“[Health and wellness coaching is] a client-centered or patient-centered process that assumes a working relationship/partnership develops between patient and clinician to advance healthy lifestyle behavior change using tools such as nonjudgmental dialogue, goal setting, and accountability.”
–Sforzo et al, Compendium of the Health and Wellness Coaching Literature
With the recent publication of the Compendium of the Health and Wellness Coaching Literature (Compendium), Sforzo et al* provide a thoughtful, easily accessed, well-constructed, resource for coaches, clinicians, educators and researchers. The investigation and presentation of accurate coaching literature is vital to the development of an empirically sound library of research and related articles. The authors’ stated goals are to create a tool that “will assist practitioners and researchers in shaping the applied and theoretical future of health and wellness coaching (HWC) as an adjunct treatment for chronic lifestyle-related diseases.” With this publication in the American Journal of Lifestyle Medicine in May 2017, the assessment of documents will certainly advance the field of HWC with careful inquiry into the design, implementation, and presentation of these findings. Keeping current on research literature provides coaches essential information for increasing integration into the clinical care. Health professionals with in primary care would do well to spend a few hours considering this data.
The pre-existing body of literature focused on the use and effectiveness of HWC as a treatment modality is diverse and inconsistent particularly in terms of definition of practice. The Compendium provided an opportunity to develop a definition of HWC sourced from the literature. This definition would then be uniformly applied across the literature. Health and wellness coaching is defined as “a client-centered or patient-centered process that assumes a working relationship/partnership develops between patient and clinician to advance healthy lifestyle behavior change using tools such as nonjudgmental dialogue, goal setting, and accountability.” This definition was essential for inclusion/exclusion criteria into the Compendium itself.
Previous systematic reviews focused mainly on randomized controlled trials (RCT). Due to the small number of successful trials, the authors felt less concerned with external versus internal validity and choose to present a broad range of conventional and alternative research designs. The published product is a series PDFs and Excel files that present the material in a useful, ready to use format. Part A is devoted to HWC articles that represent the data-based research. Part B provides articles without data – devoted to review, summary and/or commentary. The initial review identified 2,830 articles; the final Compendium includes 219 articles – 150 are data-based and 69 are not. Of the 150 data-based publications, nearly half are RCTs, 15 are mixed methodology and 9 are qualitative studies.
With the 219 articles, the study identified nine outcome measures found in much of the HWC research. These were Body weight (BMI), Systolic blood pressure (SBP), Low-density lipoproteins (LDL), Hemoglobin A1C, Health risk appraisal (HRA), Pain, Psychological factors, Exercise behaviors, and Nutrition behaviors, with an additional miscellaneous category for less frequent outcome orientations such as medication adherence, or cost analysis.
The Compendium finds seven ‘conditions’ that appear most often in the literature. Categorized in order from most frequent to least frequent representation, they are: Wellness, Diabetes, Obesity, Cholesterol, Hypertension, Heart disease and Cancer. Wellness, however, turned out to be a catch-all category including many conditions such as smoking, social isolation and fibromyalgia to name a few. With the largest category, Wellness, the most consistent findings for HWC on outcomes were in exercise behavior, psychological outcomes, nutrition behavior and hemoglobin A1C. The literature shows clear positive impacts in all four of these categories as well as evidence of impact on weight, blood pressure, cholesterol and HRA. While the findings are not definitive, the literature points to positive empirical evidence for HWC as an effective clinical intervention.
Diabetes was the largest individual disease category, represented with 29 journal articles including 14 RCTs, 7 observational studies and 1 meta-analysis. Data such as program length- the coaching program for diabetic patients lasted for between 2 and 24 months (mean 11.1) with a wide range of number of consults – from 3 to 20 (mean 9.00), provide useful data points for clinical care. The results were overwhelmingly positive for the impact of HWC on diabetic parameters. 78% of the research provided positive findings for hemoglobin A1C. Of the studies reporting body weight, 59% found weight-lowering results. 19 of 20 studies found at least one positive result in the following categories: disease management, quality of life, medication adherence, self-efficacy, satisfaction, with quality of life was the most frequently identified. 5 articles reported no effect.
Of the 35 articles focusing on obesity, 33 were data-based. 87% found a positive effect for weight reduction and/or BMI with HWC. Case studies, which follow a single participant for 3-17 months all found positive effects on weight, and several offer an in-depth understanding of HWC. Studies on obesity also tracked exercise and nutrition behaviors, finding a positive effect on exercise behaviors in 11 of 15 studies and a positive change on nutrition behavior in 6 of 9 studies.
Hypertension was the focus of 27 articles. This list continues, please see the research findings. Needless to say, there is a wealth of useful information in the literature about the impact of health and wellness coaching. The authors of the Compendium found a significantly larger number of high quality publications more recently, with 23 articles published between the years 2000 and 2008 and 196 between 2009 and 2016.
What is most striking about the Compendium is the accessibility of the material in a ready-to-use form. Appendix A and Appendix B can be downloaded and will be come an important link in establishing the clinical validity of health and wellness coaching as an effective therapy for many of the most common conditions our society faces. Researchers will undoubtedly find the design useful for identifying gaps in the literature. The authors are very clear and accurate about the limitations and potential bias of the work.
With that said, overall, the Compendium of Health and Wellness Coaching Literature “provides substantial evidence for a clinical intervention yielding a positive impact on the chronic, often life-style related diseases.” As a powerful approach to behavior change, coaching will continue to gain recognition and acceptance by this work.
Joel Kreisberg, DC, PCC, CCH
*Gary A. Sforzo, PhD, Miranda P. Kaye, PhD, Irina Todorova, PhD, Sebastian Harenberg, PhD, Kyle Costello, BS, Laura Cobus-Kuo, MLIS, MPA, Aubrey Faber, BS, Elizabeth Frates, MD, Margaret Moore, MBA
“Compendium of the Health and Wellness Coaching Literature”, Journal of Lifestyle Medicine, May 19, 2017. DOI: https://doi.org/10.1177/1559827617708562