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Review of Important Publication – h2U

OUTCOMES ACROSS THE VALUE CHAIN is a peer-reviewed article published in July 2016 examining a corporate wellness intervention for over 150,000 employees.  Health coaching was offered only to those employees at greater risk meaning about 49,500 were eligible.  After learning about health coaching about half decided to give it a try and of these 78% (~19,800) completed the recommended four coaching sessions within one year. 

The program was highly successful with coached participants significantly (p < .05) improving:

•    Systolic and diastolic blood pressure •    BMI •    LDL-cholesterol, triglycerides, and glucose •    Absenteeism and employment termination (involuntary or voluntary) •    Medical utilization (emergency room visits, hospital admission, and hospital lengths of stay) •    Medical costs

Besides reporting these tremendous outcome improvements after coaching, the authors created a unique system of health engagement to classify participants.  They considered high engagement as regular health coaching, education, and goal achievement while low engagement involved a lesser experience with these practices.  In other words, high engagement meant fully buying into behavior change activities and succeeding at the process. At the study’s end, nearly 15,500 participants were classified as high engagers.  It should be no surprise that high engagers got the best results averaging 3.9% better (one-year change scores) improvement than controls across all 33 outcome variables measured.

This study was very impressive not only because of participant number (nearly 20,000 making it the largest-ever study of coaching) and great outcomes, but also what we can learn from how coaching participants were selected and categorized.  Employees who had the most to gain, and who became fully engaged in the coaching and behavior change processes, were most successful in this wellness program.   Such an interpretation of these findings might inform both large employers and individuals (as well as health and wellness coaches) about who is ready to become invested in the coaching process.

Whether you are working with a big company or a single client, here are some important take-away points from this landmark study that might help you:

•    Largest peer-reviewed study of health and wellness coaching published to date •    Significant improvements in nearly all of 33 outcome variables (including medical costs and employee turnover) for high engagers over one year (see the citation for all variables1) •    Only high-risk employees were offered health coaching and not all of these were ready to make change (nearly 65% of those initially interested in coaching turned into high engagers) •    Those who fully engaged in the behavior change process produced the best results •    If an employee/client is not prepared to fully engage then coaching may not be as effective as it otherwise might be – consider first investing in those with the best likelihood of success •    Measurement of Readiness-to-Change (Transtheoretical Model) may be a key predictor of client success in the coaching process (but this hypothesis awaits confirmation from future research)

Outcomes Across the Value Chain for a Comprehensive Employee Health and Wellness Intervention A Cohort Study by Degrees of Health Engagement D. Adam Long, PhD, Roger W. Reed, BSN, and Ian Duncan, B Phil J Occup Environ Med. 2016 Jul;58(7):696-706 DOI: 10.1097/JOM.0000000000000765.

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