Development of the Health Coaching Quality Index: A Proposed Method for Evaluating Health Coaching Interventions

Due to the rise in lifestyle-associated chronic diseases in the United States and worldwide, Health Coaching (HC) has risen in popularity as a treatment modality. However, little consensus exists on the exact nature and definition of the HC intervention. This has resulted in difficulty comparing interventions that purport to have conducted HC. The present study has three aims, 1) to determine the extent to which studies that identify HC as an intervention are in fact including the core elements of HC, 2) to develop a tool, the Health Coaching Quality Index (HCQI), for assessing HC quality, and 3) to determine if higher quality interventions (according to HCQI scores) appear to be related to better outcomes.

This study utilized an integrative review methodology to extract and synthesize data. Manuscripts were gathered from various sources (i.e., Scopus and PubMed). They were then evaluated for inclusion based on a priori criteria (e.g., intervention study, control group used a coaching intervention). The HCQI was developed to evaluate the quality of the interventions across studies using theory-driven criteria for evaluating key coaching parameters (e.g., collaborative goal setting, use of strategic questioning).

Fifty-four manuscripts were included in the final review and analysis. Most included manuscripts evaluated health outcomes such as weight, BMI, physical activity, and chronic disease biomarkers. The results of this review found a large portion of studies fell into a "medium" (n = 22, 41%) or "low" (n = 19, 35%) quality HC intervention based on the parameters evaluated using the newly developed HCQI. Only a small portion (n = 13, 24%) were rated as "high" quality. There was heterogeneity in intervention characteristics including type (e.g., individual or group), delivery method (e.g., in-person or remote), and coaching strategies described.

The HCQI is a new tool for evaluating quality of health coaching interventions that appears to differentiate reasonably well among high, medium and low-quality interventions. We note significant heterogeneity in the quality and consistency of coaching methods employed. Additionally, higher quality HC interventions appeared to be associated with a greater proportion of positive outcomes. Future research should focus on consistency and quality in developing comprehensive HC interventions that align with underlying, evidence-based theoretical concepts. The HCQI may help researchers develop and evaluate such HC interventions.