Collaboration and Synergy in the Field of Health and Wellness Coaching: Naïve or Necessary?

Abstract

The rise of health and wellness coaching holds significant promise for facilitating sustainable behavior change to help legions of individuals prevent and manage chronic disease. We all know the threats associated with the staggering epidemic of chronic disease and associated unhealthy lifestyles. But did we get here through a failure of personal responsibility? A failure of family units to support appropriate health behaviors? A failure of educational systems to teach healthy behaviors? A failure of medicine to cultivate health behaviors in patients? A failure of municipalities from an urban planning perspective? A failure of the social sciences to apply the latest in adult learning theory, psychology, and behavioral economics to health behaviors? A failure of government to incentivize or reinforce health behaviors? A failure of industry to prioritize health over capital? A failure of society to integrate all of the above? Or is this just the perfect time to synergize all that we know from numerous disciplines to conquer the challenge of unhealthy behavior that creates chronic disease? From my perspective as a health psychologist, understanding the origins of the problems will help us draft the solution. But from my perspective as a coach, how we got here is much less important than how we get out of here.

No one can whistle a symphony. It takes a whole orchestra to play it.

—Halford E. Luccock

The rise of health and wellness coaching holds significant promise for facilitating sustainable behavior change to help legions of individuals prevent and manage chronic disease. We all know the threats associated with the staggering epidemic of chronic disease and associated unhealthy lifestyles. But did we get here through a failure of personal responsibility? A failure of family units to support appropriate health behaviors? A failure of educational systems to teach healthy behaviors? A failure of medicine to cultivate health behaviors in patients? A failure of municipalities from an urban planning perspective? A failure of the social sciences to apply the latest in adult learning theory, psychology, and behavioral economics to health behaviors? A failure of government to incentivize or reinforce health behaviors? A failure of industry to prioritize health over capital? A failure of society to integrate all of the above? Or is this just the perfect time to synergize all that we know from numerous disciplines to conquer the challenge of unhealthy behavior that creates chronic disease? From my perspective as a health psychologist, understanding the origins of the problems will help us draft the solution. But from my perspective as a coach, how we got here is much less important than how we get out of here.

The amount of relevant peer-reviewed medical literature being published on health and wellness coaching is impressive.¹ Despite the rapidly emerging data, however, the literature is difficult to interpret. Research evaluating health and wellness coaching has been fraught with methodological concerns.^2-4 To date, the term health coaching describes widely varied interventions across multiple disciplines and settings. Among other frameworks, health and wellness coaching has been variously defined in the context of health education,⁵ nursing,^6,7 medicine,⁸ life coaching,⁹ and behavioral health and psychology.^10,11 With so many disciplines involved, how can we even be talking about the same concept and processes? Moreover, is the level of collaboration needed to synergize across the disciplines truly possible?

The playing field is fraught with the complexities of turf struggles, economics, and politics. Multiple disciplines have tried to claim health and wellness coaching as their own. Multiple training programs have tried to claim that their way is the best way. Multiple vendors of coaching services promise a unique “magic” ingredient. To pose a powerful coaching question: If we work together to move the field forward, how will we bring our independent best selves into a cross-disciplinary movement to embrace a synergistic possibility that will manifest something much greater than any one of us could create alone? Lord knows there is more than enough work for all of us. At risk of inadvertently leaving someone out, let me comment on the variety of skillful practitioners and scientists ready to contribute. Practitioners of nonconventional healthcare approaches and those in medicine who have been working toward the implementation of an integrative perspective recognize and insist upon the application of the holistic— mind, body, spirit—framework that is critical in health and wellness coaching. The nurses are the original holistic practitioners and indeed are the most represented discipline participating in coaching at this point. (See the editorial by Dossey and Hess in this issue.⁷) Practitioners in health promotion and health education have been hammering away at the behavioral precursors to chronic disease on an individual and societal level for decades and have a great deal of in-the-trenches experience to contribute. Dieticians and exercise physiologists have an in-depth understanding of the science behind two of the key components of healthy lifestyles: the healing powers of food and physical activity. Mental health professionals have decades of proficiency in the skillful communication processes that are central to the process of health coaching. And psychologists can add their unique training in how to apply the latest science in human motivation and behavior change to clinical processes, as well as bringing increased methodological rigor to the study of health coaching. Similarly, the methodological rigor of other behavioral scientists is needed—in particular, those from the burgeoning fields of neuroscience, behavioral economics, and advanced biostatistical modeling. Life coaches, despite the limited regulation in the field, have a truly important function as well. “Raised” outside of conventional medicine, they are perhaps the most skillful at truly holding the clients' agendas central in the work without allowing preconceptions and biases from training as disease experts to bleed into the model. Finally, physicians and other clinicians looking to reinstall the primacy of healing relationships in medicine will feel aligned with health coaching and be able to sanction its clinical utility firsthand. We need each other.

This issue of Global Advances of Health and Medicine aims to support forward movement in the research of the rapidly growing field of health and wellness coaching. First, we present a systematic review on the peerreviewed medical literature to cull a consensus-based definition of health and wellness coaching.¹ Such a working definition will allow for larger scale reviews to help establish the evidence base for the effectiveness of health and wellness coaching and set the stage to better identify best practices in health and wellness coaching that may be widely disseminated and implemented to mitigate the negative consequences of the global chronic disease epidemic. Next steps for the field include standardization of the job tasks and credentialing for individuals providing health coaching, as well as credentialing for institutional programs endeavoring to train professionals in health coaching. Standardization and credentialing are necessary (though not sufficient) to ensure both internally and externally valid dissemination of the approach. An additional imperative is greater clarification and documentation of the processes involved, along with further development of assessment tools to verify intervention fidelity.⁴ In the interim, it is imperative that future articles on health or wellness coaching thoroughly describe the coaching intervention itself and also provide a thorough description of the background and coaching-specific training of the individuals delivering the coaching. Such detailed descriptions will enable robust comparison of approaches across settings, disease states, and populations, allowing for the future dissemination of a compendium of coaching models that have demonstrated clear evidence of their effectiveness.

Second, this issue of Global Advances in Health and Medicine puts forth several articles that aim to further explicate what health coaching is and is not by comparing it to psychotherapy¹² and motivational interviewing.¹³ Third, to continue to underline the practicability of health and wellness coaching, along with the May issue of Global Advances in Health and Medicine, this issue demonstrates the plethora of venues through which and countless populations in which health and wellness coaching is currently being employed. The venues range from schools¹⁴ to the military¹⁵ to healthcare systems. Within healthcare, health and wellness coaching is being provided through primary care in academic hospitals¹⁶ and community settings,¹⁷ through specialty practices such as obstetrics¹⁸ and bariatrics,¹⁹ and through disease and health management firms²⁰ and insurance companies.²¹

Solid collaboration of autonomous stakeholders is seen in the work of the National Consortia for Credentialing Health and Wellness Coaches (NCCHWC, www.ncchwc.org). Indeed, independent corporate, academic, professional, industry, and government stakeholders have collaborated to create a nonprofit organization that is positioned to establish standards that will ensure a basic level of functioning across disciplines for anyone using the terms health coaching and wellness coaching. There are surely other groups of which we at the NCCHWC are not aware, and we welcome help.

Douglas MacArthur, famed general of the Pacific front in World War II, noted, “Upon the fields of friendly strife are sewn the seeds that on other days and upon other fields shall bear the fruits of victory.”²² If nations can do it, surely our distinct disciplines and organizations can.