From our collaborators at Johns Hopkins Medicine | How health coaching supports employer-based wellness programs

Johns Hopkins occupational medicine study shows value of a 12-week health coaching strategy

Posted February 5, 2019By Nimisha Kalia, MD MPH MBA, Director, Division of Occupational Medicine, Johns Hopkins University

For many people, January can be a month of failed New Year’s resolutions. But if you take the right approach, which may involve a health coach for one-on-one support or engaging in a workplace wellness initiative, February could be the fresh start you and your colleagues were looking for a month ago.

A recent study at Johns Hopkins Medicine led to three important findings to support adopting positive lifestyle behaviours such as eating more plant-based fiber or maintaining a healthy weight. Here’s what we learned:

Individualized health promotion programs work best because they seek to change the root of the unhealthy behaviour based on personal barriers.
It is better to create a culture or community of wellness, not just a program. This means making wellness as convenient as possible, engaging senior leadership, providing healthy food options and allowing employees to participate in wellness programs without penalty.
It takes time to build good habits because good health and wellness are lifelong pursuits. There will be setbacks, so employees must be equipped to get back on track if they get derailed.

Here’s how we came to these conclusions, and how you can support healthier behaviours in your workplace.

The lifestyle connection to disease and health

In a 2018 report, The World Health Organization identified unhealthy lifestyle behaviours as the leading cause of disability-adjusted life years, accounting for about 71 percent of all deaths globally in 2016. Luckily, it’s not all doom and gloom.

The report offers a package of 16 “best buy” interventions that are cost-effective, feasible and scalable in all settings. These interventions include providing supportive environments that allow individuals to follow a healthier diet, as well as education in the form of awareness campaigns for physical activity, the harms of tobacco and certain dietary habits. The hope is that this guidance can help reduce the massive burden of lifestyle-based diseases in both the community and the workplace.[i]

Wellness and illness at work

Lifestyle-based diseases have significant negative consequences on individual workplace productivity, leading to increased absenteeism and presenteeism that can ultimately affect the employer’s bottom line. Researchers have also found correlations between employee sick days, obesity and stress.[ii] That’s one reason why employers may seek effective strategies to help their workforce, particularly for the secondary prevention of these conditions.[iii]

Employer-based wellness programs, also known as workplace wellness initiatives, offer such strategies. These programs are characterized by single or multifactorial interventions, designed for individuals or groups according to specific characteristics and needs.[iv]

Leading the change

Our experience at Johns Hopkins Medicine in corporate settings has demonstrated that these programs can provide meaningful and sustained improvement in lifestyle-related chronic disease health parameters, including blood pressure, weight, lipids and blood glucose. We recently conducted a 12-week wellness pilot program in which we invited 29 participants to receive in-person chronic disease management health coaching. We selected the participants because they were considered high-risk for cardiovascular disease due to risk factors such as diabetes, blood pressure or obesity. Participation in the program was strictly voluntary with no financial incentives provided to participants. The intervention’s intent was to nurture intelligent self-care through enhanced understanding of the epidemiology, cause and risk factors associated with chronic lifestyle-related diseases.

We conducted the coaching classes as two-hour group sessions between January and March 2018. A typical session included an instructional video viewing, a cooking demonstration, group discussion and an exercise component. In addition to health coaching, participants received mindfulness curriculum. The sessions touched upon relevant topics like nutrition, the incorporation of daily exercise and stress reduction.

Health coaching at Medcan increases self-efficacy

Health coaching can be presented in group sessions or individually. Medcan also offers health coaching via telephone with follow-up communication by email.

“Our sessions are usually 30 minutes each and are led by a health coach with a medical background,” says Megan McAdam, a registered nurse at Medcan with a health coaching certification. “Like at Johns Hopkins, the coaching at Medcan aims to create new habits that translate into your new lifestyle habits. Usually people have an idea that they need to change something, but they aren’t progressing. We help them identify what they need to change and teach them how to do it effectively for long-lasting results

“Another huge focus is to help clients increase their self-efficacy—internal motivation and competence,” adds McAdam, “With it, individuals are more likely to succeed. They are more likely to maintain that lifestyle change when the impetus is coming internally and links to their values.”

Keeping participants accountable and motivated

A commonality between the Johns Hopkins coaching study and health coaching at Medcan is that the medical team keeps the participants motivated and on track. This external motivator ensures accountability and consistency in the small changes that lead to large results.

At Johns Hopkins, our analysis shows that at the end of the 12-week program, there were statistically significant reductions in average weight, BMI, waist circumference, systolic blood pressure, total cholesterol, triglycerides, glucose and A1C (see Table 1). The participants also reported higher rates of engagement in physical activities (such as strength exercises and stretching) and the development of stress reduction techniques (such as exercising, reading, journaling, drawing and meditating).

More astonishingly, multi-modal employer-sponsored wellness programs can result in sustained improvements in many biometric markers, including BMI, resting heart rate, systolic and diastolic blood pressure, total cholesterol, LDL cholesterol, triglycerides and glucose for 12 to 18 months post participation.[v]

“These results are not surprising because the participants were given all the tools they needed,” says McAdam. “I think it should be noted that this population already showed a high degree of internal motivation for volunteering for this program. Just the act of signing up for an employee health program or having a consultation with a health coach already puts you in the ‘more likely to succeed’ category.”

If you are interested in Health Coaching for you or your workplace, please contact Megan McAdam at [email protected]. You can learn more about Health Coaching here.

Table 1: Before-After 12-Week Coaching Group Difference and Statistical Significance in Paired t-tests

Variables	Eligible Subjects	Before	After	Difference of Before-After	95% CI		t value	p value	Significance
Weight	29	233.14	225.76	7.38	5.13	9.63	6.72	<.0001	**
BMI	29	39.11	37.85	1.25	0.87	1.64	6.69	<.0001	**
Waist Circumference	29	43.55	42.07	1.48	1.17	1.80	9.57	<.0001	**
BP Systolic	29	128.55	121.79	6.76	4.04	9.48	5.08	<.0001	**
BP Diastolic	29	78.76	77.66	1.10	-1.48	3.69	0.87	0.3893
Total Cholesterol	29	198.41	186.38	12.03	0.68	23.39	2.17	0.0385	*
LDL	28	111.93	107.96	3.96	-7.75	15.68	0.69	0.4934
HDL	28	54.29	51.46	2.82	-0.33	5.98	1.83	0.0776
Triglycerides	29	151.83	126.55	25.28	6.92	43.64	2.82	0.0087	**
Glucose	29	115.17	100.28	14.90	2.46	27.33	2.45	0.0206	*
A1c	28	6.26	5.91	0.35	0.05	0.65	2.43	0.0222	*
* p<0.05 significant **p<0.01 very significant

References

[i] World Health Organization. NonCommunicable Disease, Country Profiles 2018. September 2018. License: CC BY-NC-SA 3.0 IGO.

[ii] Hoert J, Herd AM, Hambrick M. The Role of Leadership Support for Health Promotion in Employee Wellness Program Participation, Perceived Job Stress, and Health Behaviors. American Journal of Health Promotion. 2018 May;32(4):1054-1061. doi: 10.1177/0890117116677798.

[iii] Williams SP, Malik HT, Nicolay CR, Chaturvedi S, Darzi A, Purkayastha S. Interventions to improve employee health and well-being within health care organizations: A systematic review. Journal of Healthcare Risk Management. 2018 Apr;37(4):25-51. doi: 10.1002/jhrm.21284.

[iv] Kim RW, Nahar VK. A Guide for Understanding Health Education and Promotion Programs. Health Promotion Practice. 2018 Mar;19(2):167-169. doi: 10.1177/1524839917741487.

[v] Morton, D, Rankin, P, Kent, L, and Dysinger W. The Complete Health Improvement Program (CHIP). History, Evaluation, and Outcomes. American Journal of Lifestyle Medicine. 2016 Jan-Feb; 10(1): 64–73.