{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:11:23Z","timestamp":1789150283797,"version":"build-2803163510"},"reference-count":11,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Health Promotion Practice"],"abstract":"<jats:p>LGBTQ+ populations experience persistent mental and physical health disparities driven by minority stress and structural inequities that increase their risk for chronic disease. Health coaching is well positioned to support behavior change in these populations; however, when not delivered in an affirming manner, coaching practices may replicate bias, undermine engagement, and limit effectiveness. We provide a framework for LGBTQ+ affirmative health coaching that integrates minority stress theory, self-determination theory, and health equity models to identify mechanisms through which structural conditions shape behavior change processes. We propose six core principles and corresponding practices that operationalize affirming coaching across relational, behavioral, and environmental domains, including identity-affirming communication, minority stress-informed reframing, autonomy-supportive goal setting, resilience and social support development, inclusive environment design, and advocacy within and beyond the coaching relationship. In addition, we present recommended revisions to National Board for Health and Wellness Coaching (NBHWC) competencies to shift from general cultural awareness toward observable, equity-oriented skills that support engagement, agency, and continuity of care. Our framework positions affirming health coaching as a mechanism for advancing health equity by aligning behavior change strategies with the structural and psychosocial conditions shaping LGBTQ+ health.<\/jats:p>","DOI":"10.1177\/15248399261485284","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T09:29:21Z","timestamp":1788946161000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevating LGBTQ+ Health: Principles and Practices for Affirmative Health Coaching"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4603-5104","authenticated-orcid":false,"given":"Alex","family":"Higgins","sequence":"first","affiliation":[{"name":"California Institute of Integral Studies, San Francisco, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0845-0252","authenticated-orcid":false,"given":"Megan","family":"Lipsett","sequence":"additional","affiliation":[{"name":"California Institute of Integral Studies, San Francisco, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"e_1_3_2_2_1","first-page":"33","article-title":"Self-determination theory: When mind mediates behavior","volume":"1","author":"Deci E. L.","year":"1980","unstructured":"Deci E. L., Ryan R. M. (1980). Self-determination theory: When mind mediates behavior. Journal of Mind and Behavior, 1, 33\u201343.","journal-title":"Journal of Mind and Behavior"},{"key":"e_1_3_2_3_1","doi-asserted-by":"crossref","unstructured":"Denneson L. M. Ono S. S. Trevino A. Y. Kenyon E. Dobscha S. K. (2020). The applicability of self-determination theory to health coaching: A qualitative analysis of patient experiences. Coaching: An International Journal of Theory Research & Practice 13(2) 163\u2013175. https:\/\/doi.org\/10.1080\/17521882.2019.1673457","DOI":"10.1080\/17521882.2019.1673457"},{"key":"e_1_3_2_4_1","doi-asserted-by":"crossref","unstructured":"Fredriksen-Goldsen K. I. Simoni J. M. Kim H.-J. Lehavot K. Walters K. L. Yang J. Hoy-Ellis C. P. Muraco A. (2014). The health equity promotion model: Reconceptualization of lesbian gay bisexual and transgender (LGBT) health disparities. American Journal of Orthopsychiatry 84(6) 653\u2013663. https:\/\/doi.org\/10.1037\/ort0000030","DOI":"10.1037\/ort0000030"},{"key":"e_1_3_2_5_1","doi-asserted-by":"crossref","unstructured":"Heck N. C. Flentje A. Cochran B. N. (2013). Intake interviewing with lesbian gay bisexual and transgender clients: Starting from a place of affirmation. Journal of Contemporary Psychotherapy 43(1) 23\u201332. https:\/\/doi.org\/10.1007\/s10879-012-9220-x","DOI":"10.1007\/s10879-012-9220-x"},{"key":"e_1_3_2_6_1","doi-asserted-by":"crossref","unstructured":"Logie C. H. Lys C. L. Dias L. Schott N. Zouboules M. R. MacNeill N. Mackay K. (2019). \u201cAutomatic assumption of your gender sexuality and sexual practices is also discrimination\u201d: Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada. Health & Social Care in the Community 27(5) 1204\u20131213. https:\/\/doi.org\/10.1111\/hsc.12757","DOI":"10.1111\/hsc.12757"},{"key":"e_1_3_2_7_1","first-page":"252","volume-title":"Handbook of psychology and sexual orientation","author":"Meyer I. H.","year":"2013","unstructured":"Meyer I. H., Frost D. M. (2013). Minority stress and the health of sexual minorities. In Patterson C. J., D\u2019Augelli A. R. (Eds.), Handbook of psychology and sexual orientation (pp. 252\u2013266). Oxford University Press."},{"key":"e_1_3_2_8_1","doi-asserted-by":"crossref","unstructured":"Mink M.D. Lindley L. L. Weinstein A. A. (2014). Stress stigma and sexual minority status: The intersectional ecology model of LGBTQ health. Journal of Gay & Lesbian Social Services 26(4) 502\u2013521. https:\/\/doi.org\/10.1080\/10538720.2014.953660","DOI":"10.1080\/10538720.2014.953660"},{"key":"e_1_3_2_9_1","unstructured":"National LGBTQIA+ Health Education Center. (2024). https:\/\/www.lgbtqiahealtheducation.org\/"},{"key":"e_1_3_2_10_1","doi-asserted-by":"crossref","unstructured":"Romanelli M. Hudson K. D. (2017). Individual and systemic barriers to health care: Perspectives of lesbian gay bisexual and transgender adults. American Journal of Orthopsychiatry 87(6) 714\u2013728. https:\/\/doi.org\/10.1037\/ort0000306","DOI":"10.1037\/ort0000306"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.56021\/9781421438795"},{"key":"e_1_3_2_12_1","doi-asserted-by":"crossref","unstructured":"Wolever R. Q. Simmons L. A. Sforzo G. A. Dill D. Kaye M. Bechard E. M. Southard M. E. Kennedy M. Vosloo J. Yang N. (2013). A systematic review of the literature on health and wellness coaching: Defining a key behavioral intervention in healthcare. 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