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文章推介
What Is Health Coaching
Health Coaching VS Other Interventions
Other interventions sharing some principles of health coaching（健康训练）include self-management interventions（自我管理干预）and integrated care/complex interventions（综合护理/复合干预）. All these approaches require a process of iterative interactions between patients and/or relatives and from one to multiple healthcare providers with the goals of motivating, engaging, and supporting the patients to better manage their disease and adopt healthy behaviors.
Decades ago, the first multicenter trial（多中心试验）on self-management intervention dedicated to COPD with continuous communication and coaching of the patients by a healthcare professional demonstrated significant reduction in hospital admission（入院）at one year and at 2 years. Although heterogeneous in many aspects, several trials since then have been found to be effective on various clinical outcomes in patients with COPD（慢性阻塞性肺疾病）.
Fundamentally, health coaching programs and self-management interventions are both targeting behavior changes. For patients to be able to assume greater responsibility for healthcare decisions and actively engage in behaviors, they need the collaboration of healthcare professionals who act as a coach or case-manager. Behavior change techniques are used to elicit patient motivation, self-efficacy and skills. Motivational interviewing（动机性面谈）, a strategy that incorporates client-centered communication style（当事人中心交流法）, is often used in health coaching as well as in self-management interventions.
Definitions of Health Coaching
Understanding what is health coaching requires going back to some definitions. Recent systematic reviews（系统评价）underline significant heterogeneity among these definitions. One of the earliest (2003) stated that health coaching was “the practice of health education and health promotion（健康促进）within a coaching context, to enhance the wellbeing of individuals（个体健康水平）and to facilitate the achievement of their health-related goals”. This definition alludes to earlier concepts that formed the basis of motivational interviewing and were initially used to treat addictions.
Health promotion, an important component of health coaching in the definition given here, can be described as “the art and science of helping people discover the synergies（协同效应）between their core passions and optimal health, enhancing their motivation to strive for optimal health, and supporting them in changing their lifestyle to move toward a state of optimal health.”
From a health promotion perspective, “lifestyle change can be facilitated through a combination of learning experiences that enhance awareness, increase motivation, and build skills and, most important, through the creation of opportunities that open access to environments that make positive health practices the easiest choice”. This definition underlines that lifestyle changes need more than “simple” education: motivation is crucial too. Learning experience also refers to self-discovery, a component present in most published coaching programs.
Recently, it has been stated that “health and wellness coaching” can be successful when the “clients mobilize internal strengths and external resources for sustainable change”, emphasizing the two types of resources (internal and external) required to be mobilized to achieve benefit, mostly through patients’ empowerment. Because the process should be patient-centered and aim at achieving self-determined goals, most programs provide built-in accountability tools（内置问责制工具）to allow patients to self-manage toward the goal or goals they have set.
Glossary
integrated care综合护理
Integrated care is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. It may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems.
self-management自我管理
Self-management refers to self care, individual control of health care.
multicenter trial多中心试验
A multicenter research trial is a clinical trial conducted at more than one medical center or clinic.
motivational interviewing动机性面谈
Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior.
systematic review 系统评价
A systematic review is a type of literature review that collects and critically analyzes multiple research studies or papers.
synergy['sɪnɚdʒi] 协同效应
Synergy is the creation of a whole that is greater than the simple sum of its parts
accountability[ə,kaʊntə'bɪləti] 问责制
Accountability is the acknowledgment and assumption of responsibility for actions, products, decisions, and policies including the administration, governance, and implementation within the scope of the role or employment position and encompassing the obligation to report, explain and be answerable for resulting consequences.
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什么是健康指导？
健康指导对比其他干预
其他干预包括自我管理干预以及综合护理/复合干预,与健康指导遵循着同样的原则。所有这些方式的目的在于激发，鼓励和支持患者更好管理自身疾病，采取积极的健康行为。这需要患者以及患者亲属与一到多个卫生保健提供者之间的一个迭代交互过程。
几十年前，首次关于自我管理干预的多中心实验针对的是慢性阻塞性肺疾病 （ COPD ），采用的方法有持续沟通以及卫生保健专业人士为病人提供指导，结果显示在1年内和2年内住院情况有显著减少。此后，进行了多次实验，虽然在许多方面存在差异，但这些实验都显示出对 COPD 患者的各种临床结果是有影响的。
在本质上，健康指导方案和自我管理干预都是以行为改变为目标的。要让病人能够对重大医疗决策负起责任并积极参与行动，这就需要专业健康护理人员以指导者或病例管理者的角色进行协作，利用行为改变技术调动患者积极性、增强患者的自我效能和技能。另外，在健康指导和自我管理干预中通常都会用到动机性面谈，这是一种囊括了当事人中心交流法的策略。
健康指导定义
想要了解什么是健康指导，则需要回顾一些定义。近期的系统评价强调了这些定义的显著差异。最早（2003年）的定义中有一条认为健康指导是 "依据指导方案，开展健康教育和健康促进， 以提高个体健康水平，促进其健康方面的目标的达成"。这一定义也提到了一些更早期的理念，这些早期理念作为动机性面谈的基础， 最初被用来治疗成瘾行为。
此处定义的健康指导包含了一个重要的概念——健康促进，这个概念通常描述为“帮助人们发现自身核心信念和最佳健康状况之间协同效应”的艺术和科学， 增强他们追求最佳健康状况的动力， 并且支持他们改变其生活方式朝着最佳健康状况不断进步。
从健康促进的角度来看， "促进生活方式的改变可以结合一些有助于加强意识，增强积极性，获得技能的学习，并且最重要的一点是利用一切机会，创造积极健康支持的环境"。这一定义强调了生活方式的变化需要的不仅仅是单一的教育，更重要的是患者的信念。学习同时也是一种自我发现， 是大多数已发表的指导方案中的一个组成部分。
最近有人指出，只有在 "客户调动内部力量和外部资源来促进可持续变化" 的时候， "身心健康指导" 才能够成功，同时也强调了多数时候是在病人的委托下才会需要调动这两种资源 (内部和外部)去获得效益。因为这个过程应该以患者为中心， 并且旨在实现患者自身确定的目标，所以大多数方案都提供了内置问责制工具，以使患者能够自我管理实现自身确定的一个或者多个目标。
试译译文仅供参考
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学员评论
译后感：这应该算是一篇教学类的文章。解释health coaching 这个概念的。
疑问超级多的一篇的试译稿子，虽然借助了机翻，但是发现很多地方都要进行修改。 尤其是概念性的表达，需要很多的查阅和比对。感觉稍微偏差，疑问可能就另外一个概念了，错误的概念大概会让专业人士误入歧途吧。第一次感到翻译的责任。
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