Aromatherapy: Six Easy, Affordable Ways to a Happier, Healthier Winter

At this time of year, it’s easy to let stress get the best of us. And while there are a myriad of chemical and pharmaceutical remedies for our problems, aromatherapy offers a natural, effective and pleasurable way to bolster our health, happiness and well-being. Below are six simple ways to combat fatigue, stress and winter illness using two common and affordable essential oils: lavender oil, with its soothing and calming qualities, and eucalyptus oil, with the power to clear the head and relieve muscle tension. These essential oil remedies will leave you feeling refreshed, relaxed and energized—naturally!

1. De-stress bath to help unwind at any time: Add eight to 10 drops of lavender oil to a full warm bath and agitate to disperse. Lie back for 10 to 15 minutes and let the cares of the day gently ebb away. To soften the skin, add a cup of full-fat milk to bath water.

2. Rejuvenating steam facial to refine and detoxify pores: Add four drops of lavender oil to a bowl of hot water, and then place a towel over the head and steam for up to five minutes.

3. Tranquil meditation for quiet time and focus:Add six to eight drops of lavender oil to your favorite vaporizer. Alternatively, add to a tissue and breathe deeply to fully inhale the calming aroma. For best results, wear loose clothing, warm the room and dim the lights.

4. Winter inhalation to relieve a blocked nose: Add four drops of eucalyptus oil to a bowl of hot water, and then place a towel over the head and inhale for up to five minutes. For added benefit, place a few rosemary sprigs into the water.

5. Relaxing foot bath to relieve tired toes: Add six drops of eucalyptus oil to a bowl of warm water/foot spa and soak for 15 minutes. For added benefit, add half a cup of Epsom salt to water.

6. Muscle-reviving bath for overexertion: Add eight to 10 drops of eucalyptus oil to a full warm bath and agitate to disperse fully. Lie back for 10 to 15 minutes and let muscle tension ebb away.

Marketing Gift Certificates for the Holidays

The fall and winter seasons are the busiest time for many massage therapists. Gift-certificate sales can be brisk for the holidays, and massage therapists may see more new clients compared to any other time of the year.

Although you can’t directly charge for your services as a student, you can still receive valuable experience marketing gift certificates. Experimenting with gift-certificate promotions can do a number of things for you as you look toward building your practice.

1. It will get people in the habit of thinking of your services as a wonderful gift.
2. When people come to see you with a gift certificate, it helps you build your list of contacts and potential clients.
3. By learning how to market gift certificates now, you won’t lose valuable time learning this skill once your practice is up and running.
4. You’ll make mistakes, learning what to do and, maybe more importantly, what not to do.
5. It will help you learn how to talk to clients about how you can help them as well as other people they know.

As many massage therapists will tell you, speaking to clients about booking their next session or buying a gift certificate can feel awkward in the beginning. “I’m a massage therapist, not a salesperson,” you might say. While this may be correct, it is also true that if you care about clients feeling better, you will encourage them to receive bodywork. This goes for their friends and family, too.

Create a gift-certificate promotion
How do you express the idea that giving a gift certificate is giving the gift of health?

1. Start by researching why people seek massage. Ask your friends or clinic clients why they carve time from their schedules to receive massage. Listen carefully. They are giving you clues to what motivates people to get massage—and, consequently, to buy gift certificates for other people.
2. Link those concerns to the benefits of what you do. Here are some examples of complaints massage therapists frequently hear:

• I’m stressed to the max.
• My back (neck, feet, shoulders) hurt.
• I’m exhausted and drained.

3. Now draw the conclusion: Massage can help reduce pain, relieve stress and help people feel better as a whole. The secret is you have to tell them that.

Practice marketing at the clinic
Give yourself a practice marketing assignment at your student clinic.

1. When appropriate, gently remind clients gift certificates are available.
2. Ask if you can put up a gift-certificate display. On it, display the clinic’s gift certificates along with messages that will speak to the clinic’s clientele. Adjust the messages below to echo the concerns you heard from your clients.
   a. We live in a fast-paced world. To keep going, the people you care for need a time and space to let go. Give the gift of massage.
   b. Lighten up for the holidays. If your special someone has not been feeling his best, make the holidays better for everyone. Give him (or her!) the gift of massage.
   c. Have a friend or loved one in pain? Give the comfort of massage therapy.
   d. Reduce your holiday shopping stress. Give a beautiful gift certificate to a friend or loved one.
3. Market clinic gift certificates online, using some of the same messages you used in your display.

Practice using gift certificates on your own
If you are doing practice massage before receiving your license, consider offering friends and family members a chance to give the gift of your services to others—for no charge, of course. Make or purchase gift certificates. Give them to some of the people you have practiced on, but be selective. Give them to people you enjoy working on, either because they respond well to your favorite techniques or because you are especially able to help them with their particular challenges. These are the people who are most likely to use gift certificates, and who are most likely to pass them on to other people who will respond well to your work.

Gift certificates are basic to marketing bodywork at the holidays, and that goes for Valentine’s Day and Mother’s Day, too. Get a jump-start on understanding marketing gift certificates. Do what you can to practice now, so you have the skills later as you begin to build your practice.

Marketing Massage with Postcard Mailings

As you begin to establish your practice, you’ll be focused on how to get more people on your massage table. Most of them will like what you do so much they’ll come back. These are the people who will be your bread and butter, and to keep them scheduling, you should stay in touch with them between sessions.

Postcard mailings are an effective and inexpensive way to do this. Postcards are more likely to be read and kept than other kinds of mail, and they are also likely to be passed on to others, supporting the word-of-mouth marketing so many massage therapists depend on.

What to do with postcards
Using postcards, you can send discount coupons, appointment reminders, session follow-ups, quick informal notes, announcements for events or specials—almost anything. Postcard are also a great way to let your clients and associates know they are important, so send postcards wishing a happy birthday, thanking them for a referral or following up with some information you promised. Also, if you want to make an announcement, such as introducing your new practice, adding a new service or reminding people you have gift certificates available for the holidays, a quick postcard will keep everyone up to date.

Focus your message
David Walker, a massage therapist who has marketed his practice in numerous ways, believes postcards are an inexpensive way to stay in touch. He adds highly focused postcard promotions work exceptionally well for him.

Not long ago, Walker created three promotions:

• An afternoon special for clients with flexible schedules.
• A “get back on the table” message to inactive 9-to-5ers.
• A discount offer to his inactive house-call clients.

From experience, Walker found that giving a percentage discount doesn’t get much of a response. What does work is such a message as, “Buy a 60-minute massage, get 30 minutes FREE.” (He’s a big believer in all caps.) Walker says, “The message you put out is important. If it doesn’t work, something was probably wrong with the wording.”

Reward your referrals
Seventy percent of people in the U.S. are significantly more inclined to buy something recommended to them by family or a friend. Positive word-of-mouth support from your clients to their friends and family provides the best advertising for your practice.

At her massage and Reiki business, Victoria Hux piles a stack of “Thank you for your referral” postcards on the office desk, so every therapist has access to them. When a new client has been referred by another client, the therapist will mail her a postcard with a $10 discount offer. The client who made the referral then comes in for an appointment with the discount card in hand.

Clients really respond to the program, Hux says. “It’s about the same overall cost as an ad in area papers,” she says, “but it’s more effective because Mrs. Smith is spreading the word about her satisfaction with my service.”

Postcard essentials
Remember to include these three items on your promotional postcard.

• An attention-getting headline. This can be a special offer, an announcement of your new practice or just, “It’s been awhile ….”
• A call to action. Tell people what to do. Some examples include: “Call before the 15th;” “Call to get the time slot you want;” and “Get $5 off when you reschedule.”
• Your contact information. Don’t forget your phone number, e-mail address and other necessary contact items.

It’s also important to keep your mailing list current by using first-class postage. Undeliverable postcards will be returned to you to help you update your mailing list. Here’s how it works:

• Make sure your return address is in the upper left corner of the addressing area.
• Print the words, “Return Service Requested” directly below the return address in at least 8-point type. (The postal service has to be able to see the message.)

Building a new business with a postcard
Here’s a last word from Jon Petersen, L.M.T.: In 2008, after only a year in business, he sent 320 Christmas postcards announcing this offer: “Buy a gift certificate by Dec. 31, and get the second one for 25% off.” By February, his mailing list grew to 400. In addition, half the bookings after the holidays were new clients due to gift-certificate sales, an impressive boost for his fledgling business. Petersen says, “People delete e-mail. With postcards, you have a nice-looking card in your hand.”

5 Management Must-Haves

There is a “must-have” list for nearly anything these days. Any fashion show will call out must-have colors, textures, accessories for the upcoming season. Wired Magazine has must-have gadgets, mobile applications and tech-tools. Shopping for a new car comes with a must-have list of things like satellite radio and great gas mileage.

As a manager and business owner, I have my own must-haves to keep me on top of my game and found a short, but powerful, list I think can help any professional. These are the tools that, no matter where you are, you could still manage your business and slip back into your well-run practice.

1. Blackberry, or other smartphone. A Blackberry, iPhone or other smartphone allows you to stay in touch with the business side of your practice while away from the office. If you’re traveling and you want to check your messages or check in with employees, having such a phone will allow you to keep your business on track.

2. E-mail guidelines. It’s hard to imagine management of a business without e-mail because communication is so critical to the success of any project. However, when it’s not managed effectively, e-mail can become a time drain. It’s important to create e-mail guidelines in your business. Depending on the culture of your practice, develop e-mail rules that ensure that the communication is saving time and not wasting it.

A great guideline to set in place is to put the action items in the beginning. This sets the tone of the e-mail and offers the most important information upfront. As they say in journalism, don’t bury the lead. Make sure that what’s most important is in the first paragraph. Also, your communication should be something short, sweet and to the point, or else your message will not be received.

3. A collaborative space.Good project management (especially if you manage employees) is about collaboration and communication. We use a wiki, which is an online collaborative workspace. There are many implementations of wiki software–and most are both open source and free. Our wiki is a central hub for our work, where we coordinate our projects and processes, providing a central place to remain in touch with one another’s duties and status.

There is also Twitter and other social media platforms that can be used well for work purposes.

4. Project agreement. A project agreement will always keep projects from running amuck and to keep things running flawlessly in anyone’s absence from the business. Without a project agreement, other people might not be on board or know what their objectives are, or their roles, responsibilities and timelines. Defining a project at the beginning is critical. It’s okay if things change, and they often do, but when you have a project agreement, you have a foundation to build on and work from.

5. Project management scorecard. We use an online project management scorecard that looks at three kinds of performance: business, project and project team. The scorecard gives you a comprehensive look at all three dimensions, so you know where and how to improve within your business. Accountability and the ability to measure ensure that you will know when you’ve arrived at the destination called success.

Other than yearly reviews, people often forget to take a moment to think about what did and did not work so that future business projects have a better chance of succeeding. It’s imperative for personal and professional growth and to continue succeeding.

Harvard Researchers Launch Healthy Eating Plate

Boston, MA — Nutrition experts at Harvard School of Public Health (HSPH) in conjunction with colleagues at Harvard Health Publications have unveiled the Healthy Eating Plate, a visual guide that provides a blueprint for eating a healthy meal. Like the U.S. government’s MyPlate, the Healthy Eating Plate is simple and easy to understand—and it addresses important deficiencies in the MyPlate icon.

“Unfortunately, like the earlier U.S. Department of Agriculture Pyramids, MyPlate mixes science with the influence of powerful agricultural interests, which is not the recipe for healthy eating,” said Walter Willett, rofessor of epidemiology and nutrition and chair of the Department of Nutrition at HSPH. “The Healthy Eating Plate is based on the best available scientific evidence and provides consumers with the information they need to make choices that can profoundly affect our health and well-being.”

Comparing the Harvard Healthy Eating Plate to the USDA’s MyPlate shows the shortcomings in the government’s guide. MyPlate does not tell consumers that whole grains are better for health than refined grains; its protein section offers no indication that some high-protein foods—fish, poultry, beans, nuts—are healthier than red meats and processed meats; it is silent on beneficial fats; it does not distinguish between potatoes and other vegetables; it recommends dairy at every meal, even though there is little evidence that high dairy intake protects against osteoporosis but substantial evidence that high intake can be harmful; and it says nothing about sugary drinks. Finally, the Healthy Eating Plate reminds people to stay active, an important factor in weight control, while MyPlate does not mention the importance of activity.

The Healthy Eating Plate is based on the latest and best scientific evidence which shows that a plant-based diet rich in vegetables, whole grains, healthy fats, and healthy proteins lowers the risk of weight gain and chronic disease. Helping Americans get the best possible nutrition advice is of critical importance as the U.S. and the world faces a burgeoning obesity epidemic. Currently, two in three adults and one in three children are overweight or obese in the U.S.

“We want people to use this as a model for their own healthy plate or that of their children every time they sit down to a meal—either at home or at a restaurant,” said Eric Rimm, associate professor of epidemiology and nutrition at HSPH and a member of the 2010 U.S. Dietary

Guidelines Advisory Committee.

The sections of the Healthy Eating Plate include:

• Vegetables: Eat an abundant variety, the more the better. Limited consumption of potatoes is recommended, however, as they are full of rapidly digested starch, which has the same roller-coaster effect on blood sugar as refined grains and sweets. In the short-term, these surges in blood sugar and insulin lead to hunger and overeating, and in the long term, to weight gain, type 2 diabetes, heart disease and other chronic disorders.
• Fruits: Choose a rainbow of fruits every day.
• Whole Grains: Choose whole grains, such as oatmeal, whole wheat bread and brown rice. Refined grains, such as white bread and white rice, act like sugar in the body. Eating too many refined grains can raise the risk of heart disease and type 2 diabetes.
• Healthy Proteins: Choose fish, poultry, beans or nuts, which contain healthful nutrients. Limit red meat and avoid processed meats, since eating even small quantities of these on a regular basis raises the risk of heart disease, type 2 diabetes, colon cancer and weight gain.
• Healthy Oils: Use olive, canola, and other plant oils in cooking, on salads, and at the table, since these healthy fats reduce harmful cholesterol and are good for the heart. Limit butter and avoid trans fat.
• Water: Drink water, tea or coffee (with little or no sugar). Limit milk and dairy (one to two servings per day) and juice (one small glass a day) and avoid sugary drinks.

The sizes of the sections suggest approximate relative proportions of each of the food groups to include on a healthy plate. They are not based on specific calorie amounts, and they are not meant to prescribe a certain number of calories or servings per day, since these numbers vary from person to person. The aim of the Healthy Eating Plate is to illustrate one way to put together a healthy meal that fits within the guidelines of the Healthy Eating Pyramid, which was created by nutrition experts at HSPH in 2001 and updated in 2008. (Read about the Healthy Eating Pyramid on the HSPH Nutrition Source website.)

“One of the most important fields of medical science over the past 50 years is the research that shows just how powerfully our health is affected by what we eat. Knowing what foods to eat and in what proportions is crucial for health. The evidence-based Healthy Eating Plate shows this in a way that is very simple to understand,” said Anthony Komaroff, professor of medicine at Harvard Medical School and editor in chief of Harvard Health Publications.

Utilizing Online Education in Massage School

Online education utilized in the massage profession can add great value to any massage school and instructor. There are now some excellent software programs available to study anatomy and physiology, featuring graphics that more than likely exceed the artistic talents of a massage instructor.

Hands-on massage education will—and should—remain exactly that: hands-on, face-to-face massage class training. However, the rest of massage online education is negotiable. Imagine a massage student who has viewed the information prior to coming to class. This would give students an opportunity to hear new terminology before they come to class. The instructor would then validate this new terminology, which would be the second time the massage students are exposed to new terminology. By the end of class, the massage students now have heard the new terminology more often than if the massage student had learned it for the first time in class that day or night. (Teaching models say students must hear subject matter at least three times to make a connection.)

My favorite example of massage online education is how greatly it may improve a body ergonomics class. There is so much to teach in the subject of body ergonomics. There is first the terminology and then there are the correct poses to be positioned in to distribute proper body weight to perform specific massage techniques. What if the massage instructor could concentrate more on direct body ergonomics when the massage student was in class?

The massage student could potentially study the lesson in advance of the body ergonomics class. This way, massage students would be exposed to the new terminology and definitions, such as archers’ stance, etc. When they then arrive for class, the massage instructor could immediately begin to position the massage student in the proper stances because the student was already aware of the terms and definitions.

By utilizing online education, responsible students can walk into class relatively on the same level to begin implementation of their newly learned terminology. This then allows massage instructors to immediately begin a clinic to give a 3-D lesson of what was learned in the massage online education portion of the class. It really is a win-win for massage students and teachers.

 

Cooked Green Vegetables, Dried Fruit, Legumes and Brown Rice Associated with Fewer Colon Polyps

High consumption of these foods may decrease risk for colorectal cancer, says Loma Linda University

LOMA LINDA, Calif. — Eating legumes at least three times a week and brown rice at least once a week was linked to a reduced risk of colon polyps by 33 percent and 40 percent respectively, according to Loma Linda University research recently published in Nutrition and Cancer. High consumption of cooked green vegetables and dried fruit was also associated with greater protection, the study shows.

“Eating these foods is likely to decrease your risk for colon polyps, which would in turn decrease your risk for colorectal cancer,” says lead author Yessenia Tantamango, M.D., a post-doctoral research fellow with Adventist Health Study-2 at Loma Linda University. “While a majority of past research has focused on broad food groups, such as fruits and vegetables, in relation to colon cancer, our study focused on specific foods, as well as more narrowed food groups, in relation to colon polyps, a precursor to colon cancer. Our study confirms the results of past studies that have been done in different populations analyzing risks for colon cancer.”

Colon cancer is the second leading cause of cancer death in the U.S. and the third most common cancer in both men and women, according to the American Cancer Society.

Results also show that consuming cooked green vegetables once a day or more, as compared to less than five times a week, was associated with a 24-percent reduction in the risk of rectal/colon polyps. Consuming dried fruit three times a week or more, versus less than once a week, was associated with a 26-percent reduced risk.

The protective effects of these foods could be due in part to their cancer-fighting agents, the study reported.

“Legumes, dried fruits, and brown

rice all have a high content of fiber, known to dilute potential carcinogens,” Tantamango says. “Additionally, cruciferous vegetables, such as broccoli, contain detoxifying compounds, which would improve their protective function.”

Past studies examining the effect of meat intake and legumes on colon cancer have shown that people eating meat, associated with an increased risk of colon cancer, may receive some protection when they also consume legumes. Tantamango says this suggests that besides fiber content, there may be something else present in legumes that provides a protective effect.

Researchers analyzed data from 2,818 subjects who participated in Adventist Health Study-1 (administered from 1976-77) and who answered a follow-up survey 26 years later from Adventist Health Study-2. The first survey asked respondents to indicate how often, on average, they consumed specific foods. The follow-up survey asked respondents who had undergone colonoscopies to indicate physician-diagnosed colorectal polyps. During the 26-year follow-up, 441 cases of rectal/colon polyps were identified.

The study assessed several possible confounding factors, including a family history of colorectal cancer, education, physical activity level, alcohol intake, smoking, constipation, intake of sweets, pain medication, and multivitamins, as well as different food variables. The study then adjusted for those factors that were shown to distort the effect of the foods and food groups under study. About 25 foods and food groups in total were examined.

Tantamango says there is a need for future studies to examine foods shown to reduce the risk of colon polyps, since it is possible that interactions between various nutrients with anti-cancerous properties will be better able to explain these findings.

The Importance of Self-Care for Massage Therapists

Massage school can be an exciting time, with many techniques and approaches to learn. The skills you learn in your training will enable you to help clients maintain their health and well-being. But what about your health and well-being? Have you thought about what it will take to deal with the physical and emotional demands of your new career as a massage therapist?

Massage is a rewarding profession that places considerable demands on the therapist. As a result, 77 percent of massage therapists experience symptoms or injury during their careers.1 With such a high rate of injury in the profession, learning effective self-care and injury-prevention techniques is one of the most important things you can do to have a successful career. Proven methods exist that have been shown in decades of research to prevent work-related musculoskeletal disorders.

While you’re still in training is the best time to start learning these methods. If you start integrating self-care and injury-prevention techniques into your life now, while you are still a student, taking care of yourself will become second nature. It’s much easier—and less disruptive to your career—to prevent injury from happening in the first place than to deal with an injury once it has occurred.

When an injury happens in a massage career, it’s nearly always the result of certain factors. A successful prevention strategy will need to address all of these factors. For this reason, using just one strategy—such as good body mechanics or conditioning exercises—is usually not enough by itself to keep you from getting injured. In combination, however, a variety of tactics can be very effective.

Here are six steps you’ll need to take to stay healthy in your career as a massage therapist:

1. Maintain awareness of the risk of injury in your work. Reading this article is a good start. It’s important to acknowledge risk exists, so you can learn how to best protect yourself.
2. Understand how risk factors can cause injury. You may have personal risk factors like a previous injury, for example, that can increase your injury risk. Massage work carries a number of risk factors, including repetitive movement, awkward postures and hand force. Particularly in combination, these risk factors can lead to injury.
3. Reduce risk factors through ergonomics.Because the work of a massage therapist is so physically demanding, workplace risk factors are often the primary cause of musculoskeletal disorders. While you can’t do anything about such risk factors, such as your age or a previous injury, you can usually modify
   1. your working conditions or workplace setup to reduce work-related risk factors. The science of ergonomics concentrates on fitting the work to the worker using proven methods that can be remarkably effective in reducing injury risk.
   2. Develop good body mechanics and work practices. Once you have used the principles of ergonomics to optimize your workspace and work life, you need to reinforce those principles by using your body properly in that workspace. Good ergonomics and good body mechanics go hand in hand. For example, if you don’t have enough room around your table, you won’t be able to use good body mechanics—and if you don’t use good body mechanics at your table, you won’t get the full injury-prevention benefit of having your workspace set up properly.
   3. Take care of your general physical and emotional health. You need to be in good general health to be able to withstand the physical demands of your work. Getting enough sleep and exercise, eating well and not smoking are among the healthy practices that can help your body heal quickly after a long day at work. You’ll also need to do a combination of exercises and stretches designed to keep you in shape for the rigors of your work. Avoid burnout and seek help for depression and anxiety, as these are also risk factors for injury.
   4. Recognize and treat injury symptoms. Remember, more than 75 percent of therapists experience symptoms. Be sure to listen to your body and seek effective treatment as soon after an injury as possible. With early, effective treatment, the majority of therapists are able to continue their work and get back to health.

   It is possible to prevent injury as a massage therapist, and following this six-step program will put the chance for recovery on your side.

   Balancing self-care with client care is one of the most important lessons you can learn as a massage therapist. Learning this vital lesson at this stage, when you have your whole career ahead of you, will give you a major head start toward having a long, healthy career.

What are some easy ways to lose weight?

Approximately 60% of women are overweight and 30% are obese today (American Obesity Association). Most women would feel more positive about themselves if they could maintain an ideal body weight. Perhaps even more importantly, obesity is linked with heart disease, high blood pressure, diabetes, arthritis, back pain, some cancers, and infertility. Encouragingly, the risk of death from these conditions decreases dramatically in people who maintain a 5 to 10% weight loss over at least a year (Guideline for Healthy Weight by F.R. Jelovsek, M.D. at www.wdxcyber.com).

Specific diet plans are popular but difficult to follow, and may be too restrictive for long term weight maintenance. Adopting healthy habits may be a more practical means of attaining a healthier weight for many people. In order to lose a pound a week, 500 fewer calories must be accumulated per day (either through reduced food intake or exercise) (Brigham and Women’s Hospital). Proven weight loss recommendations include:

• Eat three meals a day (especially breakfast) to minimize overeating
• Eat eight to ten vegetable or fruit servings a day
• For satiation, eat lean protein with every meal
• Abstain from eating sweets for two weeks to quell cravings
• Exercise aerobically and with weights
• Get enough sleep and minimize stress

In order to determine your ideal body weight, you can calculate your body mass index (BMI), which is an approximate measure of body fat based on weight and height. Visit DrKoop.com to do a Body Mass Index checkup. A body mass index within the range of 18.5 to 24.9 is considered healthy.

Better Chronic Pain Management

Pain-care management needs to be improved, with health care professionals committing to improve care as well as a retooling of the health-care system to help people who are suffering, states an editorial in CMAJ (Canadian Medical Association Journal).

According to a recent analysis, chronic pain affects people of all ages, with an estimated 500,000 Canadians aged 12 to 44 years, 38 percent of seniors in long-term care institutions and 27 percent of seniors living at home experiencing regular pain.

“Experts agree that much can be done now with newer analgesics, nonpharmacologic techniques such as nerve blocks and physical therapies, as well as spiritual and supportive care,” write Drs. Noni MacDonald, Ken Flegel, Paul Hébert and Matthew Stanbrook. “Availability of quality care for pain is the major problem. Health professionals have not mounted a response commensurate with the magnitude of the problem.”

The authors argue for a broad strategy to help increase pain-management expertise, including education, technology and supported self-care and lay coaching.