Elevating LGBTQ+ Health: Principles and Practices for Affirmative Health Coaching.

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.