Presentation: Health Coaching for effective diabetes management- World Coaching Congress, 2017

Bridging the bridge between academia
and professional coaching business
AB CINAR-2017
Smile Healthy to Your Diabetes:
Health Coaching: A new Person Centred complementary
Approach for Diabetes Type 2 Management at the Clinics
AB Cinar (DDS, MBA, PhD, DSci)
Senior Research Fellow & Credited Coach (ICC), Mental Training Practioner (ISU)
University of Dundee, Scotland, UK

AB CINAR-2017
1. Insight to ‘How is it to be a patient?’
2. ‘How can I make a difference to my life and my patient’s life?’:
Smile Healthy Approach
3.Coaching as a Leadership Approach for Self and the Patient:
Learning-Acting-Growing together with every patient
We together will be able to explore, examine and discuss:
Smile Healthy to Your Diabetes
Building the bridge between
academia and coaching profession

AB CINAR-2017

AB CINAR-2017
HOW I FEEL
WHAT I THINK
FOR MY WELL-BEING
GOAL(S)
VALUE(S)
BELIEF(S)
WHAT ARE MY CHALLENGES
REALITIES
WHAT I WANT

AB CINAR-2017
If you know others and you know yourself, you will not be imperiled in a hundred battles,
If you do not know others but you know yourself, you will win one and lose one,
If you do not know others and do not know yourself, you will be imperiled in every single
battle.
Sun Tzu, The Art of War
• Making the Mindful Leader: In The Wiley-Blackwell Handbook of the Psychology of Leadership,Change, and Organizational Development

Leader’s self-concept
(self-management-credibility)
Build Your Brand as an Emerging Leader
Sterotype
”What do I want?”
Self-awareness for others
Skills and mindset
Value-based Role model
Become a Person of Influence
Coaching
Continous ”Learn-Act-Grow”
Curiosity
Intuition
Commitment
Meta-view
Questions
Listening
Mirroring
Empowerment
Presence
….
FROM TRANSITION To TRANSFORMATION: “SMILE HEALTHY “COACHING

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2. ‘How can I make a difference to my life and my patient’s life?’:Smile
Healthy Approach
Smile Healthy To Your Diabetes (2010-2015, Denmark-Turkey) Approach

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`How to make a difference to my patient’s life?’
Smile Healthy Approach
• Designed, launched: University of Copenhagen, Denmark.
• International and multidisciplinary coaching health intervention
• PI: AB Cinar
• Supervisor: Lone Schou
• Team members:
Copenhagen (DK): Colleagues, University of Copenhagen;
Danish Coaching Institute
Istanbul, Turkey: Yeditepe University; Diabetes Association;
Diabetes Clinics, a Public Education and Research Hospital
• Grants: IDF, TRYG Fonden, University of Copenhagen, FDI
• Awards:
2016 100 Best Global Coaching Leaders Award, CHRO
ASIA,2017
2016 50 Outstanding Women in Healthcare – Global Listing,
World Health & Wellness Congress & Awards-2017

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Evidence for Health
Coaching • Among the rare studies using Health Coaching
as a holistic approach targeting multi-
behavioural change
• To our knowledge it is the first study
With a structured framework and a control
group
As a prospective Research assessing the
impact
of HC on both clinical and behavioural
outcomes
 Focusing on International assessment
 Using Health Coaching as a Person-centred
Multidisciplinary approach
Coaching compared to Education is more
effective:
• Diabetes Management
Whittemore R et al. Diabetes Educ. 2004; Wolever RQ et al. Diabetes Educ. 2010.
• Dietary Behavior Modification
Sarvestani RS et al. J Adv Nurs. 2009; Stevens VJ et al. Prev Med. 2003.
• Smoking Cessation
Lancaster T, Stead LF. Cochrane Database Syst Rev. 2005.
• Weight Management
Tucker LA et al. Am J Health Promot. 2008
• Cardiovascular Risk Management
Edelman D et al. J Gen Intern Med. 2006; Vale MJ et al. Arch Intern Med. 2003
Originality of Our Research

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AIM
• to design and evaluate the impact of health
coaching (HC) compared to health education (HE)
by using self-reports and clinical measurements to
improve oral health and diabetes management
among patients with diabetes type 2 (DM2) in
Turkey (2010-2012) and Denmark (2012-2015).

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Diabetes and Oral Health
Growing global pandemic (400 million)
Contribute to the etiology of each other (Share common biological mechanisms & same
lifestyle related risk factors)
Periodontal disease is both risk factor for and complication of diabetes
Life-style oriented diseases
Patient compliance and self-management: PERSON-CENTRED APPROACH AS THE KEY FOR
SUCCESS

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RESEARCH METHODOLOGY
HEALTH EDUCATION
GROUP
COACHING GROUP
Randomization
Recruited sample
(TR:187; DK:114)
HEALTH EDUCATION G.
Advice Giving
COACHING GROUP
Coaching Sessions
COACHING GROUP
Coaching Sessions
HEALTH EDUCATION G.
Advice Giving
Baseline Initiation- Maintenance
6 months
Follow-up
12 months
*36
months
OUTCOME
MEASURES
OUTCOME
MEASURES
OUTCOME
MEASURES
OUTCOME MEASURES
A. CLINICAL MEASURES
HBA1C, HDL, LDL, TOTAL TRIGLISERID
PERIODONTAL HEALTH
BMI, BODY-FAT%
B. SUBJECTIVE MEASURES
HEALTH BEHAVIOURS
PSYCHO-COGNITIVE MEASURES (SELF-EFFICACY, SELF-ESTEEM, DIABETES COPING SKILLS,KNOWLEDGE)
C. INTERVIEWS*

Bridging the gap between academia
AB CINAR-2017
Traditional Medical Model
Told
Informed
Good patient
Doing to
Reactive
Clinician centred
Options presented
Doctor is the expert for the patient’s
health
Coaching
Asked
Guided
Challenging
Doing with, listening
Proactive
Patient centred
Informed choice
The patient is the expert for his/heJ.
O‘Connor

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• Internationally credited coaching framework
• Several psychological theories
• Self-Efficacy focusing on Empowerment
• Shared knowledge by ‘request’
• Visualization techniques
• Intutition exercises, mental relaxation
• Multi-goals anchored by a visionary goal
• Personalized tools and tasks
RESEARCH METHODOLOGY - COACHING METHODOLOGY (1-1)

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COACHING METHODOLOGY
• Creating AWARENESS BY DISSONANCE
• Facilitating personal VISIONARY GOALS
• Challenging by VALUES
• Coaching Framework
• Coaching Skills
• Professional-Medical Tools
http://www.healthchange.com/resource_optinal_tools_for_clients

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TOOLS FOR SESSION

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• Tasking with VALUES
• Diet and physical activity monitoring
• Toothbrushing charts
• + Affirmations
TOOLS FOR TASKING BETWEEN SESSIONS
Health Diary

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RESULTS

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Table1. Socio-economic measures at baseline among Health Coaching and Health Education groups
TURKISH Health Coaching Health Education
N (total =186)* n % n % p
Education
Primary school or less
At least middle school
(≤ 8-11 years of education)
At least university
74
54
31
15
101
60
23
17
ns
Current employment
Retired/not working
Employed
77
75
25
98
78
22
ns
Age (years)
≤49 years
50-59
≥60 years
72
29
55
16
92
34
41
25
ns
DANISH Health Coaching Health Education
n* % n* % p
Education
Primary School up to 10th
class
10th class (optional)
High School
Technical school
At least university
96
31
12
12
16
29
78
36
7
13
26
18
ns
Current employment
Retired/not working
Employed
111
88
12
110
84
16
ns
Age
≤49 years
50-59 years
≥60 years
108
36
8
56
86
9
35
56
0.001

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HbA1C Periodontal Disease
20
Cinar AB, et al. Clin Oral Investig 2014 18(7):1793-801; Cinar AB, Schou L. Int Dent J 2014; 64:155-6
Baseline:
Post-intervention:6.9%(TR); 7.0%(DK)
HEALTHCOACHING
7.5%(TR);7.4%(DK)
p<.05
0.5 (TR); 1.7(DK)
1.9(TR); 2.4(DK)
HEALTHCOACHING
p<.05
7.8%(TR);7.4%(DK)
p: NS
HEALTHEDUCATION
7.8%(TR); 7.4%(DK)
1.7 (TR);2.2(DK)
p<.05
HEALTHEDUCATION
2.4 (TR); 2.6(DK)

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21
CHANGES BY YEAR TWO WITHIN STUDY GROUPS FOR PATIENTS WHO WERE AT HIGH-RISK AT
BASELINE
Health Coaching Health Education
DANISH
HbA1C≥8% 9 9.8+1.3 9.0+1.6 -8% 0.015 11 9.3+1.0 8.8+1.7 -5% ns
Periodontal
Attachment Loss≥4mm
6 4.8+0.56 3.9 +0.67 -14% 0.018 9 5.6+1.2 5.0+1.2 -10% ns
TURKISH

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BASELINE POST-
INTERVENTION
P BASELINE POST-
INTERVENTION
P P
(BASELINE)
P
(POST-INTERVENTION)
Toothbrushing (%)
Never or rare
2-5 times/week
Once a day
Twice a day
14
20
34
32
1
11
18
70
0.001
25
23
30
22
9
22
44
25
0.001 NS 0.001
Physical Activity (%)
Physically inactive
Physically active
42
58
15
75
0.001
46
54
48
52
Ns NS 0.001
:) 22
TR HEALTH COACHING TR HEALTH EDUCATION H-COACHING –H-EDUCATION
FOR SELECTED VARIABLES, CHANGES BY YEAR TWO WITHIN STUDY GROUPS

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DK Physically Inactive
baseline
DK Physically Inactive
post-intervention
p
Health Coaching 43% 18% p<.05
Health Education 47% 34% p<.05
Physically Inactive
Post-intervention
Brushing once a day or less than daily Brushing twice a day or more p
Health Coaching 33% 13% p<.05
Health Education 43% 30% ns

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24
• All HC patients who brushed ‘twice daily’ were more
likely to be physically active (TR: 91%, DK: 87%) than
‘once a day or less’ toothbrushers (TR: 69%, DK:
67%), (p<0.05).
• Principal component analysis revealed that in both
HC and HE groups, health behaviours and
periodontal health and HbA1c clustered together.
• After 2 years follow-up, HbA1c in the TR-HC group was significantly 2% less than
that at the baseline (p<0.05) but there was no change in the HE group.

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By the year 2012, Turkey
60-69 aged male with a diabetes history of 14 years
“I have adopted healthy eating habits and regular tooth brushing. I
didn’t know how oral health was important for my diabetes.
Additionally I lost some of my teeth and I suffered from bleeding of
my gums. I wish there was an oral healthcare service at diabetes
polyclinics.”
50-59 aged female with a diabetes history of 2 years
“I learned everything about oral health and diabetes management by
coaching sessions. My psychology is much better. My life has
completely changed in a positive direction. Before the coaching
sessions, my life was a misery and hopeless.”
“My self-esteem has increased by the coaching sessions. I felt and
recognised that I was worthy as a person during these sessions. All
the negative thoughts about living with diabetes were erased by
these sessions.”
By the year 2014, Denmark
50-59 aged female with a diabetes history of 12 years “My
lifestyle and social life have changed; I started a new life. I
found new ideas and rebuilt my life.”
“I am now more physically active (going swimming, walking)
and drinking more water and less alcohol. I changed and
adopted these new habits because I have recognized that I
want to do better during the coaching sessions. I changed the
wrong behaviour and replaced it with the healthy one.”
Qualitative Outcomes
AB CINAR. HEALTH COACHING INCREASES SELF-ESTEEM AND HEALTHY SMILES. DIABETES
VOICE 2014:59. http://www.idf.org/diabetesvoice/special-issue-2014/basak-cinar

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26
• CONCLUSIONS

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27
• Patient-focused HC compared to HE has a significantly higher impact on better
management of clinical outcomes; improvement was more significant among
high risk group patient
• There seems to be a complex chain of interactions between health and related
behaviours; improvement at one chain (behaviour), could trigger change on
others. Empowerment via coaching seems to be the key activator
• HC not only contributes to both behaviour change and improvement at health

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Person Centred Health Coaching can be
• A complementary intervention in clinics/health-care
settings; effective empowerment and change
management methodology
• An effective medical professional-patient
communication approach to achieve the best
professional outcomes
• One of the multidisciplinary person-centred health
promotion approaches
28

AB CINAR-2017
3.Coaching as a Leadership Approach for self and your Patient:
Learning-Acting-Growing together with every patient
from TRANSACTIONAL to TRANSFORMATION
Focuses on  Current
 Getting out of traps
 Goals and Strategies
 Current and long term
 Goes through breakthrough
 Vision
Emphasizes  personal change  Leadership growth
Offers  models of effective behavior  Models of leadership; in particular co-active
What happens?  Change through cognitive learning and action  Growth through learning, thinking and action
Works with  what is readily apparent  Works with what is on the surface and beneath
Targets  Specific behavioral change  Growth in personal skills and leadership capacities

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WHERE DO WE GO?
DESIGN & IMPLEMENTATION of an INTERNATIONAL PERSON-CENTRED
HEALTH COACHING INTERVENTION
Reorient health care model
Reorient health & social care
service model
HEALTHCOACHING
(EMPOWERMENT&
DEVELOPINGPERSONALSKILLS
&CREATINGASUPPORTING
ENVIRONMENT)
Reorient health education
COACHING A SIGNIFICANT OPPORTUNITY FOR LEADERSHIP

AB CINAR-2017

AB CINAR-2017
Acknowledgements:
• Thanks are due to our patients in Turkey and Denmark for their cooperation.
• We express our deepest thanks to Prof. N. Bagriacik, Head, Turkish Diabetes Association, Associate
Prof. M. Sargin and Head Diabetes Nurse S. Isik, Diabetes Unit, S.B. Kartal Research and Education
Hospital for assistance. Prof. A. Oguz helped prepare the request for ethical permission; Prof. I Oktay
and D. Ilhan provided training for clinical examinations. ZENDIUM gave oral health-care kits,
SPLENDATR for the promotional incentives, ChiBall World Pty Ltd for chi-balls: we thank all of these
and the Danish Dental Hygienist Association for their support.
• We express our thanks to C. Dinesen, Danish Coaching Institute for his support.
• The research is part of a two phase international project: The Turkish phase was supported by FDI
and the International Research Fund of University of Copenhagen. The second phase was in
Denmark, supported by TRYG Fund, the Research Fund of University of Copenhagen and BRIDGES,
an IDF program supported by an educational grant from Lilly Diabetes.

a.cinar@dundee.ac.uk
https://www.linkedin.com/in/ayse-basak-cinar-970027a/

Presentation: Health Coaching for effective diabetes management- World Coaching Congress, 2017

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Presentation: Health Coaching for effective diabetes management- World Coaching Congress, 2017