Methods and evaluation of a health coach training practicum experience for healthy lifestyle behavior change

The promotion of healthy lifestyle behaviors is a high public health priority due to the strong links to chronic disease and the associated impacts on health and quality of life. Motivational interviewing-based health coaching is a popular behavior change strategy to work toward encouraging healthy-decision making and provide accountability in making progress toward health goals and outcomes. A key priority in the field of health coaching is proper training to ensure proficient health coaches to engage with clients, participants, or patients for healthy lifestyle change. The purposes of this dissertation were to: 1) develop and implement an effective semester-based course to train upper level college students in the skills of motivational interviewing-based health coaching, 2) examine the effects of health coaching as a behavior change strategy among incoming college students, and 3) disseminate and evaluate a brief version of the motivational interviewing training for widespread skill obtainment. The first study provided insight into the proficiency levels achieved by upper level undergraduate students that completed a semester long training in motivational interviewing-based health coaching. All students were able to obtain proficiency levels for technical and relational Global scores following the 16 week-period of training and practice. However, it was more difficult to obtain proficiency in the use of reflections with 13% meeting proficiency in the percent of complex reflections used, and 0% meeting proficiency for the reflection-to-question ratio. The second study evaluated the effectiveness of these previously trained peer health coaches in their ability to communicate with incoming undergraduate students regarding healthy lifestyle behavior changes. Incoming Freshman and Sophomore students were offered the opportunity to meet one-on-one with a trained peer health coach for 8 weeks during a semester to work toward health goals of their choice (physical activity, dietary habits, stress management, etc.). Following four health coaching sessions in an 8-week period, results show that incoming college students appreciated the accountability that a peer health coach provided and the sessions elicited positive changes in all domains observed. Participants reported an average gain of 39.6% in physical activity levels, 9.9% increase in sticking to healthy dietary habits, and a 16.3% decline in stress levels. The third study demonstrates the ability to train county extension workers to effectively learn the spirit and relational components of motivational interviewing through an online version of the training model that was adapted from the 16-week training protocol tested in study one. This study answered a novel question since it demonstrated that individuals completing training were able to communicate more effectively than those that did not complete the brief training. This dissertation adds to the existing literature on methods for health coach training but also provides an example of a novel synergy between research, teaching and practice. The training methods were developed to provide a quality training experience for undergraduates to learn the skill of health coaching; however, the practicum component also provided a direct service to Iowa State University students that received the health coaching. The systematic evaluation of the programming advances the research and provides a strong foundation to ensure a sustainable future for the CydeKicks program. This dissertation also shows merit in the broad dissemination of brief motivational interviewing training for widespread health promotion efforts. Future research is needed to further evaluation the online platform and the impacts from health coaching

Evaluation of Confidence Using Motivational Interviewing Skills Before and After In-Person Training Workshop

Motivational interviewing (MI) is a skill used to help individuals make positive behavior changes and may be beneficial for those who work with undergraduate students. A new training, comprised of online content followed by an in-person workshop, was created and offered to staff members working directly with students at Iowa State University. The aim of this study was to evaluate confidence for using MI-related components pre and post an in-person workshop. To do so, participants completed a survey regarding their confidence in using MI-related skills before and after the workshop. From the survey results, a paired t-test was conducted to examine differences, and effect size was calculated to examine the magnitude of this difference. A significant difference was found pre to post with a small-to-moderate effect size, suggesting the in-person workshop was an important component for building self-efficacy to implement principles of MI in future conversations with students

Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults’ Activity Levels: Randomized Intervention

Background: While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. Objective: This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. Methods: A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. Results: Regression analyses revealed no significant differences by group in any of the primary outcomes (all P\u3e.05). However, personal characteristics, including lower baseline activity levels (beta=–.49, P=.01) and lack of previous experience with pedometers (beta=–.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). Conclusions: This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity

A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain

Background Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one’s ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants’ perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. Methods Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. Results Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. Conclusion This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies

Methods and evaluation of a health coach training practicum experience for healthy lifestyle behavior change

The promotion of healthy lifestyle behaviors is a high public health priority due to the strong links to chronic disease and the associated impacts on health and quality of life. Motivational interviewing-based health coaching is a popular behavior change strategy to work toward encouraging healthy-decision making and provide accountability in making progress toward health goals and outcomes. A key priority in the field of health coaching is proper training to ensure proficient health coaches to engage with clients, participants, or patients for healthy lifestyle change. The purposes of this dissertation were to: 1) develop and implement an effective semester-based course to train upper level college students in the skills of motivational interviewing-based health coaching, 2) examine the effects of health coaching as a behavior change strategy among incoming college students, and 3) disseminate and evaluate a brief version of the motivational interviewing training for widespread skill obtainment. The first study provided insight into the proficiency levels achieved by upper level undergraduate students that completed a semester long training in motivational interviewing-based health coaching. All students were able to obtain proficiency levels for technical and relational Global scores following the 16 week-period of training and practice. However, it was more difficult to obtain proficiency in the use of reflections with 13% meeting proficiency in the percent of complex reflections used, and 0% meeting proficiency for the reflection-to-question ratio. The second study evaluated the effectiveness of these previously trained peer health coaches in their ability to communicate with incoming undergraduate students regarding healthy lifestyle behavior changes. Incoming Freshman and Sophomore students were offered the opportunity to meet one-on-one with a trained peer health coach for 8 weeks during a semester to work toward health goals of their choice (physical activity, dietary habits, stress management, etc.). Following four health coaching sessions in an 8-week period, results show that incoming college students appreciated the accountability that a peer health coach provided and the sessions elicited positive changes in all domains observed. Participants reported an average gain of 39.6% in physical activity levels, 9.9% increase in sticking to healthy dietary habits, and a 16.3% decline in stress levels. The third study demonstrates the ability to train county extension workers to effectively learn the spirit and relational components of motivational interviewing through an online version of the training model that was adapted from the 16-week training protocol tested in study one. This study answered a novel question since it demonstrated that individuals completing training were able to communicate more effectively than those that did not complete the brief training. This dissertation adds to the existing literature on methods for health coach training but also provides an example of a novel synergy between research, teaching and practice. The training methods were developed to provide a quality training experience for undergraduates to learn the skill of health coaching; however, the practicum component also provided a direct service to Iowa State University students that received the health coaching. The systematic evaluation of the programming advances the research and provides a strong foundation to ensure a sustainable future for the CydeKicks program. This dissertation also shows merit in the broad dissemination of brief motivational interviewing training for widespread health promotion efforts. Future research is needed to further evaluation the online platform and the impacts from health coaching.</p

Evaluation of Confidence Using Motivational Interviewing Skills Before and After In-Person Training Workshop

Motivational interviewing (MI) is a skill used to help individuals make positive behavior changes and may be beneficial for those who work with undergraduate students. A new training, comprised of online content followed by an in-person workshop, was created and offered to staff members working directly with students at Iowa State University. The aim of this study was to evaluate confidence for using MI-related components pre and post an in-person workshop. To do so, participants completed a survey regarding their confidence in using MI-related skills before and after the workshop. From the survey results, a paired t-test was conducted to examine differences, and effect size was calculated to examine the magnitude of this difference. A significant difference was found pre to post with a small-to-moderate effect size, suggesting the in-person workshop was an important component for building self-efficacy to implement principles of MI in future conversations with students.</p

A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain

Background Sedentary time (SED) is associated with many detrimental health outcomes, yet little is known about what factors influence one’s ability to reduce SED. Even less is known about these factors in specific patient populations for whom high levels of SED may influence symptoms, such as those with chronic low back pain (cLBP). The purpose of this study was to qualitatively explore participants’ perceptions of factors that influenced their ability to reduce SED across an 8-week intervention to reduce SED in adults with cLBP and elevated depressive symptoms. Methods Three months after a theory-based intervention to break up and reduce sitting, semi-structured interviews explored factors that influenced reducing SED. Three researchers independently coded each conversation. Codes were charted and mapped with participants reviewing their own transcripts and the merged codes. The research team then defined key themes. Factors that were perceived to either facilitate behavior change or acted as barriers were identified and thematized as positive or negative determinants. Results Common barriers for reducing SED included environmental constraints, opposing social norms, and productivity; these barriers were frequently encountered in the workplace. Common facilitators for reducing SED included habit development, self-monitoring tools, restructuring the physical environment, and social accountability. Notably, back pain was not a frequently reported barrier or facilitator for reducing SED. Conclusion This sample of patients with cLBP and elevated depressive symptoms had similar determinants for reducing SED as previously reported in non-patient populations and did not appear to need strategies specific to dealing with chronic pain. Since work-related social norms and environmental factors were perceived as significant barriers to sitting less, workplace interventions that provide standing desks, offer standing meetings rooms, and/or institution-wide standing breaks may help reduce SED at work. The use of an activity monitor with sitting reminders and education regarding how to use the reminders as external cues to develop new sitting habits may also aid in adoption and adherence to this behavior change across settings. Developing coping plans and restructuring physical environments were perceived as successful strategies for overcoming social and environmental barriers. Future interventions targeting SED reductions may benefit from incorporating these strategies.This article is published as Lansing, J.E., Ellingson, L.D., DeShaw, K.J. et al. A qualitative analysis of barriers and facilitators to reducing sedentary time in adults with chronic low back pain. BMC Public Health 21, 215 (2021). https://doi.org/10.1186/s12889-021-10238-5. </p

Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults’ Activity Levels: Randomized Intervention

Background: While widely used and endorsed, there is limited evidence supporting the benefits of activity trackers for increasing physical activity; these devices may be more effective when combined with additional strategies that promote sustained behavior change like motivational interviewing (MI) and habit development. Objective: This study aims to determine the utility of wearable activity trackers alone or in combination with these behavior change strategies for promoting improvements in active and sedentary behaviors. Methods: A sample of 91 adults (48/91 female, 53%) was randomized to receive a Fitbit Charge alone or in combination with MI and habit education for 12 weeks. Active and sedentary behaviors were assessed pre and post using research-grade activity monitors (ActiGraph and activPAL), and the development of habits surrounding the use of the trackers was assessed postintervention with the Self-Reported Habit Index. During the intervention, Fitbit wear time and activity levels were monitored with the activity trackers. Linear regression analyses were used to determine the influence of the trial on outcomes of physical activity and sedentary time. The influence of habits was examined using correlation coefficients relating habits of tracker use (wearing the tracker and checking data on the tracker and associated app) to Fitbit wear time and activity levels during the intervention and at follow-up. Results: Regression analyses revealed no significant differences by group in any of the primary outcomes (all P>.05). However, personal characteristics, including lower baseline activity levels (beta=–.49, P=.01) and lack of previous experience with pedometers (beta=–.23, P=.03) were predictive of greater improvements in moderate and vigorous physical activity. Furthermore, for individuals with higher activity levels at the baseline, MI and habit education were more effective for maintaining these activity levels when compared with receiving a Fitbit alone (eg, small increase of ~48 steps/day, d=0.01, vs large decrease of ~1830 steps/day, d=0.95). Finally, habit development was significantly related to steps/day during (r=.30, P=.004) and following the intervention (r=.27, P=.03). Conclusions: This study suggests that activity trackers may have beneficial effects on physical activity in healthy adults, but benefits vary based on individual factors. Furthermore, this study highlights the importance of habit development surrounding the wear and use of activity trackers and the associated software to promote increases in physical activity.This article is published as Ellingson LD, Lansing JE, DeShaw KJ, Peyer KL, Bai Y, Perez M, Phillips LA, Welk GJ; Evaluating Motivational Interviewing and Habit Formation to Enhance the Effect of Activity Trackers on Healthy Adults’ Activity Levels: Randomized Intervention. JMIR Mhealth Uhealth 2019;7(2):e10988; DOI: 10.2196/mhealth.10988. Posted with permission. </p