Health and Wealth Coaching

Health and Wealth Coaching
Background
Lifestyle change programs have demonstrated encouraging improvements in the overall
well-being of participants in clinical, worksite, and university settings. However, the majority
of published research utilizes accredited, professional health coaches. This study seeks to
establish the efficacy of health and wellness coaching implemented by coaching trainees in a
workplace/university framework.
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Methods
University faculty, staff, and students were recruited (n = 74) to participate in an 8-week
health and wellness coaching program comprised of 3 coaching sessions. The wellness
coaches were undergraduate students enrolled in a university Health and Wellness Coaching
practicum course. Participants reported satisfaction in 12 wellness dimensions. Their
satisfaction scores were used as proxy to encourage them to focus their behavior change
within 1 or more of 12 wellness dimensions. The self-reported wellness dimension scores
were recorded at baseline, and subsequent changes in the selected dimension scores were
evaluated. The control group received telephonic and video conference-based coaching, while
the intervention group participants were also offered face-to-face coaching and
social-embedded support
Results

Participants most frequently selected to work on 2 of the 12-wellness dimensions. No
differences between groups were found in the initial wellness scores. A statistical analysis
was performed on dimensions with 20 or more responses to determine whether the
intervention (social support), coaching session, and other variables had a significant impact.
A mixed model adjusted on group, coaching session, coaching trainee, and participant was
performed. The eating/nutrition and thinking wellness dimensions exhibited a significant
positive change in wellness scores in both groups (P < .001 and P < .0143, respectively).
Discussion
An increase in eating/nutrition and thinking wellness scores in both groups suggests that the
coaching trainees were effective in motivating change to boost participants’ well-being. The
results justify further research to evaluate the cost-effectiveness, approaches, and efficacy of
coaching trainees in worksite wellness programs.
Keywords: health and wellness coaching, university setting, trainees, social embeddedness,
health dimensions
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Introduction
The drastic rise in health-care costs is largely attributed to chronic preventable diseases such
as stroke, cardiovascular disease, cancer, and adult onset diabetes.1 In 2010, 86% of the U.S.
health-care expenditures were a result of 1 or more chronic medical conditions. Furthermore,
70% of mortalities were due to preventable conditions.1 The majority of modern health
complications are associated with lifestyle habits.2 These chronic conditions often develop
due to neglecting multiple aspects of wellness and unhealthy lifestyle-behavioral habits. The
well-being of individuals may be enhanced through health education, coaching, and primary
prevention strategies.
Health and wellness coaching (HWC) interventions have demonstrated valuable potential as a
supplementary modality to the medical field and worksite wellness.3,4 HWC has rapidly
grown as a primary and supplementary health promotion intervention to address issues
related to preventable chronic disease.3 HWC has proven to provide patients with long-term,

consistent improvements in health behaviors,4 quality of life,5,6 weight,6 and nutrition.2,7 In
the past decade, the application of HWC has drastically increased in health care and worksite
wellness.8–11 The holistic approach used in HWC encourages clients to view health
systematically and focus on behavioral health habits that may establish positive autonomous
life-long changes and reduce the rate of chronic disease.
HWC programs are not limited to clinical settings but are also effective in diverse worksite
and university settings. According to the American College Health Association, wellness
programs support change in the quality of life in university faculty and staff that can improve
well-being.12 A worksite/university wellness program conducted at Oklahoma State
University resulted in a reduction of metabolic syndrome risk factors in university
employees.13 In addition, the participants reported the program was beneficial to their
health.13 Similar to our study, universities such as the University of Maine, Marquette
University, and the University of Louisville have incorporated peer wellness coaching as a
means to deliver HWC.14–16 However, there remains limited published studies on the efficacy
of coach trainees. Employees participating in HWC have shown to possess fewer health-care
claims and lower costs compared to nonparticipants.12 In addition, biometric measures that
included body mass index, cholesterol, and glucose levels improved, indicating a reduction in
health risks.12 They also displayed a significant increase in work capabilities and a reduction
in employee burnout.13 The ability to manage and prevent chronic conditions may have
subsequent economic advantages including enhanced work output and decreased health-care
costs. Moreover, inclusive worksite health promotion programs improve working conditions
and reduce risk factors.17
Social-embedded support plays a role in improving health and well-being.18,19 Social
embeddedness is defined as the concept of how individual’s actions are altered by the social
associations in which they function.20 Research has demonstrated the addition of
social-embedded support encourages individuals to lose more weight.18 Yorks et al.
demonstrated that social group exercise lead to significant improvements in all quality of life
measures, while solitary exercise only resulted in an improvement mental quality of life.19 On
the contrary, a graduate and undergraduate student led HWC program at Ohio State
University did not demonstrate HWC actively encourages students to engage with their
community.21 There is limited supporting evidence of the efficacy of social-embedded
support within health behavior interventions.18 Changes in wellness domains/dimensions
have been explored. In 1976, the Dimensions of Wellness were developed to present a
holistic view of the individual.22 Existing literature has demonstrated the efficacy of
including wellness dimensions to improve health such as enhancing cognitive health and
protection against mental deficits.23 Based on a holistic view of individuals and recognition
that various aspects of health and wellness are interconnected, HWC must be addressed from
multiple dimensions.24–27
There is an abundance of health improvement programs; however, few are effective or they
display short-lived success.25 A common problem encountered in these programs is the

overwhelming amount of information available to the patient/client. Furthermore, there is
often a lack of clarity and conflicting ideas. Health promotion programs that lack
accountability, sense of community, and feedback mechanisms are more likely to fail.25 The
student trainees in our program collaborated with their clients to develop a wellness vision
and establish action goals. Social- and university-embedded activities were incorporated in
the coaching conversation in a manner that allowed coach and client to explore embedded
support options that encouraged and narrow goal-setting decisions.
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Purpose
The Commit to be Well (CtbW) Program was a workplace/university intervention delivered
by undergraduate HWC trainees. This study investigated the impact undergraduate coaching
trainees have on a wellness program carried out in a worksite/university setting and evaluated
the impact of social-embedded support.
Methods
CtbW began in 2016 as a pilot study and demonstrated an overall improvement in participant
well-being. In 2017, CtbW was available for its second year to Arizona State University
(ASU). The final design of CtbW program employed participant recommendations gained
from the pilot study to improve the program. The study acquired institutional review board
approval through the university. Inclusion of participants was based on maximizing access of
interested participants in a university wellness program. Minors, pregnant women, and
individuals who were unable to provide informed consent were excluded. CtbW was
promoted in early January, 2 months before the program began. ASU faculty, staff, and
students were recruited through marketing strategies that included internal newsletters, Sun
Devil Fitness Complex (SDFC) website marketing, college newsletters, and Health Center
digital boards. CtbW was conducted from March to April, and the data were analyzed
through September 2017. A welcome letter was e-mailed to all participants, and they were
requested to complete several assessments. Before starting the program, 2 orientation
seminars were provided, 1 live one and 1 via video conference. All participants were asked to
attend either live orientation seminar or watch the orientation video. Faculty, interns, and the
Assistant Director of Wellness attended the meetings to explain program details, define the
role and expectations of the coaching trainees, address concerns, and promote incentives and
university services available.
CtbW was a voluntary-based study, and participants were provided with university
incentives. Every participant received a free membership to the SDFC and open access to

group fitness programs. A free nutritional education course was available to all participants.
In addition, participants received information regarding additional services available through
ASU SDFC and health services such as professional personal training sessions and
consultations with a registered dietitian.
There were 93 university students, staff, and faculty who completed the CtbW application
form. From this group, 74 individuals completed the required documents (consent,
availability, and interest forms) and were deemed eligible. The 74 participants were provided
with a confidentiality form which listed the objectives of the program and ensured the privacy
of their identities. The program did not pose any significant harm or risk to the participants,
save the time commitment.
Participants completed various assessments: ASU Wellness Profile Questionnaire, a VIA
strength questionnaire, the Wellness Wheel Dimensions Scores, and a Wellness Vision
Assessment. Participants were also provided with information on ASU Wellness Resources.
The Wellness Profile Questionnaire was created by Wellsource specifically for use by
ASU.28 The ASU Wellness Profile Questionnaire evaluated participants’ family health
history, physical activity, eating practices, substance abuse, mental/social health, job
satisfaction, readiness to change, and health interests. The Wellness Wheel was adapted from
the Wellpeople’s Wellness Inventory29 and it rated participants’ satisfaction in 12 wellness
dimensions throughout the program. The Wellness Vision Assessment facilitated the
development of the participants’ wellness vision.
The VIA strength questionnaire was created by Dr Martin Seligman and concentrates on
positive character traits. This survey contrasts with the majority of strength questionnaires
because it does not focus on negative/neutral character traits. The strengths captured in VIA
questionnaire were implemented in the coaching practice.30 The VIA survey has been used in
previous studies on university wellness coaching.6,31
The health coaches were undergraduate students registered in the Healthy Lifestyle Coaching
degree. There were 18 undergraduate ASU students who served as the health coach trainees.
Ten student trainees were enrolled in a full-semester (16 weeks face-to-face) course, which
served as the intervention group coaches. The remaining 8 coaching trainees were enrolled in
a full-semester online synchronous course that served as the control group coaches. The
coaching training was comprised of case-based readings and discussions, articles/books on
key concepts of coaching psychology, and theories of health behavior. The student trainees
also completed 5 live coaching practice sessions and a practical skills assessment. After
completing the practical skills assessment, students received immediate feedback, and
evaluations of adherence to coaching methods were noted by the instructor.
An availability survey was used to determine participants’ availability and to assign them to
the control or intervention group. The selection was based on participants coaching
preference (face-to-face or video/telephonic coaching) and time/day they were available. The
participants who expressed interest with in-person coaching were placed in the intervention
group based in Phoenix, AZ. The health coaches enrolled in the online course were located
all over the nation and were only able to communicate with their clients through telephone or

video chat. Forty-one participants were assigned to the intervention group and 33 participants
were placed in the telephonic control group. The coaching trainees obtained clients’ consent
to record each coaching sessions. The recorded sessions were assessed and evaluated by the
instructor.
The CtbW program consisted of an 8-week commitment. During that time frame, participants
were expected to attend 3 separate health-coaching meetings held every 3 weeks. The
12-dimension wellness wheel was used to estimate participants’ sense of satisfaction with
each wellness dimension. Similar holistic wellness assessments were previously
validated.32–35 Wellness dimensions satisfaction have been evaluated in few HWC
programs.6,13 The use of wellness dimensions aligns with the general approach of health
promotion to incorporate a holistic view on health.23 The health coaches assessed 12
“wellness dimensions”: self-responsibility and love, breathing, sensing, eating/nutrition,
movement, feeling, thinking, playing and working, communicating, intimacy/relationships,
and finding meaning/spirituality. Participants were then asked to choose up to 5 wellness
dimensions they wished to improve upon throughout the program.
Health coach trainees used motivational interviewing (MI) techniques to assist in the
development of goals/wellness visions and preserve their clients’ autonomy. MI is a
client-centered counselling style for electing behavior change. MI may also facilitate
interpersonal relationships between coach and client.36 The first coaching session had a
duration of 60 to 90 minutes. The coach trainee and client worked as a team to explore
values, motivators, strengths, barriers, past successes, and environmental and social support
to determine the most important aspects of the participants’ well-being. During the initial
session, the health coach reviewed their clients’ assessments and guide them to create a
wellness vision. Health coaches also worked with their client’s to select specific areas of their
well-being that they wanted to improve and establish long-term goals and weekly smart goals
that aligned with their selected wellness dimensions.
The initial session was followed by two 20- to 30-minute follow-up sessions every 3 weeks.
Additional weekly support was provided as needed and requested by the participant. In
supporting the participants’ autonomy, some participants indicated their preference to receive
a motivational weekly text or e-mail. In subsequent coaching sessions, health coaching
trainees reviewed and recorded short-term goals, addressed barriers, adjusted plan of actions,
monitored confidence, importance and motivation in achieving goals, inquire and recorded
about changes in their perceived score in their selected wellness dimensions, and addressed
client’s perceived success. At the conclusion of the study, the clients were provided with an
optional post questionnaire and exit questionnaire. Health and wellness coaching trainees
recorded participants’ data for each of the 3 coaching sessions.
The control group received coaching telephonically, while the intervention group received
face-to-face coaching in addition to supplemental resources on university-/social-embedded
activities. The intervention group was provided a form containing specific ASU and SDFC
university-embedded programs and activities. In the form, clients were informed about how

the selected activities were connected to each wellness dimensions. The coaches highlighted
embedded support activities that supported clients’ wellness vision and goals. In order to
maintain autonomy, the intervention group was able to report if they “would participate,”
“decline to participate,” or “maybe participate” in wellness dimension specific activities. The
coaches then recorded participants’ responses and completion of the recommended
social-embedded activities to measure its impact in each dimension score.
This study was a quasi-experimental design to measure and analyze the participants’ selected
self-reported wellness scores. T test and χ2 test were performed to observe baseline
characteristics between the groups. For dimension with more than 20 responses across the 3
coaching sessions, a statistical analysis was done using a mixed model. A mixed model with
equal variance-covariance structure of the random effects adjusted on group, coaching
session, coaching trainee, and participant was performed.

Health and Wealth Coaching

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