Exploring facilitators and barriers to long-term behavior change following health–wellness coaching for stroke prevention: A qualitative study conducted in Auckland, New Zealand

Abstract

Introduction: Health–wellness coaching (HWC) has grown in popularity as a means of empowering individuals to take responsibility for their health behavior and make lifestyle changes to reduce their risk of stroke. Understanding the facilitators and barriers to long-term behavior change is key if preventive strategies such as HWC are to be robust and effective. This study aimed to explore the experiences of people at risk of stroke after receiving HWC for stroke prevention, specifically the facilitators and barriers to long-term behavior change from the perspective of study participants. Methods: All participants received HWC as part of a randomized controlled trial 3 years earlier. Semi-structured telephone interviews were conducted with eight participants from the trial sample. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to identify key concepts and themes. Results: Three overarching themes were identified: “Awakening of the mind” captured the importance of seeing the bigger picture, recognizing the impact of potential disease and using skills and tools to support decision-making. “It's not just about health behavior” conveyed the importance of being respectfully responsive to individual need and addressing emotional well-being alongside physical health. “Social connectedness” encapsulated the significance of community engagement, accountability, and paying it forward. Conclusions: Enhancing awareness of personal risk and the impact of potential disease are facilitators of long-term behavior change and should be incorporated into coaching conversations. This supports the process of “waking up” to health needs and the possibility of change, which are important precursors to long-term change. Health coaching should be responsive to individual need, with emotional well-being, happiness, and life satisfaction being addressed alongside physical health. The opportunity to develop skills to support decision-making and self-management should be included in coaching initiatives, to enhance self-efficacy and help facilitate long-term behavior change.