An Evidence Based Rationale for Health and Wellness Coaching as a Complementary Certification in Undergraduate Health Education

Abstract

Health and wellness coaching (HWC) is an effective intervention for many chronic lifestyle diseases. Chronic diseases represent a majority of our severe national healthcare burden. Yet, HWC certification programs vary in delivery method and degree awarded. The purpose of this paper is to provide an evidence based rationale for HWC as a complementary area of study to non-licensure granting, undergraduate health degrees in higher education. A comprehensive review of the literature related to the efficacy of HWC was completed. In addition, the national program directory was mined for descriptive data for approved HWC programs. Given the growing body of support for HWC as an effective intervention, we recommend that institutions deliver HWC curricula as an academic minor for undergraduate students in non-licensure granting health-related degrees to position graduates for entry level careers in HWC. Evidence from the successful deployment of an undergraduate program in HWC supports our contention that HWC be delivered as an academic minor in support of lifestyle health and wellness education. In doing so, the field can offer HWC in a way that is widely accessible to the undergraduate population, while providing a mechanism for direct employment as a professional health and wellness coach.

“We believe that the institutional adoption of formal, academic programs in HWC will only continue to solidify the title and reputation of HWC in our communities.”

Introduction

Health and wellness coaching (HWC) is a young and rapidly growing field that is being increasingly considered as an effective modality across a range of clinical conditions, particularly those related to chronic, preventable lifestyle disease. ¹ Nearly 2 thirds of Americans face chronic disease diagnoses, with associated costs representing a majority of our massive national healthcare burden. ² Indeed, cost effective, accessible interventions aimed at prevention and treatment of these conditions have the potential to significantly impact the physical, mental, and financial wellbeing of our country.

HWC began in earnest in the early 2000s. As a new profession, HWC faced challenges not uncommon in emerging fields, including the initial lack of standardization of learning competencies, inconsistent certification/licensure mechanisms, and need for clarity with regard to professional scope. ³ Ultimately, the early champions of the field came to define HWC as a

Patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach. The coach is a healthcare professional trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic motivation and obtain skills to create sustainable change for improved health and well-being. ⁴ (p39)

In 2012, the National Board for Health and Wellness Coaching (NBHWC) was established to oversee training and certification in HWC. In partnership with the National Board of Medical Examiners, the NBHWC has since developed required educational competencies, program standards, and a national certification examination to ensure training consistency across HWC programs. NBHWC-approved programs must deliver 75 contact hours of training across 4 required content domains that are represented on the national certification exam. ⁵ Recently, the NBHWC applied for a taxonomy code for HWC that went into effect in April of 2021, an important step toward broader national provider recognition and the ability to be reimbursed for HWC services. ⁶

According to the NBHWC, as of May 2023, there were 113 approved HWC training programs in the United States, including credit bearing (e.g., minors and concentrations.) and non-credit bearing (e.g., non-degree certificates) academic curricula, as well as non-academic, commercial programs within the private sector. ⁷ The NBHWC does not stipulate what type of institutional recognition/degree conferral is applied to HWC programs, only that the aforementioned 75 contact hours are met per the published standards. As of March 2023, 22% of the approved HWC programs in the NBHWC directory were offered for academic credit, and 19% as academic non-credit certificates.

The Bureau of Labor Statistics forecasts that HWC jobs will grow 12% in the next decade, which is more than double that of the 5% average rate of growth for occupations as a whole. ⁸ Given the projected demand for HWC in the healthcare arena, and the burgeoning interest in HWC training across the country, the purpose of this paper is to provide an evidence based rationale for HWC as a complementary area of study to non-licensure granting health-related degrees in higher education.

Efficacy of Health and Wellness Coaching

Despite ongoing advances in research and evidence based clinical interventions, lifestyle disease rates continue to rise, ⁹ and are primary drivers of morbidity and mortality in the United States. In fact, nearly 90% of the nation’s multi-trillion dollar healthcare expense is driven by chronic physical and mental health conditions. ¹⁰ Scholars have recognized the lack of training in both lifestyle behavioral counseling and preventative wellness prescription in traditional medical curricula, ¹¹ and have made recent, urgent calls for refocused efforts at lifestyle disease prevention. ¹² One intervention that has been identified as an effective modality in many clinical populations for the prevention and treatment of lifestyle disease(s) is HWC. ¹

HWC is a client-centered coaching process that “facilitates and empowers the client to achieve self-determined goals related to health and wellness.” ¹³ (p2) The health coach is an accountability partner for the client vis a vis goal setting, self-discovery, and motivational techniques aimed at improving client self-efficacy, motivation, and sustained behavior change related to healthy lifestyle choices. This partnership typically takes place across several weeks to months, at varying frequencies, and can be delivered in person, by phone, or using virtual meetings online. ¹³

Despite being a relatively new field, HWC benefits from a growing body of empirical support. In particular, HWC has been shown to be an effective intervention for health-related behavior change in both the prevention and treatment of obesity, cancer, diabetes, and heart disease, to name a few.^1,14-22 On the whole, HWC has been shown to be a highly acceptable, effective intervention, with 1 meta-analysis reporting no adverse effects across 150 HWC studies. ¹ Indeed, research has recognized health coaching interventions as “an important component of the armamentarium of interventions that can be used in the ‘global war’ against potentially preventable, non-communicable, chronic diseases.” ²³ (p164) Given these findings, and in response to the dire need for health behavior change in our nation, it is important to explore pedagogical best practices to effectively train health coaches for this emerging, critical role.

Recommendations for Curricular Models in Health and Wellness Coaching

We believe that increasing the number of certified health coaches will have a positive impact on our nation’s health. Currently, several mechanisms exist, both academic and commercial, to obtain board certification. Here, we offer a model for a flexible, academic HWC curriculum delivered at the undergraduate level as a complementary plan of study for a variety of majors. A primary aim for this program is to offer students interested in health a flexible, focused plan of study that culminates with NBHWC certification eligibility.

The vast majority of undergraduate health-related degrees in the U.S. do not lead to a nationally recognized clinical certification (e.g., exercise science, psychology, health science, nutrition, and biology.). Thus, students require several more years of study at the master’s or doctoral level in order to achieve licensure as healthcare providers (e.g., physical or occupational therapy, speech pathology, counseling, and medicine.). For students in those majors in particular, the HWC minor serves as a direct entry point into the healthcare arena, giving them the skills and certification necessary to earn reimbursement for HWC client services. Certainly, they may choose to continue on to more advanced training, but either in the interim, or long term, they will have earned a nationally recognized certification to work as a professional health and wellness coach.

The HWC program at the University of Vermont was approved by the NBHWC in 2019, as a 12-credit undergraduate certificate. At the same time, a non-credit certificate was approved, aimed at professionals and community members looking for career advancement via professional and continuing education. These 2 pathways shared online coursework in order to maximize efficiency of our teaching roster. In the first 4 years, over 100 students completed the HWC curriculum with 100% successfully passing the NBHWC certification exam, more than double the projected enrollment. Given this significant demand across campus from students in many different colleges, an academic minor in HWC was approved by the institution in 2021 to replace the undergraduate certificate.

The rationale for this change was 2-fold. First, like many universities, some of our colleges/programs require students to choose a minor in addition to their major of choice (e.g., College of Arts and Sciences). This resulted in many students being unable to complete the HWC certificate in addition to their required major and minor degrees. Second, based on student feedback and conversations with leaders in the field, we believed that expanding the curriculum to a 15-credit minor would add credibility and recognition more commensurate with the role of a board certified health and wellness coach as a valuable member of the modern healthcare team.

The HWC minor is comprised of fifteen total credits—twelve required, and 3 elective. Of the twelve required credits, the first 8 cover the NBHWC mandated content areas (i.e., coaching structure, process, ethics, and health and wellness). The 3 elective credits are selected from specialty topic areas by the student based on interest. Examples include family wellness coaching, autism, integrative health, employee wellness, and research. Notably, the non-credit certificate pathway shares this coursework, but also offers non-matriculated professional students, who neither need nor desire the institutional certificate, to complete only the first 8 credits of the program, thus achieving the minimum required contact hours and content to meet NBHWC education standards. Upon completion of any of these pathways, students must complete the requisite 50 coaching sessions on their own in order to be fully eligible for the NBHWC exam.

Discussion and Translation to Health Education Practice

We believe that the institutional adoption of formal, academic programs in HWC will only continue to solidify the title and reputation of HWC in our communities. In offering HWC training as a minor degree, students in health-related majors have access to NBHWC-approved content that positions them to become board certified and enter the workforce immediately following graduation. For some, this may represent an entry level career, while for others, perhaps only a stepping stone. However, for students in the latter group, HWC certification will allow not only financial income in the intervening time between undergraduate and graduate education, but also the potential to accumulate clinical hours and experiences with clients that are required for many graduate programs in health and medicine.

Our recommendations are not solely based on anecdotal institutional experience. Recent research has recognized the potential positive impact for HWC as complementary training for health and fitness professionals in the exercise arena in particular.^4,24 In fact, HWC has been specifically implicated as a primary skill set that can improve client outcomes in the fitness setting, as some argue that many fitness professionals, while technically sound, lack skills in behavioral motivation for their clients. ²⁵ Add to that the recently documented, significant personal benefits that HWC training offers students in coaching training programs, ²⁶ and it is clear that HWC programs have great potential to improve health and wellness for both coaches and clients. Finally, it is our recommendation that new HWC academic programs align themselves with the NBHWC standards and competencies as the NBHWC is the leading body in the field of HWC.

The purpose of this manuscript was to provide a rationale for HWC as a complementary area of study to non-licensure granting health-related degrees in higher education. This is not to suggest that this is the only level at which HWC is beneficial. However, given the growing body of evidence in support of HWC as an effective intervention, as well as the aforementioned benefits that a HWC minor degree offers students both personally and professionally, we believe it deserves a place in undergraduate education. Specifically, it is our recommendation that institutions consider elevating NBHWC-approved HWC curricula to that of an academic minor for undergraduate students in non-licensure granting health-related degrees as a means to position them for direct, entry level careers in health coaching. In doing so, universities are offering an evidence based response to both student demand for novel professional healthcare opportunities, while also preparing the next generation of healthcare providers in support of our nation’s health.