Health Coaching Program Research Articles

Comorbidities and patient-reported outcomes among individuals with cancer enrolled in a digital health coaching program.

e19278 Background: Many individuals with cancer, as high as 90% in some studies, experience co-morbidities, which are associated with survival, quality of life and health care costs. Patient reported outcomes (PRO) have demonstrated efficacy in tracking outcomes for individuals with cancer and other chronic conditions. We present real world evidence of co-morbidities and PRO data from a cohort of individuals with cancer engaged in a digital health coaching program. Methods: A retrospective analysis was conducted of self-reported co-morbidity data and PROs collected from individuals with cancer upon enrollment in a digital health coaching program. Descriptive statistics define frequency of co-morbidities and means of PRO, including the Patient Reported Outcome Measures Information System-Global Health (PROMIS-GH)10, for individuals with cancer only compared with those who also had a co-morbid condition. Results: Of 570 individuals, 127 reported a co-morbid condition on enrollment into the coaching program (22%). Of these, 49.6% (n = 63) reported 1, and 50.4% (n = 64) reported 2 or more conditions, of which the most commonly reported were cardiovascular (45.6%), metabolic (39.3%), and immune-related (22.8%). Mean PRO scores at baseline are presented for each measure for individuals who reported either no or 1 or more co-morbid conditions at baseline (Table). Interestingly individuals with at least 1 comorbidity reported higher PRO scores for physical and mental health at baseline than those with cancer alone. Conclusions: Co-morbid conditions, while known to influence clinical outcomes among individuals with cancer, may also influence trends in PRO. Higher scores in this cohort may suggest that experience with a pre-existing condition may support the individual’s ability to cope with a cancer diagnosis and its physical and emotional sequelae. Digital health coaching may offer a unique non-clinical approach to gather this data and to support individuals to optimize self-efficacy, improving health outcomes beyond the clinical setting. [Table: see text]

The effect of community pharmacist–led health coaching on clinical outcomes

ObjectiveTo evaluate the impact of a community pharmacist–driven health coaching program on clinical outcomes from baseline to 1 year. SettingIndependent community pharmacy in western North Carolina. Practice descriptionSona Pharmacy + Clinic is an independent community pharmacy offering enhanced clinical services such as medication synchronization, adherence packaging, and free delivery. Sona Benefits offers pharmacy benefit manager (PBM) services to self-funded plans in western North Carolina. Practice innovationSona Health Management Program is a disease management program offered to Sona Benefits PBM clients; the services began in October 2016. Evaluation: Change in clinical outcome measures (total number of medications, blood pressure, hemoglobin A1c, weight, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], patient health questionnaire [PHQ-9] scores, and asthma control test [ACT] scores) were assessed for members who participated in the program for a minimum of 12 months for at least 2 of the following conditions: hypertension, hyperlipidemia, diabetes, depression, and asthma. ResultsHealth coaching was provided to 42 members (mean age of 55.9 years and 2.7 qualifying disease states). The mean number of medications per patient significantly decreased from 7.2 to 6.2 (P = 0.02). Systolic and diastolic blood pressures were significantly reduced from 130.8 mm Hg to 125.7 mm Hg (P = 0.04) and 76.9 mm Hg to 73.7 mm Hg (P = 0.04), respectively. Other clinical outcome measures evaluated, such as hemoglobin A1c, weight, LDL-C, HDL-C, TG, and PHQ-9 and ACT scores, were improved but did not reach significance. ConclusionThese results suggest that community pharmacists can have a positive impact on patients with multiple chronic conditions through health coaching services. This project suggests a potential model of pharmacist health coaching through pharmacist-run PBM services.

Treating Severe Obesity to Reduce Dyspnea in Patients With Chronic Lung Disease: A Pilot Mixed Methods Study

Treating Severe Obesity to Reduce Dyspnea in Patients With Chronic Lung Disease: A Pilot Mixed Methods Study

Impact of Physician Referral to Health Coaching on Patient Engagement and Health Risks: An Observational Study of UPMC's Prescription for Wellness.

Evaluate impact of physician referral to health coaching on patient engagement and health risk reduction. Four-year retrospective, observational cohort study with propensity-matched pair comparisons. Integrated delivery and finance system in Pittsburgh, Pennsylvania. 10 457 adult insured members referred to health coaching by their physician; 37 864 other members identified for health coaching through insurer-initiated outreach. Practice-based, technology-supported workflow and process for physician prescribing of health coaching during regular office visit, with follow-up on patient's progress and implementation supports. Patient engagement based on completion of pre-enrollment assessment, formal enrollment in health coaching, completion of required sessions, health risk levels, and number of health risks pre- and post-health coaching referral. Difference-in-difference analysis to assess change in health risk levels and number of health risks pre- and post-health coaching and probability weighting to control for potential confounding between groups. Members referred by a physician were significantly more likely to enroll in a health coaching program (21.0% vs 6.0%, P < .001) and complete the program requirements (8.5% vs 2.7%, P < .001) than when referred by insurer-initiated outreach; significant within group improvement in health risk levels from baseline (P < .001) was observed for both the groups. Patients are significantly more likely to engage in health coaching when a referral is made by a physician; engagement in health coaching significantly improves health risk levels.

The Effect of Smartphone Apps Versus Supervised Exercise on Physical Activity, Cardiorespiratory Fitness, and Body Composition Among Individuals With Mild-to-Moderate Mobility Disability: Randomized Controlled Trial.

BackgroundAdequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are associated with profound health benefits for individuals with mobility disability (MD). Despite the vast amount of research published in the field of PA interventions, little attention has been given to individuals with MD.ObjectiveThe aim of this study was to examine the efficacy of an app-based versus a supervised exercise and health coaching program to support adults with MD to increase levels of PA, CRF, and improve body composition.MethodsParticipants with self-perceived MD, aged 18 to 45 years, were included in this 12-week parallel-group randomized controlled trial and allocated at random to an app-based intervention, using commercially available apps—the Swedish Military training app (FMTK), the Acupedo walking app, and the LogMyFood food photography app—or a supervised exercise and health coaching intervention, including 1 weekly supervised exercise session and healthy lifestyle coaching. The primary outcome was the level of moderate-to-vigorous PA (MVPA) measured with accelerometers. Secondary outcomes included CRF measured by a submaximal test performed on a stationary bicycle and body composition measured by bioelectrical impedance. All outcomes were measured at baseline, 6 weeks, and 12 weeks. Linear mixed-effect models were used to assess the between-group differences, as well as the within-group changes through time, in each intervention group.ResultsA total of 110 participants with MD were randomized to an app-based intervention (n=55) or a supervised exercise and health intervention (n=55). The mean age of participants was 34.9 years (SD 6.1), and 81.8% (90/110) of the participants were women. CRF showed a moderate increase in both groups after 12 weeks—1.07 (95% CI –0.14 to 2.27) mL/kg/min increase in the app-based group and 1.76 (95% CI 0.70 to 2.83) mLkg/min increase in the supervised exercise group. However, the intention-to-treat analysis showed no significant differences between the groups in MVPA or CRF after 12 weeks. Waist circumference was significantly lower in the app-based intervention group.ConclusionsCommercially available apps increased levels of CRF and improved body composition over 12 weeks to the same extent as supervised exercise sessions, showing that both are equally effective. However, neither the app-based intervention nor the supervised exercise intervention increased MVPA.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): 22387524; http://isrctn.com/ISRCTN22387524.

219. Differences in Engagement in STI/HIV Education Among Young Women with and Without A History of Adverse Reproductive Outcomes: Findings from a Feasibility Pilot of a Health Coaching Program to Improve Contraceptive Continuation

Condom use rates are low among adolescent women using hormonal contraceptives and those with prior STI diagnoses and unintended pregnancies. Optimizing reproductive outcomes for high risk adolescent women requires successful engagement in risk-reduction skills building. We explored differences in engagement in sexually transmitted infection (STI) and HIV education among young women with and without a history of an adverse reproductive outcomes participating in a health coaching intervention to improve contraceptive use.

Changing Weight Management Self-efficacy Among Obese Puerto Rican Adults: A Quantitative Study using a Health Coaching Intervention

Purpose: Obesity and associated healthcare-related issues continue to increase. The prevalence of obesity is on the rise, which has led many health professionals to find ways to improve health interventions. Health coaching can be a viable tool to reduce the obesity epidemic. The purpose of this quantitative study was to investigate the effects of an 8-weekhealth coaching intervention in obese individuals from Puerto Rico and to determine if self-esteem and body image influence weight managementself-efficacy. Method: A pretest-posttest design using a weight management self-efficacy scale helped the researcher evaluate the effectof the coaching sessions. In addition, body image was measured using the 9-figure Body Size Scale and self-esteem was analyzedwith the Rosenberg Self-esteem Scale. Forty Hispanic adult men and women participated in the study. Results: Health coaching had a statistically significant effect on weight management self-efficacy (t (39) = -6.58, p &lt; .001). Additionally, body image and self-esteem affected weight management self-efficacy and positive health coaching outcomes were significant regardless of positive or negative perceived body image. Conclusions: These findings suggest that body image and self-esteem should be considered when creating programs for obesity and a health coaching program can be effective in increasing weight management self-efficacy.

Mobile Health (m-Health) Coaching Program During Pregnancy

Mobile Health (m-Health) Coaching Program During Pregnancy

For Physical Laborers with Type 2 Diabetes, Telephonic Health Coaching is not Enough to Improve A1C.

Telephonic health coaching has been studied extensively as an interventional approach for chronic disease management. No studies have been conducted evaluating the outcomes of a multiyear study on health coaching participation and glycated haemoglobin (A1C) changes. Chronic disease has been widespread in physical laborers, with a high onset of type 2 diabetes. The purpose of this study was to establish the efficacy of telephonic health coaching as a means to manage type 2 diabetes in adults with physical labor occupations. The eligibility criteria were: 1) Adults aged 20-80 during the study entirety; 2) A diagnosis of type 2 diabetes; and 3) Yearly A1C and Body Mass Index (BMI) testing via verified biometric screenings. Participants completing health coaching for at least 2 years during the study period were assigned to the experimental group and participants who only had yearly biometric screening were assigned to the control group. From 2014-2018, 350 participants met the inclusion criteria. The mean age at baseline was 56 years (SD 8.26), with a mean baseline A1C of 7.14% for the test group, and 5.41% for the control group. Pre-post test changes saw an increase in A1C of 0.85% in the test group, and 0.95% in the control group. BMI changes were not statistically significant. Further study is needed to refine current telephonic health coaching programs for disease management. This study suggests that the efficacy of telephonic health coaching in its current form is not enough to improve BMI outcomes in patients with diabetes, and over the phone coaching alone is insufficient to improve patient A1C levels and sustain them for long-term.

‘Beyond Cancer’: a study protocol of a multimodal occupational rehabilitation programme to support breast cancer survivors to return work

IntroductionWith more women working and surviving breast cancer, issues concerning sustainable employment must be addressed. Support to transition back to work is a gap in survivorship care. This paper describes...

Impact of a Mobile App-Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study.

BackgroundEffective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement.ObjectiveThe aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status.MethodsThis was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan.ResultsA total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001).ConclusionsAmong overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.

Is an oral health coaching programme a way to sustain oral health for elderly people in nursing homes? A feasibility study.

This study examines the feasibility of an oral health coaching programme involving practical support on individual level to staff in a nursing home in Sweden, aiming to improve oral health care-related beliefs of nursing staff and the oral health of residents. This intervention study consisted of three wards from one nursing home, and both staff (n=48) and residents (n=58) were invited. In the control ward, 9 staff and 16 residents participated; in test ward 1, 10 staff and 13 residents participated; and at test ward 2, 14 staff and 17 residents participated. An oral health coaching programme was performed 4h/wk for 3months. The staff completed the nursing Dental Coping Beliefs Scale at baseline and after 9months. Oral health of the residents was assessed using the Revised Oral Assessment Guide and mucosal-plaque score at baseline and after 3, 6 and 9months. At baseline, 33 staff participated and 22 at 9months follow-up. For the residents, the figures were 48 and 32, respectively. After the intervention, the nursing DCBS revealed changes related to usage of fluoride, oral health support, gum disease and approximal cleaning. The most frequently reported oral health problems among the residents pertained to teeth and gums. The residents' relatively high level of oral health was stable during the study period. Despite limitations in the programme, an oral health coaching programme can support nursing staff in maintaining a high level of oral health in residents. The programme was shown feasible, although design improvements are needed.

Effects of a structured group intervention on obesity among breast cancer survivors.

Obesity is associated with an increased risk for developing breast cancer and poor cancer-related outcomes. Endocrine therapy is a key part of treatment for breast cancer, but can result in weight gain. This study examined the efficacy of a structured group intervention during adjuvant endocrine therapy for obese patients with breast cancer. The intervention involved a combination of proper nutrition, exercise, and group coaching. Participants were patients with breast cancer who were undergoing adjuvant endocrine therapy and exhibited apparent weight gain while undergoing therapy, or had a diagnosis of abnormal lipid metabolism. We conducted a single-arm prospective study with a combined intervention. The intervention comprised 15 min of nutrition education, a 30-min group health coaching program, and three 45-min group aerobic exercise sessions. We evaluated participants' parameters (e.g., body weight, body mass index [BMI], cholesterol, psychological distress) at baseline, and at 1, 3, and 6 months after the intervention. At 1 month after the intervention, there were significant reductions in body weight (p < 0.01), BMI (p < 0.01), triglyceride levels (p < 0.05), total cholesterol levels (p < 0.01), psychological distress (p < 0.05), and cancer-related fatigue (p < 0.01). At 3 and 6 months after the intervention, we observed further reductions in body weight, BMI, and triceps skinfold thickness. Our study showed that a short-term structured intervention helped modify dietary and exercise behaviors and promote health among breast cancer survivors, and resulted in favorable changes in participants' body weight.

Retrospective Evaluation of an Online Diabetes Health Coaching Program: A Pilot Study.

An estimated one third of American adults have prediabetes; over 30 million have type 2 diabetes mellitus. Health and wellness coaching is an emerging tool for preventing and treating chronic disease. Mastering Diabetes (MD) promotes a low-fat, plant-based, whole-food diet, utilizing online education, day-to-day accountability and support, and video conferencing. This pilot study provides a retrospective view of the effectiveness of MD to treat diabetes. Current and former clients of MD were invited to participate in a survey. On completion of the online consent, subjects were asked a series of questions in a REDCap-based survey: age, gender, enrollment date in MD, changes in weight, HbA1c, medication use, overall health, and current level of adherence to achieved changes. Overall, 253 (8.9%) participants responded to the survey; 80.6% were females, mean age was 56 years. Most of those responding (78.4%, P < .001) reported weight loss; 68.8% (P < .001) reported decreased HbA1c; 52.4% reported decreased medication use; 86.8% reported continued health improvement since having participated in MD; and 83.5% found the online program very helpful. This study demonstrated improvement in HbA1c and weight in participants in an online health and wellness coaching. Study limitations prevent drawing generalizable conclusions; further prospective evaluation is needed.

Self-reported patient barriers and the impact of digital health coaching on PRO in cancer.

189 Background: Barriers during cancer care include lack of social support, financial concerns, and communication with providers. While navigation has been identified as a way to address these concerns in the clinical context, opportunities exist to identify and address patient-reported barriers through digital health coaching to support patients beyond the clinical care setting. Methods: A retrospective analysis evaluated patient-reported barriers during cancer care for 708 individuals over the course of a digital health coaching program. Barriers were assessed in six domains, each represented by 5-10 questions in a company developed survey. The questions were administered prior to coaching on content aligned to the domains, specifically eating healthy, exercise, financial, access to care and medication adherence. Patients ranked both the presence and severity of the barrier. Patient reported outcomes such as exercise (Godin), health eating (Start the Conversation), financial toxicity (Comprehensive Score for Financial Toxicity (COST)) and physiologic and psychosocial outcomes (Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) 10) were measured and aligned to the barrier domains identified by the participants. Results: The eating healthy domain (2.43) received a significantly higher average score compared to other domains: financial (1.86), exercise (1.71), medication adherence (1.68) and access to care (1.65). Over the 12-week coaching program, physical activity increased by 56%, fatigue was reduced by 32%, financial toxicity was reduced by 8%, the healthy eating score improved by 17% and pain was reduced by 13%, as reflected in the PROMIS GH-10, Godin, STC and COST data. Conclusions: Outcomes suggest that healthy eating is a significant barrier identified by cancer patients during their treatment, followed by financial concerns and exercise, each of which demonstrated improvement over the course of digital health coaching. These results suggest digital health coaching provides a benefit to addressing barriers during cancer treatment and may improve patient reported outcomes, particularly as they relate to wellness behaviors such as healthy eating and exercise.

Evaluation of a specialty pharmacy health coaching program

Background: Fairview Specialty Pharmacy provides comprehensive therapy management (TM) for patients, yet some patients require additional social, physical, and psychological support that may be unmet by a pharmacist or nurse. To address complex patient needs and remotely improve social determinants of health, a health coach is employed. The projected benefits of a health coaching program for patients include providing holistic support for health and mental well-being, identifying and overcoming barriers to healthy coping, and identifying additional resources for support. Aims: Goals of this study were to determine the impact of a health coach in patients who receive specialty pharmacy services as measured by number of referrals to this program, patient satisfaction and perceived impact on health, and impact on patient depression scores. Methods: Health coaching services were offered to patients during initial TM call or when a trigger was identified, such as emotional distress, new chronic illness diagnosis, life transition, coping issues, stress management, end of life, advanced care planning, or family concerns. Initial outreach health coach call to the patient provided program overview, confirmed interest, determined focus area (emotional/spiritual needs, loss/grief, lifestyle changes, or stress management), encouraged goal setting, and documented baseline depression score using the Patient Health Questionnaire (PHQ-9). Follow-up calls between the patient and health coach were focused on patient goals; referrals to additional services were documented. At the end of the third call, the PHQ-9 was given and a satisfaction survey was mailed to the patient. Program impact was determined based on satisfaction surveys, referrals, and the change in PHQ-9 after the third call. Results: 623 health coaching assessments were completed in 82 patients (April 2016-January 2019). The most common coaching focus (46% of patients) was combined emotional/spiritual and loss/grief. PHQ-9 was assessed in 54 patients at baseline and session 3; improvement occurred in 30 of the 54 patients (56%). In patients with baseline moderate to severe depression, 70% of patients experienced decreased depression. Anonymous patient experience survey (n = 21) revealed that 86% of patients in this program strongly agreed or agreed that their physical health and 95% strongly agreed or agreed that their mental health was positively impacted by working with the health coach. All patients (100%) strongly agreed or agreed that they were satisfied with the Fairview Specialty Pharmacy health coaching program. The health coach referred 37 patients to additional services, including support groups, social workers, case managers, physicians, psychiatrists, and hospice or advance care planning. Conclusions: The specialty pharmacy health coaching program was impactful, as measured by high patient satisfaction, positive patient perception of program impact on physical and mental health, improved patient depression scores, and referrals to other resources.

Health coaching for healthcare employees with chronic disease: A pilot study.

Health coaching promotes healthy lifestyles and may be particularly helpful for employees with chronic disease. Evaluate the effects of a health coaching program that targeted health-system employees with at least one cardiovascular disease (CVD) risk factor. Fifty-four employees volunteered for a health coaching program (6-session, 12-week program, at least one cycle). 40 (74%) completed (mean age [SD] = 53.3 [10.3] years, Female = 95%, Caucasian = 83%). A certified and integrative health coach/nutritionist provided coaching. Self-reported outcomes were collected using a pre-post design. Participants reported high rates of obesity (75%), hypertension (52.5%), diabetes/prediabetes (47.5%), and hyperlipidemia (40%). In addition, 20% reported chronic pain/rehabilitation needs, 17.5% seasonal depression, and 30% other significant co-morbidities. Following coaching, participants reported significant weight loss (mean [SD] 7.2 [6.6] pounds, p < 0.0001, d = 1.11), increased exercise (from 0.8 to 2.3 sessions/week, p < 0.001, d = .89), reduced perceived stress (p < 0.04, d = .42), and a trend for improved sleep (p = 0.06, d = .38). Reduced stress correlated with both increased exercise (r = -.39, p < 0.05) and decreased fatigue (r = .36, p = 0.07). Health coaching for healthcare employees with obesity and other CVD risk factors is a promising approach to losing weight, reducing stress, making healthy lifestyle changes, and improving health and well-being.

Efficacy of the Autoimmune Protocol Diet as Part of a Multi-disciplinary, Supported Lifestyle Intervention for Hashimoto's Thyroiditis.

BackgroundHashimoto’s thyroiditis (HT), also known as chronic lymphocytic thyroiditis, is an autoimmune disorder affecting the thyroid gland and is the most common cause of hypothyroidism in the US. Despite medical management with thyroid hormone replacement, many individuals with HT continue to experience symptoms and impaired quality of life. Given the limited number of efficacious treatments outside of hormone replacement and the overall burden of continued symptomatic disease, this pilot study was designed to determine the efficacy of a multi-disciplinary diet and lifestyle intervention for improving the quality of life, clinical symptom burden, and thyroid function in a population of middle-aged women with HT.Materials and methodsThe study recruited 17 normal or overweight (body mass index (BMI) <29.9) female subjects between the ages of 20 and 45 with a prior diagnosis of HT. The 17 women participated in a 10-week online health coaching program focused on the implementation of a phased elimination diet known as the Autoimmune Protocol (AIP). The 36-Item Short Form Health Survey (SF-36) and Cleveland Clinic Center for Functional Medicine’s Medical Symptoms Questionnaire (MSQ) were used to measure the participant’s health-related quality of life (HRQL) and clinical symptom burden, respectively, before and after the 10-week program. The participants completed serologic testing that included a complete blood cell count (CBC) with differential, complete metabolic profile (CMP), thyroid function tests, including thyroid stimulating hormone (TSH), total and free T4, and total and free T3, thyroid antibodies, including thyroid peroxidase antibodies (TPO) and anti-thyroglobulin antibodies (TGA), and high-sensitivity C-reactive protein (hs-CRP). ResultsSixteen women (n = 16) completed the SF-36 and MSQ before and after the 10-week program. There was a statistically significant improvement in HRQL as measured by all eight subscales of the SF-36 with the most marked improvements noted in the physical role functioning, emotional role functioning, vitality, and general health subscales. The clinical symptom burden, as measured by the MSQ, decreased significantly from an average of 92 (SD 25) prior to the program to 29 (SD 20) after the program. There were no statistically significant changes noted in any measure of thyroid function, including TSH, free and total T4, free and total T3 (n = 12), as well as thyroid antibodies (n = 14). Inflammation, as measured by hs-CRP (n = 14), was noted to significantly decrease by 29% (p = 0.0219) from an average of 1.63 mg/L (SD 1.72) pre-intervention to 1.15 mg/L (SD 1.31) post-intervention.ConclusionsOur study suggests that an online diet and lifestyle program facilitated by a multi-disciplinary team can significantly improve HRQL and symptom burden in middle-aged female subjects with HT. While there were no statistically significant changes noted in thyroid function or thyroid antibodies, the study’s findings suggest that AIP may decrease systemic inflammation and modulate the immune system as evidenced by a decrease in mean hs-CRP and changes in white blood cell (WBC) counts. Given the improvements seen in the HRQL and participants’ symptom burden as well as markers of immune activity and inflammation, further studies in larger populations implementing AIP as part of a multi-disciplinary diet and lifestyle program are warranted.

The effects of wellness coaching on the wellness and health behaviors of early adolescents

This study evaluated the impact of a wellness coaching program on the health behaviors of eighth-grade students. The study population comprised 132 adolescents (Wellness Coaching Group n=33, Health Education Group n=33, Control Group n=66). A pretest/posttest randomized controlled study was used. Students completed a demographic information form, the Five-Factor Wellness Scale-Adolescent Form (5F-Wellness-AF) and the Adolescent Lifestyle Scale (ALPS). The wellness coaching program of group education, individual consulting, physical activity, and health education was provided for 12weeks. The data indicated a significant difference in the total 5F-Wellness-AF and ALPS scores after the program. No statistically significant difference was observed in the total scores of the two scales for the Health Education Group, while the Control Group's 5F-Wellness-AF mean score declined after the intervention. At the beginning of the study, 15.2% of students in the wellness coaching program were overweight; this percentage decreased to 9.1% at the end of the study. This wellness coaching program significantly increased the wellness of adolescents and improved their healthy lifestyle behaviors. This program can be used together with health education provided by a public health nurse.

Piloting a Telephone Based Health Coaching Program for Pregnant Women: A Mixed Methods Study

Objectives Get Healthy in Pregnancy (GHiP) is a telephone based lifestyle coaching service for pregnant women, in New South Wales, Australia. GHiP had two service options; a telephone-based health coaching program consisting of up to 10 calls and information only (including one call). This study sought to compare the outcomes of the two GHiP options, to determine the characteristics of women likely to use the service and to explore the feedback from women and health professionals. Methods A pragmatic stratified clustered randomised controlled trial was conducted. Two metro and three rural hospitals were randomised into health coaching or information only arms. Self-reported measures of height and weight and health behaviours (dietary and physical activity) were collected at baseline and 36 weeks gestation. Process evaluation included descriptive analysis of routine program data, and semi-structured interviews with participants and health professionals. Results Of 3736 women screened, 1589 (42.5%) were eligible to participate, and of those eligible, 923 (58.1%) were recruited. More women in the health coaching arm gained weight within the target range for their BMI at 36 weeks gestation (42.9%) compared with information only (31.9%). Women found GHiP to be useful and supportive and midwives and doctors said that it facilitated conversations about weight with pregnant women. Conclusions for Practice Telephone-based lifestyle programs integrated with routine clinical care show promise in helping pregnant women achieve healthy gestational weight gain, but in this case was not significantly different from one information telephone call. Strong positive feedback suggests that scaled-up service delivery would be well received.Trial RegistrationACTRN12615000397516 (retrospectively registered).