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ENGAGEMENT IN WELLNESS PROGRAMS: DEFINITIONS, EVOLUTION AND KEY FACTORS
By Sean Slovenski, President and CEO, Hummingbird Coaching Services
Everyone agrees that engagement is vital to the success of any wellness initiative. If employees aren’t engaged, employers have wasted the money and time invested in the initiative, and they stand to lose more money and productivity if at-risk employees do not improve their health or if low-risk employees move to high-risk status.
But not everyone agrees on the definition of engagement, and it’s a more important question than one of semantics. It determines whether a wellness program is an actual success, a perceived success or a failure. Enrollment does not equal engagement. Participation is not an effective way to talk about engagement, either, because it’s easy to incorrectly measure participation.
Signing up for a program and logging onto a help site or making one phone call could be called participation—but is it engagement? For the purpose of adding some rigor to health coaching, and of this white paper, engagement can best be defined as actively working with a coach over a period of time. But why isn’t this definition of engagement widely accepted? A look at the industry’s history will provide insight.
How Coaching Has Evolved
The coaching industry began as a cottage industry and remained so for close to 30 years. In the last two to three years, however, “coaching” has become a buzzword and acquired the sort of overnight success status that has left coaching companies striving to meet growing demand.
As a result, established health organizations have entered the field and added coaching to their list of services. Insurers, EAPs, and disease management companies reassigned or renamed employees to accommodate the trend—sometimes without providing any specialized training. “Health coach” became an imprecise term, ranging from degreed counselors to self-directed online health portals, and encompassing a range of professionals:
§ disease management nurses
§ call center nurses
§ health educators
§ utilization/case management nurses
§ fitness trainers
§ any of the above who are cross-trained
However, organizations that rushed to market with poorly defined, low-quality coaching offerings have often left employers disappointed, which ultimately comes back to haunt the whole industry. There are over 100 entities that certify “health coaches,” but there are currently no standard industry definitions or guidelines for what a health coach is. Health coach certification programs have widely varying requirements.
Examples include:
§ 20 hours of professional health coaching, documentation that the health
coach has coached for a fee for 60 hours or has been employed full time as a health coach for six months.
§ An 8-14 week teleconference format.
§ A free six-lesson Web Audio Class.
An accreditation process to assess vendors in the wellness industry is scheduled to launch in 2009 but until then, it is caveat emptor for employers. They must educate themselves on the differing definitions of health coaching and vet coaching vendors accordingly.
Because there are now so many players in the field, defining “engagement” is as individualized as defining “health coach.” Health coaching companies regularly provide statistics on engagement, satisfaction and success, but these figures are based on self-reported projections, not scientific measures.
A 60% engagement rate sounds impressive until one learns that the definition of engagement is that 60 percent of the people who initially signed up, logged onto a website at least once. Or that 60 percent represents the number of people who were successful out of the total number who signed up for coaching – not out of the total employee population. There are many ways to portray data that, while not technically incorrect, can certainly be misleading.
Finding The Best Model For Engagement
Coaching began as classroom instruction on a specific risk factor (e.g. smoking). About 15 to 20 years ago, companies began offering phone consultation as a complement to the classroom. Most health coaching companies now offer a dosed call model with 2-10 phone calls, depending on the risk factor, over the course of a year.
The usual length of the call is 15-30 minutes, and the client often speaks with a different coach each time. This approach leaves a lack of continuity in relationship, accountability and the flexibility to support an individual in their unique behavior change process. Experience and common sense reveal that people don’t change their behavior this easily.
“Evidence for the ability of telephone counseling interventions to produce behavior changes1that last beyond the end of the intervention is mixed. Fewer studies evaluated true maintenance outcomes, and only half of them reported positive maintenance findings.”
For lasting, significant change, clients require more consistent interaction, encouragement and accountability that phone coaching doesn’t typically offer. Scalability is also an issue with phone coaching. On average, a coach has to make eight to 12 phone calls to set up the first interaction with a client. This proves increasingly more challenging in a world where employees telecommute, travel for business and must meet the many other demands of modern life. Finding time to interact in “real time” becomes more challenging.
Almost all vendors have realized that they need to offer online coaching solutions as well as telephonic. Online coaching is more scalable and cost-effective and offers the convenience clients need. But again, definitions must be clarified. What does a vendor mean by online coaching?
Beware of “online coaching” that’s a self-directed Web portal or a self-study course. Most Web health portals began with the premise that if you just provide the information people need to change their lives, they will change. Yet portals have typically been unable to keep people involved longer than 6-12 weeks. It takes more than information to create lasting behavior change.
This is where true online coaching shines. An effective online format provides more frequent contact with the same coach, which creates a sustained relationship, motivation and accountability. Although it would seem like phone coaching—with a live, warm voice—would create a more personal interaction, self-reported industry statistics do not bear this out. There is a tendency toward greater openness due to the “anonymity” that the Internet provides.
Research on online coaching is still pending, but industry statistics show that this model produces more than double the engagement rate (defined as actively working with a coach over a period of time) of the phone model AND over twice the success rate (defined as accomplishing a stated health goal). One leading online coaching company reports 60-80% engagement rates and a more than 90% satisfaction rate; 2/3 of its participants achieved their goals.
1 Eakin EG, et al. Telephone interventions for physical activity and dietary behavior change: A systematic review. Am J Prev Med 32(5), 2007.
Positive Psychology: A Better Approach
The field of psychology was founded to try to help people with psychological problems. It’s no surprise, then, that psychology has become a problem-based discipline. Find out what the patient’s problem is, and then try to help them overcome it. While noble in intention, this mindset overlooks that which is good and is working in people’s lives. It can lead to people feeling desperate, powerless and dependant upon a counselor.
Positive Psychology is a relatively new methodology, starting in the late 1990s. Psychologists who subscribe to this methodology focus on what is best about people, based on an extensive study of character qualities common to all humans. In a coaching situation, a coach assesses the strengths of the client and then leverages those strengths to help the client achieve a stated goal.
The emphasis shifts from “How do I fix what’s wrong with me?” to “How can I use my strengths to attain my goal?” Clients feel empowered, motivated and encouraged. They take from the coaching relationship a skill set that they can use for the rest of their lives.
Key Factors In Engagement
In a rapidly growing and maturing industry, standardization is hard to come by. There is currently no accrediting body or hard scientific research at this point and employees need assistance now. What is clear is that engagement, in order to mean anything, needs to mean more that just showing up. Industry data thus far show that there are at least four key factors in engagement:
1.Convenience: In today’s 24/7 world, chatting via instant message or composing an e-mail is much easier than sticking to a scheduled phone call or meeting face to face. Health coaches are much more accessible, and more responsive, in the online format.
2. Increased interaction due to the convenience: On average, employees who work with an online health coach interact with their coach three to four times per month, compared to five to seven phone calls a year with the phone model. The more interaction an employee has with a coach, the greater likelihood of success.
3. Motivation: Interventions that are not staged to the “readiness” of an individual will be less likely to create engagement. Motivation is a key factor in successful behavior change. Techniques that assess human motivation and evaluate a person’s “readiness to change” will increase adherence and goal realization.
4. The Use of Positive Psychology: Employees feel empowered when they can identify and leverage their strengths to change behavior and achieve goals. This approach removes the shame or stigma that may be associated with an unhealthful behavior or condition and provides tools for real change.
Consider these factors when looking for a health coaching company. Though not a magic formula, these criteria have been shown to increase true engagement— actively working toward a goal over a period of time. Employees who are engaged in their own wellness plans stand to modify unhealthful behaviors, achieve their goals, reduce the employer’s health care burden and become more productive workers.
ABOUT HUMMINGBIRD COACHING SERVICES
Cincinnati-based Hummingbird Coaching Services was founded in 1997. Co-founder and President/CEO Sean
Slovenski is recognized as a health care industry visionary, with over 15 years experience in prevention and
wellness.
He helped to invent and manage one of the nation’s first large-scale telephonic wellness and health
coaching product lines. Envisioning the widespread usage of the Internet, Mr. Slovenski pioneered the delivery
of health and fitness coaching online.
Hummingbird’s comprehensive workplace wellness programs impact employee health and productivity with a proprietary coaching model and online delivery platform, Hummingbird provides coaching services to businesses such as Motorola, United Healthcare, Leeza Gibbons Inc., and the Muhammad Ali Center.
Visit www.hummingbirdcoaching.com, or contact us at 1.877.240.4588.
