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The Future of Health Coaching: Inclusivity - Understand the Essentials

Updated: Aug 12, 2023




An Inclusive Health Coach designs their coaching practice to create an environment that is sensitive to justice, equity, diversity, and inclusion issues as it relates to health inequities. They ask, "How can I honor my patient’s unique story?” and help them discover answers within themselves that are true to their beliefs and values.


Inclusivity creates environments where individuals feel welcome, safe, and comfortable no matter who they are. Inclusivity gives people a voice and ways to feel valued regardless of race, ethnicity, religion, size, gender, ability, sexual orientation, or socioeconomic status, to name a few.


Research shows that workplaces thrive when they are inclusive and decline when they aren’t. Boston Consulting Group reveals that inclusive workplaces increase productivity by 40%, improving collaboration. Employees are thirteen times more likely to quit or change jobs without inclusivity. It follows suit that the health coaching industry will thrive when it becomes more inclusive.


The health coaching industry is dominated by white middle to upper-middle-class professionals. Here are the basic statistics:

White66.1%Hispanic or Latino14.3%Black or African American10.6%Asian4.4%Unknown4.0%American Indian and Alaska Native0.6%



Which Populations Remain Underserved?


Large population groups remain marginalized in healthcare, which trickles down to the coaching profession. Coaches, just like any other healthcare profession, and for that matter, any industry, must ask themselves who they include in their coaching practice. Here are ways to define potential categories of exclusion:


Gender/Gender Identity

In time, the social construction of concepts such as masculinity and femininity in a specific culture. It involves gender assignment (the gender designation of someone at birth), gender roles (the expectations imposed on someone based on their gender), gender attribution (how others perceive someone’s gender), and gender identity (how someone defines their own gender). Fundamentally different from the sex one is assigned at birth.

One’s internal, personal sense of their own gender. Since gender is a social construct, an individual may have a self-perception of their gender that is different or the same as their assigned gender or sex at birth. Gender identity is an internalized realization of one’s gender that may not manifest in their outward appearance (gender expression) or their place in society (gender role). It is important to note that an individual’s gender identity is completely separate from their sexual orientation or sexual preference.


LGBTQIA+

This acronym stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and more. It’s important to note that Violet’s benchmarking framework addresses LGBQ and TGNC communities separately; however, we often use LGBTQIA+ as an umbrella term in blog posts or more. Other appropriate terms: LGBQ (Lesbian, Gay, Bisexual, Queer), LGBTQ (Including Transgender), LGBTQIA2+ (including two-spirit), Queer (for some, this term might invoke historically negative associations), GSM (Gender and Sexual Minorities),


Socioeconomic Status

A way of describing people based on their education, income, and type of job. Socioeconomic status is usually described as low, medium, and high. People with a lower socioeconomic status usually have less access to financial, educational, social, and health resources than those with a higher socioeconomic status. As a result, they are more likely to be in poor health and have chronic health conditions and disabilities.


Size

Individuals that are a size larger than what societal expectations deem appropriate experience discrimination or prejudice because of their size and especially because of their weight.


Sexual orientation

The nature of an individual’s physical, romantic, emotional, or spiritual attraction to another person. Gender identity and sexual orientation are not the same. Transgender and gender-variant people may identify with any sexual orientation, and their sexual orientation may or may not change before, during, or after gender transition.


Race

is a social construct used to group people. Race was constructed as a hierarchical human-grouping system, generating racial classifications to identify, distinguish and marginalize some groups across nations, regions, and the world. Race divides human populations into groups, often based on physical appearance, social factors, and cultural backgrounds.


Ethnicity

or ethnic group is a grouping of people who identify with each other on the basis of perceived shared attributes that distinguish them from other groups. Those attributes can include common sets of traditions, ancestry, language, history, society, nation, religion, or social treatment within their residing area. Often, these categories intersect, requiring even more sensitivity from all practitioners, including health coaches.


“Wellness isn’t for anyone, if it isn’t for everyone.”

Fariha Roisin


Author and inclusive wellness advocate Fariha Roisin argues that we don’t need wellness, “We need a justice-based ethos of reciprocity, compassion, and care.” (Chan-Malik, 2022)


Inclusive Health Coaching Answers the Call for Prevention


Inclusive health coaching will give you the tools and knowledge to serve more diverse and marginalized populations based on:

Race

Ethnicity

Gender/Gender Identity

Age

National origin

Religion/No Religion

Ability

Sexual orientation

Size

Socioeconomic status

Education

Marital status

Other identities


The inclusive health coaching values feature:


  • Training future health coaches committed to improving health equity

  • Confronting and dismantling systemic oppression, the white supremacy myth, ableism/stigma, colonialism, white-centric health care models and coaching practices

  • Landback, Indigenous Sovereignty, Black Liberation, Fat Acceptance, Neurodiversity, Universal Design, and Intersectional Justice

  • Life-long learning

  • Imperfections

  • Being action-oriented while collectively educating, striving for accountability, and healing

  • Empathy, unconditional positive regard, and the inherent worth of all individuals in this world

Health Coaches Ensure Linguistic Access, Cultural Sensitivity, and Cultural Humility


The health coaching industry can follow models of successful community intervention used by coaches employed in the medical industry. For example, the Medicare Advantage Plan, founded in 1977 by seniors, has served over 270,000 low-income beneficiaries in California, Arizona, Nevada, and Texas. Headquartered in Long Beach, Ca, the program motto is LEARN-INTERVENE-MONITOR. (Scan Health Plan 2022, pp. 2,9). It operates on a foundational principle: “Building trust requires different acts across different communities. Insights into problems produce actions that yield results. (Scan Health Plan 2022, p.11). The scan program delivered services successfully to lower socioeconomic groups, including BIPOC, by homing in on key aspects of trust-building through listening. The points are well worth adapting to coach training and coaching practices. See their strategy below.


Building Trust Depends on Listening

The study revealed that providers must listen to their patients/members. Recommendations included:

  • Listen to members rather than challenge or ignore a member’s reality

  • Establish trust first, then have conversations about medications

Language and Culture Matter

Researchers discovered that members do not feel heard when uncomfortable with provider communication. They discuss health more openly when communication is culturally familiar and in their preferred language. Therefore, effective provider relationships depend on the following:

  • Pairing members with staff familiar with a patient’s language and culture and using familiar vocabulary

  • Providing materials in relatable visuals and preferred languages

Respect & Humility Matter

Humility solidifies the patient/coach relationship. The study proved that members only engage openly if they feel respected and included.

  • It is imperative to use endearing words and tone and continually validate member participation

  • The family/caregiving system needs acknowledgment. Greater medication and recommendation acceptance occurred when involving and thanking the caregiver

Health Communication Is Vital Between Providers and Patients

The study demonstrated that patients do not take medications appropriately when they do not understand their importance. When they internalize medication’s importance, their adherence to medication routines increases.

  • Coaches can apply findings from the Scan study to enhance their trust and rapport with patients to improve patient outcomes ultimately. To summarize, coaches must:

  • Cultivate listening as a form of trust

  • Integrate a patient’s feeling excluded or underserved into the coach/patient dialogue

  • Provide inclusive resources if a patient requests more information

  • Honor each individual's culture and the intersectionality of their individual experiences through unconditional positive regard

  • Acknowledge, validate, and use an accepting tone and body language.

  • Learn and practice cultural humility

  • Spread awareness of free and low-cost services, help patients connect to them, and promote low-cost wellness resources

  • Encourage screening tools if working in a healthcare system that allows patients of all sizes, socioeconomic levels, BIPOC, and LQBTQ+ communities to find required resources. (Scan Health Plan 2022, p.11).


Cultural Competence versus Cultural Humility


“Being culturally humble means I am willing to learn.”

Joe Gallager

Cultural humility is a lifelong practice. Many people confuse cultural competence with cultural humility. They are different. Cultural competency means that someone can function through another culture’s mores and beliefs. However, knowing about a culture does not guarantee competence in practicing within a particular culture, and competency indicates there is an endpoint or place where you have reached full competency, which is not the case when it comes to cultural understanding. That is why cultural humility and cultural competence must go hand in hand.


Cultural humility means knowing a culture other than one’s own is impossible. Humility does not mean being weak or meek. It signifies being clear about and admitting one’s limitations due to accurate self-assessment. All of us have knowledge gaps. Theoretically, anyone can become open to innovative ideas, resolve conflicting viewpoints and perceptions, and receive advice. Cultural humility means grasping and applying all knowledge to help correct power imbalances. Keeping an open mind and remaining respectful is central to the practice. (Lekas, M., Pahl, K., & Lewis, C. F., 2019)


Relationships between employees/employers, faith leaders/faith organization members, and therapists/patients revealed similar data. For instance, humility comes under the greatest scrutiny when a person is under strain; it reveals itself when they can self-regulate. Just like a muscle, without practice, humility atrophies; however, it becomes strengthened by regular “exercise.”


Higher levels of humility increase health outcomes. Navigating differences can be stressful, yet humility buffers it. Sometimes this is called the “Health Hypothesis,” demonstrating humility leads to positive long-term health outcomes. Those who do not practice humility have more difficulty forming and repairing social bonds. (Emerson Davis Jr. & Hook, 2013)


Humility rests at the core of the ability to coach diverse individuals through an inclusion lens. Inclusion is the heart of our program. Having the confidence to coach anyone and authentically connect with those that are different from you is priceless.


Chan-Malik, Sylvia, “Wellness is something we all want. How has it become a luxury? Washington Post, July 25, 2022, 8:00 a.m. EDT


Emerson Davis Jr., Don, and Joshua N. Hook, “Measuring Humility and Its Positive Effects,” September 30, 2013, Seen on: https://www.psychologicalscience.org/observer/measuring-humility-and-its-positive-

effects


Lekas, M., Pahl, K., & Lewis, C. F. (2019). “Rethinking Cultural Competence: Shifting to Cultural Humility.” Health Services Insights, 13. https://doi.org/10.1177/1178632920970580


Lorenzo, Rocio, and Martin Reeves, “How and Where Diversity Drives Financial Performance” Harvard Business Review, January 30, 2018, Seen on: https://hbr.org/2018/01/how-and-where-diversity-drives-financial-performance, May 6, 2023.


Scan Health Plan, Reducing Racial Disparities in Medication Adherence, 2022.



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