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醫(yī)言E語是由南方醫(yī)科大學外國語學院師生創(chuàng)辦的醫(yī)學專業(yè)和外語學習公眾號，專注于人體系統(tǒng)、疾病及治療、醫(yī)學文章等內容推介。

我們將每日推介一篇醫(yī)言E語公眾號內的文章，并在文章后面的學習討論區(qū)展示譯聯(lián)大學黃埔學院學員們的相關精彩評論~

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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（健康訓練）include self-management interventions（自我管理干預）and integrated care/complex interventions（綜合護理/復合干預）. 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（多中心試驗）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（動機性面談）, a strategy that incorporates client-centered communication style（當事人中心交流法）, 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（系統(tǒng)評價）underline significant heterogeneity among these definitions. One of the earliest (2003) stated that health coaching was “the practice of health education and health promotion（健康促進）within a coaching context, to enhance the wellbeing of individuals（個體健康水平）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（協(xié)同效應）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, “l(fā)ifestyle 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（內置問責制工具）to allow patients to self-manage toward the goal or goals they have set.

Glossary

integrated care綜合護理

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多中心試驗

A multicenter research trial is a clinical trial conducted at more than one medical center or clinic.

motivational interviewing動機性面談

Motivational Interviewing is a method that works on facilitating and engaging intrinsic motivation within the client in order to change behavior.

systematic review 系統(tǒng)評價

A systematic review is a type of literature review that collects and critically analyzes multiple research studies or papers.

synergy['s?n?d?i] 協(xié)同效應

Synergy is the creation of a whole that is greater than the simple sum of its parts

accountability[?,ka?nt?'b?l?ti] 問責制

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.

本部分內容轉載自醫(yī)言E語公眾號

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討論學習區(qū)

試譯譯文

什么是健康指導？

健康指導對比其他干預

其他干預包括自我管理干預以及綜合護理/復合干預,與健康指導遵循著同樣的原則。所有這些方式的目的在于激發(fā)，鼓勵和支持患者更好管理自身疾病，采取積極的健康行為。這需要患者以及患者親屬與一到多個衛(wèi)生保健提供者之間的一個迭代交互過程。

幾十年前，首次關于自我管理干預的多中心實驗針對的是慢性阻塞性肺疾病 （ COPD ），采用的方法有持續(xù)溝通以及衛(wèi)生保健專業(yè)人士為病人提供指導，結果顯示在1年內和2年內住院情況有顯著減少。此后，進行了多次實驗，雖然在許多方面存在差異，但這些實驗都顯示出對 COPD 患者的各種臨床結果是有影響的。

在本質上，健康指導方案和自我管理干預都是以行為改變?yōu)槟繕说?。要讓病人能夠對重大醫(yī)療決策負起責任并積極參與行動，這就需要專業(yè)健康護理人員以指導者或病例管理者的角色進行協(xié)作，利用行為改變技術調動患者積極性、增強患者的自我效能和技能。另外，在健康指導和自我管理干預中通常都會用到動機性面談，這是一種囊括了當事人中心交流法的策略。

健康指導定義

想要了解什么是健康指導，則需要回顧一些定義。近期的系統(tǒng)評價強調了這些定義的顯著差異。最早（2003年）的定義中有一條認為健康指導是 "依據(jù)指導方案，開展健康教育和健康促進， 以提高個體健康水平，促進其健康方面的目標的達成"。這一定義也提到了一些更早期的理念，這些早期理念作為動機性面談的基礎， 最初被用來治療成癮行為。

此處定義的健康指導包含了一個重要的概念——健康促進，這個概念通常描述為“幫助人們發(fā)現(xiàn)自身核心信念和最佳健康狀況之間協(xié)同效應”的藝術和科學， 增強他們追求最佳健康狀況的動力， 并且支持他們改變其生活方式朝著最佳健康狀況不斷進步。

從健康促進的角度來看， "促進生活方式的改變可以結合一些有助于加強意識，增強積極性，獲得技能的學習，并且最重要的一點是利用一切機會，創(chuàng)造積極健康支持的環(huán)境"。這一定義強調了生活方式的變化需要的不僅僅是單一的教育，更重要的是患者的信念。學習同時也是一種自我發(fā)現(xiàn)， 是大多數(shù)已發(fā)表的指導方案中的一個組成部分。

最近有人指出，只有在 "客戶調動內部力量和外部資源來促進可持續(xù)變化" 的時候， "身心健康指導" 才能夠成功，同時也強調了多數(shù)時候是在病人的委托下才會需要調動這兩種資源 (內部和外部)去獲得效益。因為這個過程應該以患者為中心， 并且旨在實現(xiàn)患者自身確定的目標，所以大多數(shù)方案都提供了內置問責制工具，以使患者能夠自我管理實現(xiàn)自身確定的一個或者多個目標。

試譯譯文僅供參考

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學員評論

譯后感：這應該算是一篇教學類的文章。解釋health coaching 這個概念的。

疑問超級多的一篇的試譯稿子，雖然借助了機翻，但是發(fā)現(xiàn)很多地方都要進行修改。 尤其是概念性的表達，需要很多的查閱和比對。感覺稍微偏差，疑問可能就另外一個概念了，錯誤的概念大概會讓專業(yè)人士誤入歧途吧。第一次感到翻譯的責任。

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