Level of Understanding and Attitudes Towards Poverty, Confidence Working With Individuals Experiencing Poverty, and Active Learning of Health Coaches Participating in a Poverty Simulation

More than 39 million (12.3%) people in the U.S. live in poverty. Health plans have an invested interest in the impact of the social determinants of health and poverty on health outcomes because of the effect on healthcare and spending. The Community Action Poverty Simulation© (CAPS) is a learning tool created to help people understand the realities of living in poverty. During the simulation, participants role-play the lives of low-income families for one month over a several-hour training period. The purpose of this study was (1) to evaluate health coaches’ pre/post levels of understanding of and attitudes towards poverty, and confidence working with individuals experiencing poverty, and whether these differ by demographics; and (2) to evaluate the health coaches’ level of active learning after attending the CAPS. The study design was a needs assessment with a single group, pre /post design including 24 health coaches in a health plan setting. Overall, health coaches demonstrated significant improvements in their understanding, attitudes, and confidence after participating in the CAPS training. Further, a majority of coaches reported high levels of active learning. The results of this study have implications for potential positive social change on the individual, organizational, and community levels. Specifically, this study provides initial evidence of how participating in a poverty simulation has the potential to increase coaches’ understanding of poverty, improve attitudes towards those living in poverty, and inspire action in the own community to help those living in poverty

Strengthening the Impact of Digital Cognitive Behavioral Interventions Through a Dual Intervention: Proficient Motivational Interviewing–Based Health Coaching Plus In-Application Techniques

BackgroundThe COVID-19 pandemic has accelerated the adoption of digital tools to support individuals struggling with their mental health. The use of a digital intervention plus human coaching (“dual” intervention) is gaining momentum in increasing overall engagement in digital cognitive behavioral interventions (dCBIs). However, there is limited insight into the methodologies and coaching models used by those deploying dual interventions. To achieve a deeper understanding, we need to identify and promote effective engagement that leads to clinical outcomes versus simply monitoring engagement metrics. Motivational interviewing (MI) is a collaborative, goal-oriented communication approach that pays particular attention to the language of change and is an effective engagement approach to help people manage mental health issues. However, this approach has been traditionally used for in-person or telephonic interventions, and less is known about the application of MI to digital interventions. ObjectiveWe sought to provide a dual intervention approach and address multiple factors across two levels of engagement to operationalize a dCBI that combined cognitive behavioral therapy–based techniques and MI-based interactions between the digital health coach (DHC) and user. MethodsWe reviewed hundreds of digital exchanges between DHCs and users to identify and improve training and quality assurance activities for digital interventions. ResultsWe tested five hypotheses and found that: (1) users of a dual digital behavioral health intervention had greater engagement levels than users of a noncoached intervention (P<.001); (2) DHCs with a demonstrated competency in applying MI to digital messages had more engaged users, as measured by the DHC-to-user message exchange ratio (P<.001); (3) the DHC-to-user message exchange ratio was correlated with more engagement in app activities (r=0.28, 95% CI 0.23-0.33); (4) DHCs with demonstrated MI proficiency elicited a greater amount of “change talk” from users than did DHCs without MI proficiency (H=25.12, P<.001); and (5) users who were engaged by DHCs with MI proficiency had better clinical outcomes compared to users engaged by DHCs without MI proficiency (P=.02). ConclusionsTo our knowledge, this pilot was the first of its kind to test the application of MI to digital coaching protocols, and it demonstrated the value of MI proficiency in digital health coaching for enhanced engagement and health improvement. Further research is needed to establish coaching models in dCBIs that incorporate MI to promote effective engagement and optimize positive behavioral outcomes