DBA 701

Template for Analyzing the Logic of an Article 1 Hill, B., Richardson, B., & Skouteris, H. (2015, May/June). Do we know how to design effective health

coaching interventions: A systematic review of the state of the literature? American Journal of Health Promotion, 29(5), e158–168. doi:10.4278/ajhp.130510-LIT-238

1. The main purpose of this article was “to systematically review health coaching interventions regarding effectiveness of health coaching for specific outcomes, optimal intervention approaches, and identification of specific techniques associated with effectiveness” (Hill et al., 2015, p. e158).

2. The key questions the author(s) centered on health coaching effectiveness, outcome effectiveness, optimal interventions, classification of BCTs, and theoretical bases tied to intervention effectiveness.

Assess[ed] the extent to which the literature is capable of addressing and answering the following questions crucial to intervention design: (1) Is health coaching effective at eliciting positive behavioral or outcome change? (2) Are there specific outcomes or populations for which health coaching is more (or less) effective? (3) Is there an optimal intervention duration that is most effective? (4) Are studies including and reporting sufficient detail to allow BCTs to be accurately classified according to Michie and colleagues’21 criteria? (5) Are certain theoretical bases associated with more effective interventions? (Hill et al., 2015, p. e159)

3. The most important information in this article related to the means by which the Hill et al.

(2015) study was conducted to include the CALO-RE taxonomy framework proposed by Michie and colleagues, which helped to reveal gaps in prior literature reviews.

The systematic search was conducted according the PRISMA criteria and yielded 94 results for perusal, of which 16 were deemed relevant for the current review. Of these 16 papers, were also included in the Olsen and Nesbitt review. Figure 1 outlines the flow of studies included in this review. Additionally, File 2 (http://dro.eakin.edu.au/view/DU:30059375 ) presents full-text excluded papers and their reasons. Authors of all 16 studies were contacted to request further information about the intervention; five authors responded, of whom three provided additional information. No authors provided additional information regarding the theoretical bases of their interventions.

1 Paul, R., & Elder, L. (2020). The miniature guide to critical thinking concepts and tools (8th ed.). Foundation for Critical Thinking.

Figure 2 presents risk of bias assessment for all studies. Low risk of bias was apparent in over 75% of studies for the domains of random sequence generation, incomplete outcome data, and selective reporting. Blinding of participants and personnel had the greatest number of studies with high risk (31%), whereas allocation concealment was difficult to determine (unclear risk; 81%). Aims, participants, approach, underpinning theories, BCTs (classified according to the CALO-RE taxonomy of Michie et al.), and main findings pertaining to the 16 studies included in this review are presented in Table 1. Key study characteristics are presented in Table 2. (Hill et al., 2015, p. e164)

4. The main conclusions in this article are identified that while health coaching does evidence

overall positive results, among the studies reviewed it was determined that three issues limited the full conclusions that could be drawn in the literature review, as shared by the authors :

The analysis showed that 94% of studies reported a positive intervention effect on at least one outcome variable, with overall study quality deemed fair. Hence, we could deduce that health coaching shows promise as a technique for eliciting positive behavioral or outcome change, at least for certain outcomes that were measured in a sufficient number of studies to form some conclusions (e.g., BMI, perceived health status, and fat intake). Three definitive issues have limited our ability to draw further conclusions from the literature: (1) diversity of intervention approaches, (2) lack of detail reported in studies, and (3) diversity of outcomes.

In order for a clear assessment of the effective aspects of health coaching on differing outcomes, including behavior change processes, and physiological and psychological outcome domains, we suggest some recommendations to be considered in future studies.

❖ Clarity in reporting intervention details ❖ Clearer definitions of health coaching and theoretical bases ❖ Consistency in reporting BCTs ❖ Inclusion of process variables and mediators of change as outcome measures ❖ Focus of research towards specific issues (Hill et al., 2015, p. e167)

5. The key concepts we need to understand in this article are what health coaching is, its overall

aim, and the fact that prior health coaching research, particularly a prior literature review, did not fully reveal information. Thus, absent from the field of study is a comprehensive review of prior research for which Hill et al. (2015) recommend using a particular framework: the CALO-RE taxonomy.

In 2010, Olsen and Nesbitt conducted an integrative review of studies reporting evaluations of health coaching interventions. Their aim was to determine the effectiveness of health coaching interventions for improving healthy lifestyle behaviors and to identify the key features of an effective health coaching program. Olsen and Nesbitt’s findings suggest that the term ‘‘health coaching’’ is being used to characterize a wide range of specific interventions that vary considerably in terms of the

behavior change techniques (BCTs) they use and their effectiveness. (Hill et al., 2015, p. 159)

By these concepts, the author means health coaching holds promise for effectual outcome s but to better understand prior research a framework is needed to consistently categorize interventions that have been employed so that consistency and higher success rates in the field are obtained.

Although this framework is designed specifically for interventions addressing physical activity and healthy eating behaviors, it can be applied to any health coaching program. In their framework, Michie et al. propose 40 features/techniques a program might employ, such as behavioral or outcome specific goal setting, action planning, providing rewards contingent on effort or outcome, and motivational interviewing. The aim of this review was to extend the work of Olsen and Nesbitt by applying the CALO-RE framework to existing health coaching literature. (Hill et al., 2015, p. e159)

6. The main assumption(s) underlying the author’s thinking is that “health coaching is a promising strategy for health improvements” (Hill et al., 2015, p. e164) but even with the availability of a good literature on health, there are gaps in the literature.

Health coaching has been posited as a holistic approach to improving health behaviors. It combines information and education with health behavior modificatio n, problem solving, and psychosocial support (although not all components are included with all iterations of health coaching). It has been widely used as a tool to promote changes in unhealthy behaviors that lead to prevent able diseases across a variety of populations. Health coaching is applied across multiple contexts, including primary health care, the workplace, and health plans. (Hill et al., 2015, pp. 158–159)

“Although Olsen and Nesbitt11 produced an integrated review, they did not attempt to characterize existing studies using a published framework designed to identify the key features of health coaching interventions” (Hill et al., 2015, p. e159).

7a. If we take this line of reasoning seriously, the implications are that “practitioners will not be able

to confidently replicate interventions or draw on effective aspects of health coaching until several issues within the literature have been resolved” (Hill et al., 2015, p. 168).

7b. If we fail to take this line of reasoning seriously, the implications are practitioners may falsely assume that single or limited reviews of literature are consistent in their views and that replication of interventions is a given when it is not. There will not be a realization by the readership that the literature on health coaching has inconsistent findings.

8. The main point(s) of view presented in this article is that while there is widespread agreement on

the benefits and overall effectiveness of health coaching, significant variability exists and such variances have not been adequately captured in a single research study, namely a comprehensive literature review.

There is some evidence supporting the effectiveness of health coaching; however, it is not conclusive, and there is considerable variability in the nature of the techniques employed by the various interventions. This is the first review to attempt to characterize existing health coaching studies using a published framework designed to identify the key features of health coaching interventions. (Hill et al., 2015, p. e168)