An Exploratory Study of a Health and Wellness Intervention on STEM College Students During COVID-19

Abstract

To address the growing health challenges faced by college students, campus recreation departments have evolved from a primary university intramural sport setting to organizations that have an increased emphasis on student recruitment, retention, and overall wellness. Among the strategies used to attract and engage students in campus recreation programs and services, health coaching shows some promise as a potentially effective intervention strategy. This study examined the efficacy of a university campus recreation health coaching program. Students from Science, Technology, Engineering and Math (STEM) disciplines (n = 34) were provided with individual, group, and virtual support to assist in developing effective strategies for academic success. Fitbit data measuring participants’ sleep and physical activity were collected along with self-reported measures of stress and perceived happiness and focus group qualitative data focused on participants’ perceptions of the program. Despite the COVID-19 pandemic forcing the program to adapt, findings suggest that health coaching may be an effective intervention strategy to help university students cope with the heightened anxiety and stress levels associated with campus life.

Introduction

A growing number of colleges and universities across the United States are reporting an increasing number of students experiencing unanticipated stress leading to a wide range of mental health challenges. For example, a study of more than 67,000 college students from over 100 institutions, found that 3 out of 4 students reported having experienced at least one stressful life event in the past year, and 20% reported experiencing six or more stressful life events in the last year (Liu et al., 2018). These life stressors were strongly associated with an array of mental health diagnoses (e.g., anxiety disorders and depression) and an increasing occurrence of self-harm behaviors and suicide. Data also shows that prolonged stress and anxiety lead to depression, which further undermines student success (Beiter et al., 2015; Millett-Thompson, 2017).

According to the American College Health Association (2020), 49% of college students reported feeling moderately stressed and 28% reported feeling high stress. Steinhardt and Dolbier (2008) suggest that due to developmental gaps in coping ability among college-age students, they are susceptible to both negative psychological and physical health issues that can lead to unhealthy behaviors. College students are highly vulnerable to stress and anxiety and the underdevelopment of stress management skills can contribute to serious mental, physical, and social health issues.

Stress associated with attending college has resulted in a disturbing number of mental health challenges for college students. While campus counseling centers strive to address the growing demand for services, it seems clear that resources are not able to adequately meet these needs (Beauchemin et al., 2021; McCarthy, 2020) as the number of enrolled college students with preexisting mental health conditions is rising (SAMHSA, 2021). Even prior to the 2020–2021 COVID-19 pandemic, data showed that anxiety, depressive moods, lack of self-esteem, psychosomatic problems, alcohol and substance abuse, and suicidality had increased among students across the world (Holm-Hadulla & Koutsoukou-Argyraki, 2015). Furthermore, the COVID-19 pandemic has further exacerbated the mental health of all students (Aristovnik et al., 2020) resulting in increased anxiety and depression (Cao et al., 2020).

While there is certainly a need for more proactive approaches to provide students with the tools and skills to manage their stress before it grows into a need for counseling center services, these services may be increasingly important for students in STEM disciplines and/or from marginalized households. For example, studies have shown that STEM students have higher rates of perfectionism which has resulted in increased levels of depression (Posselt & Lipson, 2016; Reilly et al., 2019; Rice, 2015).

Thus, the purpose of this study was to examine the efficacy of a university campus recreation health coaching program while further contributing to the scholarship related to campus recreation's role in student health and well-being. Staff and faculty from Wellness and Recreation (formerly campus recreation), and two campus academic STEM colleges developed and piloted an academic health coaching program (Wolfpack Success), specifically focused on students enrolled in a STEM-related major. The program leveraged the known benefits of physical activity along with the lifestyle-related benefits of health coaching to improve student health and thus success within the STEM disciplines.

Review of Literature

Since the 1990s, campus recreation departments across the United States have evolved from a primarily university intramural sports setting to departments that manage more complex services and facilities spanning fitness and wellness, education, aquatics, outdoor adventure programs, sport, and community programs. For example, in response to the increased university emphasis on student recruitment and student retention, the construction and renovation of recreational facilities (considered a recruitment/retention tool) have increased at many colleges and universities throughout the United States (Kampf et al., 2018). As campus recreation services, facilities, and staff increased, there was a need to document the benefits of these services and programs, beyond evidence that was primarily anecdotal (Hamilton, 2013). For example, as university campus recreation services have evolved to encompass community health (Litwiller et al., 2021), the link between these services and both the physical and mental health of students has become increasingly important.

In one of the earlier studies looking at the health benefits of campus recreation programs, Kanters (2000) found that students who participated more frequently in campus recreational sports reported lower anxiety concluding that campus recreation can act as a stress-buffering intervention. More recent studies (Andre et al., 2017; Eubank & DeVita, 2021; Forrester, 2015) confirmed some of these earlier findings, showing that campus recreation programs were effective in reducing students’ stress and thereby positively contributing to participants’ mental health.

It is well documented that physical activity can decrease and manage stress through decreasing stress hormones such as adrenaline and cortisol (Wood et al., 2017) and increasing endorphins that decrease pain and elevate mood. Systematic reviews have documented that physical activity can reduce fatigue, improve alertness and concentration, and enhance overall cognitive function (Donnelly et al., 2016). Furthermore, studies have shown that regular physical activity may be attributed to a higher Grade Point Average (GPA) among college students (Sanderson et al., 2018). While the positive impacts of physical activity are well documented (Chan et al., 2019; Jakicic et al., 2019) and have been recognized more broadly within the campus recreation literature (Forrester, 2015; Ori & Berry, 2022), these benefits can only be realized if students use campus recreation facilities and participation in their programs and services.

Among the many strategies used to attract and engage students in campus recreation programs and services, health coaching shows some promise as a potentially effective intervention strategy (Bleck et al., 2022; Linden et al., 2010). Health coaching has gained traction in the overall general health education and promotion realm over the past decade (Fogaca et al., 2022). The general premise behind health coaching is to facilitate participants’ health goals through a tailored health intervention approach. Dubovi and Sawyer (2018) noted that given the increased focus on preventive health within college campuses, universities have begun to integrate health coaching into a variety of campus health services. While more research is needed, early findings show promising results for health coaching programs that aim “to improve healthy lifestyle behaviors” and “facilitate goal attainment and performance enhancement” (Ammentorp et al., 2013).

Despite the promise of health coaching as a behavior change, it lacks conceptual and theoretical clarity (Olsen, 2014). For example, in a review of the health coaching literature, Olsen and Nesbitt (2010) found considerable variation in the duration, frequency, and method of delivery of health coaching, and differences in the background and the preparation of the health coaches. Thus, given the high prevalence of mental health issues on university campuses and the potential benefits of health coaching, further research to establish validated connections between health coaching and improved mental health that would also provide evidence-based best practices is needed (Hale & Giese, 2017). Furthermore, although health coaching has increased within campuses, few evidence-based health coaching initiatives are implemented within a campus recreation program.

RQ1: How does STEM college students’ participation in the Wolfpack Success program affect their physical activity levels and sleep quality?

RQ2: How does STEM college students’ participation in the Wolfpack Success program affect their perceptions of stress and happiness?

RQ3: What were the perceived benefits and barriers of participating in the Wolfpack Success program?

RQ 4: What were the program elements that participants felt were important to keep them involved with health-related behaviors both before and after participation?

Methodology

We used a mixed-methods design consisting of objectively measured (Fitbit) sleep and physical activity data, a pre–post-self-report measure of perceived stress and happiness survey, and two focus groups with a subset of the Wolfpack Success participants.

Participants:

Working in partnership with two campus academic STEM colleges, all undergraduate students were sent an email inviting them to participate in a health wellness intervention program during the months of January to April 2020. In addition, advisors promoted the event with their advisees. To be eligible, students had to be willing to attend a weekly 1-hour-in-person workshop, complete 2.5 h of physical activity per week for 6 weeks and be willing to download their Fitbit data on a smartphone every 2–3 days. All participants who consented to the study were able to participate in the program. Program participants were placed in a cohort, which met weekly with a health coach for four consecutive weeks. Each week, participants completed assignments focused on developing skills and strategies around time management, stress management, sleep optimization, and goal setting. At the completion of the 4 weeks, participants met individually with a health coach to develop a personalized action plan focused on implementing the skills learned throughout the group sessions. Study participants (n = 34) were on average 22.25 years old (SD = 2.85 years; range: 20–32 years old) and the majority were male (73.5%). Most participants identified themselves as White (62%), followed by Asian (15%), Spanish/Hispanic/Latino (12%), Black (3%), Pacific Islander/Hawaiian (3%), and Other (5%).

Wolfpack Success Program

Between February and April 2020, 34 students from STEM disciplines were provided with individual, group, and virtual support to assist in developing effective strategies for academic success. By design, the program was planned to be delivered 100% in person. The complete program was 6 weeks in length with the first session being the kick-off meeting where participants received their FitBit, an overview of the program, and an opportunity to ask questions to the program administrators. Four weeks were reserved for the weekly group wellness coaching topics (goal setting, time management, stress management, physical activity, and sleep optimization.) The final week of the program was designated for individual (action planning) coaching sessions. All four weeks of in-person sessions were able to be delivered before the University moved to online classes. The wellness coaching team conducted the individual action planning sessions via Zoom with those who were still interested. The program had 38 participants, although 4 participants had incomplete data. Each group coaching session was limited to 10–15 individuals and we ran 3 groups per week. Groups were selected to remain small to enhance participation and improve the ability for the student wellness coaches to facilitate meaningful discussion among the group. As part of the program design, each student was expected to have 1 individual action planning session following the Wolfpack Success group coaching sessions. However, this is a free and available service for all NC State students and we did see some members of the study sign up for individual coaching on their own to help maintain and further explore the topics discussed as part of the program.

The program had two overarching goals. First, increase the academic success of college students enrolled in a STEM-related major through participation in a physical activity and health coaching program. The second goal focused on improving the overall health and well-being of college students enrolled in a STEM-related major through participation in a physical activity and health coaching program. Each weekly group coaching session was facilitated by two ACE Health Coach certified student coaches, with each group following the same curriculum for the designated topics. The curriculum was developed in-house from the wellness coaching program with the leadership of one professional staff member (Coordinator, Wellness) and the student wellness coaches who delivered the program. The curriculum was developed utilizing best practices in health education and health promotion to address the above-mentioned topics paired with NC State-specific language, scenarios, and information to help tailor the information to the student population.

Examples of weekly assignments: Goal setting—Personal Wellness Inventory, SMARTER Goal setting sheet. Stress Management—Stress Management Assessment, Stress Recall Diary. Time Management—Time Blocking Tool, Most Important Tasks (MITs) Tool. Sleep Optimization—Wake Up and Wind Down Routine Worksheet, and Helpful/Harmful Sleep Strategy Brainstorm. For each of the above listed assignments/tools, students were given the opportunity to have an open group discussion with questions facilitated by the student wellness coaches. This opened the floor up for group information sharing, creative thinking/processing about the topic, and provided a pathway to introducing resources/assignments for students to practice together and adopt for their personal use.

After being placed in a cohort, program participants met with a health coach for four consecutive weeks. Each week, participants were asked to complete assignments that focused on developing skills relating to time and stress management, sleep optimization, and goal setting. At the conclusion of 4 weeks, participants were scheduled to meet individually with a health coach to develop a personalized plan of action on how they will implement the strategies learned during the cohort sessions. Additionally, participants were given access to a supervised physical activity program with the goal of meeting the recommended 150 min of weekly physical activity. To achieve this specific goal, participants initially met with a fitness professional from Wellness and Recreation to learn a physical activity routine. After that initial meeting, participants were given access to an Instagram account that had preloaded exercises with exercise instructions. Participants were instructed to complete a physical activity routine for a minimum of 3 days per week for a 50-minute period. Approximately 20% of the participants had established fitness/movement routines before the onset of the program. They were encouraged to continue what they were doing and utilize the fitness programming as needed.

Unanticipated events—the COVID-19 factor: When the Wolfpack Success project began at the end of January 2020, few people could have anticipated the disruption that the COVID-19 pandemic would have had on the campus community. The program was designed to be delivered completely in person and had to be shifted to a virtual format for the final component of the program (individual action planning sessions). However, this proposed research project provided a unique opportunity to see the impact of this intervention and whether it acted as a buffer to alleviate some of the stresses caused by the COVID-19 pandemic outbreak.

Data Analysis and Measures

Fitbit data: All participants accepted into the study received an orientation with the study team. During the orientation, study staff provided each participant with a Fitbit Inspire HR and instructions on its proper use, including how and when to charge it, wear use instructions, and data sync protocols. Participants were also given instructions on the structure of the health and wellness coaching program, including how to sign up for sessions and how to access the physical activity program. Participants’ individual Fitbit accounts were linked to a cloud-based data collection provider, Fitabase. Physical activity was categorized into total steps per day and measured into separate categories for very active, fairly active, light active, and sedentary minutes per day. Sleep quality was assessed based on minutes per day of total time asleep and quantified as separate categories for minutes in-bed awake, light sleep, deep sleep, and Rapid Eye Movements (REM) sleep. The accuracy of consumer wearable activity monitors has been formally assessed. While the algorithm used by Fitbit company products is proprietary, it has been used and validated in health research (Evenson et al., 2015; Tully et al., 2014). To address RQ1, ANOVA tests examined the physical activity or sleep indicators based on the four study stages. Differences between means based on the four study stages, were determined using an ANOVA with Tukey’s post hoc method and a significance level of p < .05. Due to the COVID-19 factor, PA and sleep measurement were reported over four study stages: physical activity from 1-week baseline (Pre-Program); participation in Wolfpack Success pre-COVID-19 (Program Pre-COVID-19); participation in Wolfpack Success during COVID-19 (Program COVID-19); and post program (Post-Program).

Self-report measures: Perceived happiness was measured using the 24-item Authentic Happiness Inventory (AHI) (Proyer et al., 2017). Perceived stress was measured using the 10-item Perceived Stress Survey (PSS) (Cohen et al., 1983), one of the most widely used psychological instruments for measuring the perception of stress. Items for both scales showed acceptable internal reliability (α > .70) (Taber, 2018) and were averaged to create an overall construct score. Wolfpack Success participants completed a pre-intervention survey with both the PSS and AHI. A post-survey was administered to participants at the end of the program. Items for both scales (pre- and post-) showed acceptable internal reliability (α > .70) and therefore were averaged to create overall construct scores. To address RQ2, t-tests were conducted to compare constructs during the Pre-Program and Post-Program.

Focus groups: To supplement the quantitative data, focus groups were conducted with a subset of students before and after the program. All students were sent an email inviting them to participate. One focus group, consisting of five students, was conducted prior to the program and one focus group consisting of six students was conducted at the end of the program. Of the 11 students in total, only one student participated in both focus groups. Data gathered from this focus group was used to understand some of the challenges and stress STEM students face as well as their goals for the program. The focus group data were also collected to understand elements of the program that participants felt would both entice them to be involved with a health coaching program and ensure sustained involvement both during and beyond the program.

An additional focus group consisting of six participants was conducted after the program to help understand the context, efficacy, and impact of the intervention. Both focus groups were conducted via Zoom and lasted approximately 90 min. The focus groups consisted of eleven questions regarding their perceptions of their stress and their perceptions related to the health coaching program. For example, examples of questions asked prior to the intervention included “Can you describe what you hope to get out of the Wolfpack Success Program?” and “When thinking about your health as a college student, what aspects do you think college students most struggle with?” Examples of the questions asked after the program included: “Based on your engagement in the program, can you describe habits that you are confident will be changed long term and others that you feel will be more challenging?” and “Can you describe some of the least beneficial aspects of the program for you?” A copy of the final questions can be provided upon request.

The data were recorded and transcribed verbatim. After the interviews were completed and transcribed, the final transcriptions were sent back to participants to review Data analysis was conducted through a constant comparative method (Marshall & Rossman, 2016), consisting of both open coding and axial coding. Open coding served as the first phase in which data were analyzed separately by two members of the research team to develop a list of themes. The second phase of axial coding consisted of the same two members of the research team, comparing their themes, and examining a limited set of codes to the data around research questions 3 and 4. If there were any disagreements, a third member of the research team was brought into the discussion to help with any consensus. In all cases, pseudonyms were used to maintain confidentiality and anonymity.

Results

For the analysis of RQ1, data from the individual participants was downloaded from Fitabase and transferred to IBM SPSS version 25.0. Individual respondent data were combined into one data set where the participants were identified through a participant number and physical activity and sleep data were coded to a specific study stage.

Physical Activity

Results for physical activity and differences based on study stages are shown in Table 1. Examining the average total number of steps per day, there are significant differences across all of the stages. The Wolfpack Success program was successful in contributing more steps to daily life as participants gained significantly more steps when they started the Wolfpack Success program. However, this gain dropped significantly during COVID. The average total number of steps per day was the lowest Post-Program.

Table 1.

Physical Activity Based on Study Stages.

	Study stages
	Pre-Program (n = 186)		Program Pre-COVID-19 (n = 1,139)		Program during COVID-19 (n = 305)		Post-Program (n = 163)
PA indicator	Mean	SD	Mean	SD	Mean	SD	Mean	SD	F-value	Sig.	Post hoc
Total steps	8,540.75	4,472.84	10,095.84	5,224.08	7,099.37	4,399.23	6,214.79	3,409.26	52.78	< .001	a, b, c, d, e
Very active minutes	25.05	38.35	36.24	46.58	24.05	35.00	25.45	35.04	10.03	< .001	b, d, e
Fairly active minutes	18.68	27.32	23.94	34.08	17.24	28.06	13.45	18.96	8.25	< .001	c
Light active minutes	213.23	81.18	219.81	81.73	182.05	84.85	163.15	71.97	35.08	< .001	b, c, d, e, f
Sedentary minutes	649.28	281.15	659.37	312.59	724.41	356.69	751.39	333.04	6.81	< .001	b, c, e

Note. a = significant difference between Pre-Program and Program Pre-COVID-19; b = significant difference between Pre-Program and Program during COVID-19; c = significant difference between Pre-Program and Post-Program; d = significant difference between Program Pre-COVID-19 and Program during COVID-19; e = significant difference between Program Pre-COVID-19 and Post-Program; f = significant difference between Program during COVID-19 and Post-Program.

A similar trend was found for active minutes (very/active/light). Participants spent more time in higher active zones (more active minutes) during the Wolfpack Success program (pre-COVID-19) compared to Pre-Program. The results for sedentary activity showed no significant differences when participants started the Wolfpack Success program, so the physical activity benefits of the program were based primarily on the more active categories (very active and fairly active). Participants spent significantly more time in sedentary activity during COVID-19 (program and post-) stages. This, most likely, was the result of stay-at-home orders affecting mobility.

Sleep Quality

Sleep quality was measured based on the same study stages as physical activity. The Fitbits auto-captured sleep and categorized sleep into total minutes asleep, minutes in-bed awake, minutes of light sleep, minutes of deep sleep, and minutes of REM sleep over a 24-hour period (per day).

Results for sleep quality are shown in Table 2. While there was variation in the means for each sleep indicator, the ANOVA results showed no significant differences (p < .05) between the study stages based on all sleep indicators. Participants’ average for the study stages ranged from getting a high of 6.3 h per day (Pre-Program) to a low of 5.6 h (program during COVID-19).

Table 2.

Sleep Quality Based on Study Stages.

	Study stages
	Pre-Program (n = 186)		Program Pre-COVID-19 (n = 139)		Program during COVID-19 (n = 305)		Post-Program (n = 163)
Sleep indicators (minutes/day)	Mean	SD	Mean	SD	Mean	SD	Mean	SD	F-value	Sig.
Asleep	377.31	134.94	350.49	156.11	336.17	189.34	348.37	174.71	2.50	.058
time in-bed awake	47.10	25.04	44.58	29.11	44.96	31.49	46.98	30.42	0.64	.592
Light sleep	199.13	97.83	182.70	109.42	181.52	121.12	185.53	111.49	1.26	.285
Deep sleep	66.93	35.96	60.72	38.79	58.96	41.80	62.89	40.82	1.81	.143
REM	71.41	43.76	65.07	44.15	63.04	44.79	67.97	46.24	1.61	.185

Perceived Stress and Happiness

Research question two sought to see how the Wolfpack Success program may have affected participants’ perceived stress and happiness levels (Table 3). Based on pre-and post-surveys, the results indicated that there were no significant increases or decreases with perceived stress levels. Results did find that perceived happiness levels were significantly higher Post-Program.

Table 3.

Perceived Stress and Happiness Based on pre- and Post-Program.

Scale	N	Mean	SD	t-value	Sig.
Stress—Pre	34	28.18	6.15	0.375	0710
Stress—Post	34	27.79	4.97
Happiness—Pre	34	2.83	0.53	−2.99	.006
Happiness—Post	34	3.03	0.65

Note. Higher scores indicate higher values of construct.

Focus Group Data

Research questions 3 and 4 focused on participants’ perceptions of the program and associated benefits and potential barriers. Two members of the project team identified three key themes related to program benefits and a need for the program for discussion and analysis, including general topics that came up in the interviews and emergent themes observed in the participant responses. These included (1) Health-related struggles; (2) fitness and accountability, and (3) long-term health improvements. Each theme is described below.

Health-related struggles were an identified theme among focus group participants. More specifically, lack of sleep and stress management were most frequently discussed among participants as health-related concerns with all but one of the participants identifying sleep. As Aaron stated “sleep, sleep, sleep is definitely the hardest thing because like you know some projects you just have to stay up all night, but the problem is not the night, but the second day- so yeah, definitely sleeping and stress management.” Rahan stated “sleep is probably the big one – I do not sleep well like when I laser focus on assignments.” Greg stated “sleep is a big one” with regard to identifying the health aspects he struggled most with. Mandy verbalized that “not sleeping- I think that is the main problem that comes”. Sleep was also identified as a major surprise to four of the six participants in the second focus group. Jaxon stated “the Fitbit component and being able to track my sleep that made a big difference to me that was really surprising.” Lynn was surprised at how little sleep she was getting. “It was really surprising because I didn’t realize how much like feeling groggy in the morning and not resting would counteract and affect the rest of my day.” Luke was surprised to find how bad his sleep was with the Fitbit tracking and stated, “it was nice to see that. I don’t know, maybe I can find some way to try to improve it.”

Participants’ interest in the program was piqued by their frustration with and feeling that student health is ignored or not proactively addressed by either the College or professors, despite data highlighting stress is a significant issue among the STEM disciplines. Mandy elaborated on the lack of open discussions around this “there was only one time, because something happened- they never talk about stress or time management, or like healthy eating, never. I’ve never heard anything.” Lynn suggested that more of an effort be made by professors to emphasize the importance of sleep “I would love to see a little bit more like practical effort, whether that's what the college department is or something about you know like practice like practical ways to make sure professors and departments are ensuring students get enough sleep”. Luke pleaded for additional support for resources with regard to sleep “…make sure we can get our sleep and help us with those resources”. Lynn also supported the idea of the university and colleges focusing on the importance of sleep “I think there needs to be a little bit more practical motivating factors for getting more sleep. I don’t know what that looks like at the university level or college level. I think it's important to keep in mind”.

Fitness and accountability—One of the goals of the focus group was to ascertain elements of the program that participants felt would both entice them to be involved with a health coaching program and would help ensure their success both during and beyond the program. Participants had varying levels of knowledge of specific campus wellness programs prior to entering the program and saw the benefits as both exposing them to a wider repertoire of services as well as giving them the confidence to use them. Greg stated “I’m not really too familiar with them. I mean I know about them, but haven’t looked into the depth of them.” Rhan also did not have experience working out on campus prior to the program: “since coming to college I have never really worked out, because I didn’t really have to or know how to”. Aaron exhibited an interest in the Wolfpack Success program and stated “I just think this is another resource that can actually help me.” All five of the participants spoke about the benefits of the Wolfpack Success Program specifically with regard to accountability in the second focus group interview. James mentioned that he had to write down his goals and indicated that “[you can] ask for advice from other people- just to keep you accountable.” Luke stated that the worksheets “really helped me like just like writing down everything.” Jaxon discussed “I thought it was just an all-around encompassing great way for you to be more aware of yourself.” Jaxon elaborated later and stated:

One thing that I thought was really great was the group aspect of it- we got to hear from everyone in the group. I think that was really important also knowing what everyone struggles with—you can start holding each other accountable. You can start feeling like you are not alone.

Participants mentioned that particular worksheets such as the goal setting worksheet and the balance worksheet helped them to focus their efforts on accountability of fitness.

Long-Term Health Improvements

Participants discussed the long-term habits created from engagement in the Wolfpack Success Program. Exercise and physical activity were mentioned by most of the focus group participants as a key benefit of the program both as an accountability measure and refining their knowledge about health that would benefit them long term. For example, Luke talked about how the program helped him exercise, making him accountable and slowly becoming part of his daily routine. As he pointed out, “this [program] made sure I had to exercise- just coming in the habit of like either just go for a run or going to the gym, stuff like that and then sleep.” Luke stated that this helped feed into other habits such as getting enough sleep and enough quality sleep “so that I can study the next day.” Jaxon and Luke both noted that the program and the use of the Fitbits helped with tracking exercise and that the Fitbits helped create this longer-term visual. For example, Jaxon pointed out that the Fitbits and the program allowed him to keep track of his activity even when assignments and school commitments were a significant source of pressure. As he pointed out, “it was nice tracking your exercise. You could keep track of that because the right balance is not always within a day. It could be within a week and being able to physically see that, like, okay, Wednesday, Thursday, I was really sedentary but made up for that on other days because I had that test or whatever. I could always have all the resources that I can always go back and kind of remind myself.” Lynn discussed that the Fitbit and the program helped her to have better workouts and “push myself much more once I had the Fitbit and I got into the habit of actually trying much harder.” She also talked about how this program, and the use of the Fitbit, helped to create a longer-term habit and is “something I’ve continued even after switching the Fitbit over to my own account.”

Discussion

Findings suggest that health coaching may be an effective intervention strategy to help university students cope with the heightened anxiety and stress levels associated with campus life. There was an immediate increase in students’ physical activity levels (from Pre-Program to Program prior to COVID-19) but post-COVID-19, participants were engaged in significantly more sedentary activity. We posit that this was likely due to lockdown orders and the closure of campus facilities, preventing them from having access to spaces to be physically active, an issue that affected college students nationally (American College Health Association, 2020). It is possible that the health coaching program was successful in that although participants’ physical activity rates decreased due to COVID-19 restrictions, they may have decreased less than peers that were not part of the program. Similarly, it has been shown that stress levels experienced by college students were significantly exacerbated by the pandemic (Wang et al., 2022). We further propose that while our findings did not vary between pre and post-data collection, research confirms that students were experiencing heightened stress levels during the pandemic (von Keyserlingk et al., 2022) and that no change in stress levels among study participants between pre and posttests may actually be an encouraging indicator that the health coaching program mitigated stress levels to some degree. However, without a matched control group, that is hard to ascertain, something noted in the limitations. That being said, data from the qualitative focus groups suggested that the program's accountability measures (continuing to meet online and log physical activity data) did encourage participants to continue to be active, despite facility restrictions. Some worked out in spaces at home, whereas others talked about making time to exercise outdoors.

In terms of sleep behavior and patterns, the duration of sleep measured by the Fitbit did not increase. However, data from the focus groups suggested that students perceived the sleep management component of the program and learning about the importance of sleep as the most impactful. Research has shown that changing sleep behavior and patterns in young adults (Paterson et al., 2019) can take time. Thus, future research should consider a longer timeframe, and post-program implementation to examine whether sleep patterns were successful.

Limitations and Strengths

The primary strength of this article is that it is one of the first studies that has examined the impact of a student health coaching program developed and run by a campus recreation department. It also used multiple data collection methods (survey, focus groups, and Fitbit biometric data). Finally, it provided a real-time analysis of how the COVID-19 pandemic affected student behavior. Despite these strengths, some limitations must be acknowledged. Despite recruitment efforts, the low number of students and a lack of a control group limit the generalizability of the results. Second, although Wellness and Recreation staff were able to pivot to move the second half of the intervention to a virtual format due to the COVID-19 pandemic, the original intervention was not designed in that manner and thus the adaptation may have impacted the program's efficacy. That being said, this also afforded us the opportunity to collect data in real time and assess how the pandemic affected college students’ health and wellness. For example, data from the focus groups suggested that despite being motivated to be physically active, participants were suddenly faced with a lack of access to facilities once the pandemic started.

Conclusion and Implications

One of the successes of the Wolfpack Success program was being able to bridge the gap between the tangible and intangible aspects of the college student health coaching program. For example, the students described how the program helped them to see the connection between physical activity and other programmatic aspects tied to academics such as goal setting, stress, and time management. As some of the focus group data showed, students were able to connect how each of the different facets of the program helped in other areas of their life. For example, the connection that students were able to make through the regular weekly meetings was important as that also allowed them to share ideas with each other about what they learned which, in turn, helped reinforce some of the behavior changes and provided an opportunity to reflect and connect with their peers. As noted in the focus groups, the ability to connect over common experiences and problem-solving health-related concerns offered a unique opportunity to learn from one another and establish accountability. These sessions also exposed them to other programmatic opportunities available to them through campus recreation and the wider university community. Finally, students shared that the program length was manageable while still affording them the opportunity to put the skills they learned into place.

In light of universities lacking resources to address the increasing mental health demands, it is critical that colleges examine strategies that can support students’ health and prevent an escalation of some of the mental health challenges facing students today. As Litwiller et al. (2021) pointed out, campus recreation programs are a much lower-intensity option that uses fewer resources than traditional mental health services and can be utilized as a preventive health option. At a time when many campus health services are stretched to serve the health needs of college students (SAMHSA, 2021), this study provided some evidence that campus recreation can provide viable and promising health coaching interventions. Furthermore, this study suggests that an intervention focused on virtual or group health coaching could be a promising strategy for campus recreation professionals to consider.