Running head: HEALTH COACHING 1 The Effect of Health Coaching on Health Risk A Dissertation submitted by Melissa Anne Young to College of Saint Mary In partial fulfillment of the requirement For the degree of DOCTOR OF EDUCATION With an emphasis on Health Professions Education This Dissertation has been accepted for the faculty of College of Saint Mary by: HEALTH COACHING 2 We hereby certify that this Dissertation, Melissa Anne Young, conforms to acceptable standards and fully fulfills the Dissertation requirements for the degree of Doctor of Education from College of Saint Mary MJ Petersen, EdD, MSN, RN Chair Christy Hutchison, J.D. Committee member Mary Kay Smid, EdD, MSN, RN Committee member HEALTH COACHING 3 Copyright © Date, 2017 Melissa A. Young HEALTH COACHING 4 Acknowledgement Page I would never have been able to finish my dissertation without the guidance of my committee members, encouragement and cheers from friends and co-workers, and the support and love from my family and husband. I would like to first thank my dissertation chair, Dr. MJ Petersen. She provided guidance, patience and support for doing this research project. The door was always open whenever I ran into a trouble spot or had a question about my research writing. She consistently allowed this paper to be my own work, but steered me in the right direction whenever I needed it. I would like to thank my committee member, Christy Hutchison and Dr. Smid, thank you both for your honest feedback. You both have been a tremendous support to me through this process. Each of you have provided me with personal and professional guidance and taught me a great deal about both scientific research and life. My family has been an important part of this process as I worked to complete this research project. I would like to thank my parents, whose love and guidance are with me in whatever I pursue. I would like to thank my sister, Michelle. She is always there cheering me up and stood by me through the good times and bad. Both my parents and sister are excellent role models who have taught me that my job in life was to learn, to be happy, to know and understand myself and to make a difference in our world. Most importantly, I would like to thank my loving and supportive husband, Brad, and my three wonderful children, Dylan, Landon and Morgan. Thank you for always encouraging me in all of my pursuits and inspiring me to follow my dreams. I appreciate your love, encouragement and tolerance when I became overwhelmed. Without your patience and sacrifice I may not have completed this research project. HEALTH COACHING 5 Table of Contents LIST OF TABLES .......................................................................................................................... 8 LIST OF FIGURES ....................................................................................................................... 9 ABSTRACT .................................................................................................................................. 10 CHAPTER I: INTRODUCTION................................................................................................. 12 Purpose of the Study ......................................................................................................... 12 Background and Rationale ................................................................................................ 13 Problem Statement ............................................................................................................ 20 Research Question(s) ........................................................................................................ 21 Limitations……………………………………………………………………………….22 Assumptions ...................................................................................................................... 23 Delimintations ................................................................................................................... 23 Definition of Terms Operationalize .................................................................................. 24 Summary ........................................................................................................................... 27 CHAPTER II: LITERATURE REVIEW .................................................................................... 29 Health Coaching................................................................................................................ 29 The Effects of Comprehensive Wellness Programs.......................................................... 31 Self-Management ........................................................................................................ 32 Medical Cost ............................................................................................................... 34 Health Risk.................................................................................................................. 36 HEALTH COACHING 6 Wellness Program Participation and Incentive ................................................................. 37 Transtheoretical Model Behavior Change ........................................................................ 39 Precontemplation ........................................................................................................ 39 Contemplation ............................................................................................................. 40 Preparation .................................................................................................................. 41 Action .......................................................................................................................... 41 Maintenance ................................................................................................................ 42 Application of Transtheretical Model Behavior to Healthy Behaviors ...................... 42 Motivational Interview...................................................................................................... 43 Express Empathy ........................................................................................................ 44 Support Self-Efficacy.................................................................................................. 44 Roll with Resistance ................................................................................................... 44 Develop Discrepancy .................................................................................................. 45 Self-Efficacy ..................................................................................................................... 46 Summary ........................................................................................................................... 47 CHAPTER III: RESEARCH DESIGN…………………………………………………………..49 Research Design................................................................................................................ 49 Participants ........................................................................................................................ 52 Data Collection ................................................................................................................. 54 Instrument ......................................................................................................................... 56 HEALTH COACHING 7 Data Analysis .................................................................................................................... 57 Ethical Considerations ...................................................................................................... 61 Summary ........................................................................................................................... 61 CHAPTER IV: RESULTS…………...…………………………………………………………..62 Wellness Participation ...................................................................................................... 62 Analysis of Research Question ......................................................................................... 64 Additional Findings……………………………………………………………………...69 Summary of Results .......................................................................................................... 71 CHAPTER V: DISCUSSION AND SUMMARY…………..…………………………………..73 Discussion of the Results of the Research Question ......................................................... 73 Health Coaching and Clinical Risk Group, Medical Cost, and Medical Utilization ........ 74 Incentives .......................................................................................................................... 75 Health Risk........................................................................................................................ 76 Limitations ........................................................................................................................ 76 Recommendations ............................................................................................................. 77 Summary ........................................................................................................................... 79 REFERENCES…………………………………………………………………………………..81 APPENDICES A. Permission from HealthFitness………………………………………………………91 B. Permission from Health Insurance Carrier…………..……....………………………92 C. Coding for Descriptive Stats…………………………………………………………93 HEALTH COACHING 8 LIST OF TABLES TABLE PAGE 1. Research Study Design…………………………………………….……..….….51