The service user's motivation is a fundamental element in the success of health promotion services for the elderly [1
]. Service users who proactively participate in the service provider's health programs are better able to maintain or improve their health, and consequently, avoid the need for long-term care prevention program. Therefore, service providers should not only provide good health programs but also encourage service users to proactively participate in such programs. Increasing service users' participation in health promotion programs aimed at preventing the need for long-term care is important.
In Japan, a health care and rehabilitation service for preventing the need for long-term care, called “Long-term Care Prevention,” was established in 2005 [2
]. This service assesses elderly people living at home need to maintain or improve daily functions. The contents of this service are tailored to the user's health condition and include programs for exercise (e.g., stretching, balancing, and muscle building), improvement of oral function, and dietary improvement as well as health consultation and guidance for homebound service users and those with mental disorders such as dementia or depression. During the first year of the program, only 0.05% of the elderly aged 65 years and above participated, far below the estimated 5% [4
]. This low participation rate may be because the elderly did not feel the need for such services or their motivation to participate is low [6
]. Therefore, measures to increase the motivation of users to participate in the long-term care prevention programs are needed. For the long-term care prevention service to succeed, it is important to define the users' daily needs and goals and to tailor the service accordingly [7
The public health nurses (PHNs) who assess the participants' needs and who work with the participants to create an individualized long-term care prevention plan must be able to communicate well enough to help increase the users' motivation to participate. According to Wong et al., communication in the provider-patient relationship is an important determinant in patient satisfaction [8
]. However, no method has yet been developed for motivating elderly people to participate in proactive health programs. Similarly, nor any method has yet been established for improving the communication abilities of PHNs. Consequently, PHNs are ill equipped to communicate with elderly individuals with sensitive or additional needs, particularly those who are depressed or who have lost hope. The PHNs' sense of performance expectancy [9
] regarding their communication abilities needs to be enhanced through a training program that develops their communication abilities so that they can help motivate elderly individuals, particularly those with sensitive or additional needs.
In this study, we developed and implemented a communication skill training program that teaches PHNs to use coaching techniques to help service users achieve their goals. Recently, coaching has been introduced in the field of medicine and has been shown to be effective in areas such as self-management of patients with cardiovascular disease [10
], pain control in cancer patients [11
], pain assessment and management practices of pediatric nurses [12
], negative attitude toward antidepressants of depressive patients [13
], communication skills of pediatricians [14
], support for patients with chronic diseases [15
], and the health behavior of the elderly [17
This study aims to examine the effectiveness of a communication skill training based on a coaching theory for PHNs who were engaged in prevention care management. Specifically, we tested the following two hypotheses: (1) the training improves the PHNs' sense of performance expectancy regarding their communication skills; (2) the training increases the service users' satisfaction with the PHNs and their spontaneous behavior in their daily livings.