Implementation and evaluation of a health coaching–based patient-centred communication intervention in primary dental care: a mixed-methods study

Abstract Background Patient-centred communication (PCC) is fundamental to improving oral health outcomes; however, its implementation in primary dental care remains limited in many low- and middle-income countries. Health coaching (HC) has emerged as a promising strategy to facilitate patient-centred behaviour change communication (PCBCC) and strengthen clinician–patient interactions. This study explored the feasibility and application of HC in enhancing PCC during primary dental care consultations in Malawi. Objective To explore and evaluate the application of HC in enhancing patient-centred communication in primary dental care settings in Malawi. Methods A convergent mixed-methods pre–post study design was conducted with HC implemented as the intervention. Oral health professionals (OHPs) registered with the Medical Council of Malawi and practising in primary dental care, together with their patients, were recruited from Queen Elizabeth Central Hospital, Blantyre, Malawi, between 2020 and 2022. OHPs received HC training delivered by a certified European Mentoring and Coaching Council coach. Originally planned for three months, training was extended due to the COVID-19 pandemic. Two three-hour online sessions per week were delivered between January and May 2021 via Zoom. Facebook and WhatsApp group interaction pages were also used by the trainer to post questions and training exercises for OHPs. OHP–patient consultations were video-recorded at baseline and post-intervention. Communication behaviours were quantitatively assessed using the Four Habits Coding Scheme (4 H). Qualitative data were collected through focus group discussions and in-depth interviews to explore OHPs’ post-intervention experiences. Quantitative and qualitative data were analysed independently and integrated during interpretation. Results Post-training, HC was found to be associated with a shift in dental consultations toward more person-centred, behaviour change–focused communication and increased shared decision-making. Paired-samples t-test was used to assess such changes in PCBCC scores within the 4 H. Categorical outcomes of the 4 H, including the presence or absence of specific behaviours within Habits 1, 2, and 4, analysed using McNemar’s test for paired binary comparisons also revealed such changes. Mixed-methods triangulation indicated improvements in patient-based communication and consultation structure, although quantitative findings were limited by small sample size and high attrition. Qualitative data supported these trends, suggesting greater engagement and relational depth in consultations post-training. However, results should be interpreted cautiously due to contextual constraints, potential measurement limitations, adaptations to training delivery and small sample size. Conclusion HC training was feasible and showed potential to enhance patient-centred communication in primary dental care in Malawi. Despite methodological limitations, HC appears to be a promising approach to support behaviour change communication and strengthen oral health service delivery. Larger, controlled studies are recommended to confirm and extend these findings.