing information is always a two-way street and a coach's choice to share information should be responsive to what the member is saying.

This video from Dawn Clifford (author of the book ‘Motivational Interviewing in Nutrition and Fitness’) is a really great summary of this technique if you need a reminder!

Examples in asynchronous coaching:

Example 1 (video):

Jenny, when we spoke on our video call you shared that you wanted to look at the balance of foods in your meals, and you’ve shared some pictures for me to look at with you. What have you noticed may be missing or could be changed? From what you’ve read on the programme so far, is there 1 particular thing you want to focus on? [ELICIT]

As you asked me to make suggestions also, here’s what I noticed about your meals, they are often lacking in protein-rich foods, for example, eggs, meat, fish, and beans, which is one of the areas that people can find makes a difference to their energy and hunger following a meal [PROVIDE].

There’s a short piece in your learning tab on protein already, and if it’s something you want to explore further, I can share some more information about the role that protein can play in supporting health, especially for your long-term goal of managing your blood sugar levels - let me know and I will attach it in my next message. How does this fit with what you noticed about your meals? Tell me a bit more about the protein foods you have in your diet right now and whether this is an area you would like to work more on? [ELICIT]

Example 2 (written message):

Hi Dave

How’s the week been for you? From your updates, it sounds like you feel frustrated about the conflicting information you’re getting from different people around what exercises are best for you. I hear you, it is tough to figure out what is right for us, and you’re absolutely not alone in feeling this.

➡️ What do you think is most important when it comes to choosing the exercise that you want to focus on?

➡️ How important is it to you to focus on increasing your movement right now? [ELICIT]

If it’s ok with you, I’ve added a short bit of info about different types of exercise, and in my video I’ve shared a few examples from other people about what being active means to them. I’ve elaborated a little more in my video. [PROVIDE]

What ideas do you have already for being more active? [ELICIT]

Q&A

What if there isn’t enough to say about the person's goals that week or they haven't logged anything at all, what else should I talk about?

First, we know that silence doesn’t mean that a person isn’t there or isn’t motivated, so we want to make sure that we keep the coaching space open, relaxed and free of any judgement for why this person hasn’t felt able to provide updates this week. This can look like acknowledging and normalising challenges

‘Hey Geoff, I haven’t heard how things are with you this week - I hope you’re ok, and life is just keeping you busy. Sometimes it can be a challenge to focus on yourself right! I’m here when you are ready to share more, and I appreciate when you are able to spend that time updating the app - it’s not always easy! 🌻'

This is where open-questions can come in - we don’t need to fill the silence with information. If the person is overwhelmed or finding their goals challenging, jumping in with more advice and information is likely to add to the feeling of overwhelm and increase their withdrawal from engaging. There’s a nice summary in this article about MI and ‘non-compliance’ that is worth a read.

‘How is that exercise goal to do 3 x 30 mins walks a week feeling for you right now Geoff? When we first set them you felt 9/10 motivated to focus on it, but perhaps that’s not the case anymore. It’s totally normal to have dips in motivation, or have things crop up along the way that might make the goal not as realistic as when we were on the call together. If you’re up for it, we can come up with some solutions together to adapt the goal to be better suited to you right now - would you say you are still 9/10 on the motivation scale for this? And if it has changed, what do you think has made that happen? What can we do to increase the motivation again?'

 I see that lots of people misunderstand certain topics so I want to educate them on this in my videos, isn’t that my job?

In Liva, our role as a health coach is to guide someone on their health journey, rather than direct them. We retain some control over the direction and structure of the coaching eg it’s a 9-month programme, focused on diabetes prevention, so we’re not giving personalised diet plans and developing exercise plans, but people on our programme retain the responsibility for change in the areas that are important to them.

We can’t assume that everyone makes the same misunderstandings, so without first asking questions to ascertain what this person knows about the topic, for example carbohydrates, we can’t then address it. By assuming someone doesn’t understand a topic, we make a judgement about their knowledge and their health behaviours so far - when people feel misunderstood, judged or patronised, they are likely to withdraw from interacting or share frustration (directly or indirectly) about us.

‘Jill we briefly touched on carbohydrates in our video call, and it is an area I hear a lot of confusion about from other people I work with. You might see differing opinions within the Group space on the app as well. Tell me more about what you understand about carbohydrates and how they fit into health. Is there anything that you are unsure of in this area that I can support you with?’

Is it ok to structure my check-ins around topics so I am talking to people about the same thing at each point in the programme?

This approach assumes that every person on the programme is going to have the same goals and focus at every time point along the way. It is not a collaborative person-led approach to coaching. For someone whose primary goal is to increase their movement, to suddenly be talked to about fibre by their coach can feel distracting, or that their coach is not listening to them, or that they are not being given a tailored coaching experience. We hear this in complaints to support, bad reviews on TrustPilot and in messages in the Groups within the app.

There will inevitably be similarities along the way when you are coaching, which is where the Liva library and your bookmarks folder can come in handy. But week 4 for one person might be totally different to week 4 for another person, and that is exactly why we have the learning content disconnected from your coaching message. The automated learning is there - right now it does the dirty work of providing the information that we are required to provide across the duration of our programmes - but it’s not smart enough to tailor to every individual (at least not yet!), and that’s where our coaches come in.