Employee wellness coaching as an interpersonal communication intervention: exploring intervention effects on healthcare costs, risks, and behaviors

In order to address the rise in healthcare expenditures, employers are turning to wellness programs as a means to potentially curtail costs. One newly implemented program is wellness coaching, which takes a communicative and holistic approach to helping others make improvements to their health. Wellness coaching is a behavioral health intervention whereby coaches work with clients to help them attain wellness-promoting goals in order to change lifestyle-related behaviors across a range of areas. Given the limited amount of research on wellness coaching, this project had four main purposes in order to fill gaps in the literature: to (1) identify whether wellness coaching interventions have an impact on client healthcare outcomes, (2) apply confirmation theory to this context in order to provide an explanatory framework to better understand the communication mechanisms that underlie this intervention, (3) identify the various topics that are discussed during wellness coaching sessions, and (4) test the extent to which a wellness coaching intervention should be targeted to specific clients. To examine these questions, a large employee wellness coaching program was evaluated, which serviced a population of over 14,000 employer insured individuals from several local employers of which almost 500 specifically attended wellness coaching sessions. Secondary data linking the use of coaching services with health claims information such as healthcare costs, risks and behaviors for all employees and their covered dependents were analyzed. By utilizing a statistical tool called propensity scoring, coached participants were matched with noncoached participants on key characteristics in order to create a meaningful comparison group to test treatment effects. Evidence demonstrates that participation in wellness coaching is associated with higher levels of healthcare costs and utilization, which is mediated by increased indicators of patient engagement. Results suggest that initial healthcare costs associated with improved patient engagement with healthcare providers decreases over time. These results are consistent with other research on wellness interventions that find that initial costs show a return on investment over time. These results also support previous research on confirmation theory, indicating that the scope of this theory may be broader than contexts previously studied. Analysis of participant wellness goals reveal that a range of issues are discussed during coaching sessions including physical health and mental, relational and financial/professional wellbeing. Finally, results suggest that this communicative intervention shows comparably broad impact across a range of client characteristics but may work particularly well for clients with chronic disease management goals, weight management goals, and mental wellbeing goals. Clients with multiple wellness goals also showed stronger results than those with fewer wellness goals. Those with smoking cessation goals were the only group that showed results in the opposite direction. The results of this project have theoretical, practical and methodological implications and suggest several areas for future research

Why this Flip Wasn\u27t a Flop: What the Numbers Don\u27t Tell You About Flipped Classes

This paper details the conversion of a large, required Civil Engineering fluid mechanics course into a more student-centered, active learning-oriented course through the flipping of one lecture per week. In the flipped class, students collaboratively solve homework problems in groups while receiving “expert” feedback from instructors and TAs. To offset the lost lectures, some course material that has been delivered in traditional lectures has been placed online in the form of short videos and textbook readings, with low-stakes quizzes for assessment. Student learning gains were quantitatively assessed by comparing quiz and final exam scores for three semesters (1 pre-flip and 2 post-flip). To maintain some element of consistency across the course transformation, a comprehensive, multiple-choice final exam has served to provide quantitative metrics on which the course improvement can be gaged. In addition, quiz questions remained relatively similar across semesters. One-way ANOVAs revealed a statically significant difference on quiz performance, with post-flip students performing better than those in pre-flip semesters. In addition, students in the final iteration of the course transformation significantly outperformed previous students on final exams by about 7%. Taken together, the numbers suggest that the process of flipping a large fluid mechanics course is associated with small but positive improvements to quiz and final exam performance. However, it is best to rely on other indicators beyond course performance in order to more accurately depict the impact of a course transformation. To supplement the results of the quantitative analyses, student comments about the course and instructor observations of the transformation implementation were assessed. Students found the work sessions to be very effective, enjoyed collaborating with peers and the instructor, and thought the online videos were helpful. The instructor indicated that the benefits of the flipped class include the following: heightened student engagement during class periods; greatly increased instructor awareness of student perceptions, challenges, personal issues, and conceptual bottlenecks; eventual reduction in instructor preparation time; improved instructor-student relationships; and a better focus on more important course objectives

mHealth to Improve the Diet Among Low-Income Populations Enrolled in an Established U.S. Nutrition Program: Design and Rationale of a Randomized Controlled Trial

Aim: To describe the theoretical basis, and implementation of a randomized controlled trial to improve the diet and nutrition of low-income families in the United States. Background: Numerous community and state-wide programs exist in the United States to help improve the health and well-being of people with low incomes. One state-wide program, Small Steps to Health (Small Steps), focuses on improving diet and nutrition among SNAP (Supplemental Nutrition Assistance Program) recipients. Small Steps is a series of 10 1-hour educational classes that focus on a range of nutritional and diet topics, including: how to read food labels, how to prepare and cook home meals, as well as various ways to improve diet (e.g., reducing fat/sugar and increasing fruit/vegetable consumption). This program has been found to be effective in increasing vegetable consumption, meal planning, and physical activity. However, there has been no difference found in overall diet change nor in difficult diet behavior change, such as eliminating sugary drinks, reducing fast food intake, and replacing high-fat and sugar snacks with healthier options. Changing difficult behaviors requires more than education. For example, research shows that learning why sugary drinks are unhealthy is not enough to stop people from drinking these beverages. Beyond education, people benefit from counseling that focuses on increasing motivation and confidence, assistance with overcoming barriers, identifying social support, and creating specific action plans. Providing behavior change counseling to large numbers of people is challenging, however. Widespread use of short-message services (SMS) provides one potential tool for researchers to help individuals change difficult behaviors. For instance, SMS intervention is effective at helping smokers reduce or eliminate cigarettes, increase patients adherence to various medical regiments, and most importantly, aid in weight loss. Although promising, one of the limitations with current SMS interventions is that most have relied on providing reminder texts at the conclusion of an education/counseling session(s) − either reinforcing previous educational material or providing basic motivational messages. Very few have focused on incorporating effective counseling techniques to promote behavior change through interactions with participants during these educational sessions. The aim of our study is to explore what types of SMS behavior change techniques are most effective at helping individuals make challenging behavior change regarding diet and nutrition − Counseling vs. personalized Coaching vs. Reminding text messages. Method: To describe the design and rationale of an SMS randomized four-arm control trial that compares the dietary changes of an intervention using: 1) a standardized Counseling SMS group; 2) a personalized Coaching SMS group; 3) an educational information Reminding SMS group; each of which are compared to 4) the usual care control condition of a No SMS group. The Counseling and Coaching SMS groups were developed based on constructs of social cognitive theory (self-efficacy, motivation and outcome expectations) and the theory of planned behavior (barriers, social support, and action plans). Reminding SMS was the attention-control group and No SMS was the true control. A total of up to 300 SNAP recipients enrolled in the Small Steps to Health program in the state of Indiana will be randomized into one of four groups for three months to determine the efficacy of text-based behavioral interventions focusing on diet and nutrition. Every two weeks, participants will focus on a specific dietary behavior corresponding with the first four lessons taught in the Small Steps class. Behavior Change 1 (weeks 1 & 2): drink water instead of sugary beverages. Behavior Change 2 (weeks 3 & 4): eat breakfast every day. Behavior Change 3 (weeks 5 & 6): choose fruit as snacks and dessert instead of calorie-laden sweet and high-fat snack foods. Behavior Change 4 (weeks 7 & 8): switch to low-fat calcium sources. The main outcome measured is improvement in overall diet using a Self- 24-Hour Dietary Recall (ASA-24) and a Food Frequency Questionnaire (NHANES Food Questionnaire). Secondary outcomes are: specific behavior changes (as described above) as well as confidence, motivation and outcome expectation. Study completion is anticipated in May 2016. Conclusion: The results of this SMS intervention will inform the Small Steps program on the best way to incorporate technology into their program. In other words, does standardized counseling, personalized coaching or simple reminders work best for helping SNAP recipients improve their diets? If effective, the results will be implemented into the Small Steps To Health program