Digital Coaching to Address Health,Wellness,and Burnout Among Healthcare Workers: Pilot Study Results

Abstract

Background:

Healthcare worker (HCW) well-being is essential for safe, high-quality patient care, but clinicians and front-line staff continue to experience alarming rates of burnout. This pilot study evaluated a novel 6-week program of remote wellness coaching supported by daily digital messaging to reduce burnout and increase well-being among HCWs.

Methods:

In spring 2023, staff from a large community health center in California were invited to participate in this single-group pretest–posttest study in an academic-practice partnership. Thirty-four participants who were mostly female (91%), Latina (77%), 36 years old on average (range = 20–61), and represented all major job categories provided informed consent and completed the baseline survey. Of these, 17 completed 6 weekly 20-minute coaching sessions; received daily messages about stress management, self-care, workplace well-being, social connections, and lifestyle and health behaviors, and completed follow-up data collection. The Wilcoxon matched pair signed-rank tests assessed changes from baseline to 2-months follow-up.

Results:

Self-reported burnout decreased from 59% at baseline to 35% at follow-up. Work exhaustion (p < .05), stress (p < .05) and sleep problems (p < .01) reduced significantly, and wellness practices (p < .05), moderate physical activity (p < .01), and healthy daily eating (p < .05) improved.

Conclusions/Applications to Practice:

Our pilot study suggests that a brief digital wellness program may address burnout and increase health and well-being among front-line staff and clinicians. Healthcare settings should consider this type of program for their workers, especially given the added burden of COVID-19 on the healthcare system.

Keywords

healthcare workers burnout coaching wellness digital intervention

Background

Burnout is plaguing the healthcare system. Resulting from multiple factors causing chronic stress in the workplace, healthcare workers (HCWs) facing burnout display emotional exhaustion, increased feelings of detachment from work, feelings of negativism about the job, and a reduced sense of professional efficacy and personal accomplishment (Maslach et al., 1997). Burnout results in emotional and physical fatigue among employees, staff attrition and turnover, and decreased safety and quality in the provision of care (Hall et al., 2016; Trockel et al., 2018). Mental health concerns including stress, anxiety and depression, sleep difficulties, substance abuse, and suicidal ideation also have been linked to burnout (Leo et al., 2021; Murthy, 2022).

Although attention to HCW stress and burnout has increased since the onset of the COVID-19 pandemic (Leo et al., 2021; Murthy, 2022; Prasad et al., 2021), there is limited research on workplace interventions to effectively reduce burnout and promote a healthy workplace for employees (Pollock et al., 2021). Self-care practices, defined as actively engaging in strategies that promote health, enhance well-being, and boost coping and stress management (World Health Organization, 2022), have shown promise in addressing HCW burnout (Leo et al., 2021; Tamminga et al., 2023). Strategies include mindfulness and relaxation techniques, spiritual practices, supportive digital health tools, coaching, and enhancing interpersonal communication skills to help HCWs manage the stresses of providing patient care. Adopting a healthy lifestyle and supportive behaviors, engaging in hobbies and recreational activities, and prioritizing personal relationships and family also are linked to reduced stress and burnout among HCWs (Boet et al., 2023; Leo et al., 2021; Pollock et al., 2021; Sanchez-Reilly et al., 2013; Tamminga et al., 2023).

This project aimed to enhance self-care and stress management practices through a unique intervention combining remote health and wellness coaching with daily digital messaging. Coaching, defined as a collaborative and goal-oriented process that is client-centered and promotes learning and growth, has been shown in systematic reviews to reduce occupational stress for HCW (Tamminga et al., 2023) and to reduce burnout among physicians (Boet et al., 2023). Coaching for HCW provides participants with tools to cope with stress, handle work-life balance, and attain valued personal and professional outcomes (Boet et al., 2023). Although there are many digital programs designed to decrease stress and improve health and wellness, rarely have they been applied to support HCW well-being. Recent studies have shown that a smartphone app may reduce burnout by increasing resilience and mindfulness among emergency department HCW (Monfries et al., 2023) and that automated text messages were useful for stress reduction and coping for nurses (Kelly et al., 2021). To increase engagement and assist participants in attaining health and wellness goals, digital communications have been combined with coaching interventions, although mostly for chronic illness (Chatterjee et al., 2021; L’Engle et al., 2023). The combination of wellness coaching supported by daily prompts for practicing self-care behaviors is a novel and promising intervention approach for the healthcare workforce.

Methods

Study Design

A brief digital health and wellness intervention was developed and evaluated to reduce burnout and improve health and well-being among both clinical and non-clinical staff at a Federally Qualified Health Center (FQHC). The intervention was evaluated in a single-group pretest–posttest pilot study. The study was designed as an academic-practice partnership between the FQHC and a private university in Northern California. The FQHC led participant recruitment and convened focus groups with staff to guide program development. The university partner adapted the Examen Tu Salud/Examen Your Health intervention (L’Engle et al., 2023) for HCWs, trained coaches, monitored study procedures and implementation, and conducted data collection.

Sample and Recruitment

In 2020, the FQHC employed 1,200 people across their 35 sites to serve more than 75,000 patients, of whom almost two-thirds were Hispanic and 95% were uninsured or had public insurance. The FQHC’s Wellness Council, which aims to enhance staff well-being, promoted the study to all staff employed by the organization, including clinicians, clinical office support staff, and administrators. The FQHC shared recruitment materials with staff during meetings and via electronic newsletters and department announcements. Recruitment fliers were developed with focus group input and stated, “Want to try new ways to improve your health and well-being? Strengthen your physical, mental, and social health! Join the Examen-La Clinica digital health and wellness program!” Recruitment highlighted voluntary participation with participants completing coaching sessions during their own free time and that all current employees were eligible. Interested staff members were asked to complete an online interest form to gather their name, primary clinic location, and contact information. They were asked to select the job title (or write in a different one) from a list that included: clinical office assistant; medical assistant; other office support such as laboratory, x-ray, billing, facilities; health educator; registered nurse; or provider including physician, nurse practitioner, physician assistant, or clinical nurse midwife. A total of 77 staff completed the form.

Study Procedures

Staff members who completed the interest form received an email with a link to the informed consent form and online baseline survey, and 34 participants completed these documents and were enrolled into the study. The baseline survey asked participants sociodemographic and background characteristics, and logistical questions about preferred coaching times. In addition, participants were asked to complete survey questions on burnout, wellness practices, stress, and other health indicators which are described in the section “Measures.” Coaches were assigned to participants based on compatible schedules for weekly coaching and emailed their participants to arrange the first coaching session. Each session was scheduled for 20 minutes, with 6 total coaching sessions during the 6-week program. Coaches were second year Master in Public Health (MPH) students who received approximately 60 hours of coaching training and practice from experienced community and behavioral health educators on the project team. The same coach conducted all coaching sessions with the assigned participant, usually via videoconference, but occasionally via phone. At the first coaching session, participants were enrolled into the digital messaging platform (Simple Texting, Miami Beach, FL, USA) and began receiving daily messages on their mobile phones. Between coaching sessions, coaches provided additional resources such as healthy recipes or meditation exercises that were tailored to the goals of the participant, using the digital messaging platform. One week after the final coaching session, a link to the follow-up online survey was emailed to each participant, which included the same measures as the baseline survey, as well as an evaluation of their overall experience. The FQHC’s Quality Assurance Committee and the Institutional Review Board at the University approved all study procedures.

Measures

The baseline survey assessed sociodemographic and other background characteristics, including age and gender, race/ethnicity, marital status, hours per week worked at the FQHC, job title, and number of years working at the FQHC. Burnout, professional fulfillment, wellness practices, stress, anxiety and depression, sleep, physical activity, nutrition, and overall health were self-reported and assessed at both baseline and follow-up using the same questions in both surveys. All responses were scored so that a higher number corresponded to a greater level of the variable being measured. For example, a score of 1 meant lower burnout, while a score of 5 indicated higher burnout. A complete version of the survey questions for all measures described here is shown in the Supplemental Appendix.

Burnout was measured with both a single overarching question (Dolan et al., 2015) and the multi-item Stanford Professional Fulfillment Index (PFI; Trockel et al., 2018). A single measure of burnout symptoms correlates well with longer assessments of burnout and particularly scales measuring emotional exhaustion and has been used in previous studies with clinical and administrative staff in healthcare settings (Brady et al., 2022; de Dolan et al., 2015; Knox et al., 2018; De Marchis et al., 2019; Rohland et al., 2004). Study participants were asked to consider their personal definition of burnout and self-report their level of burnout ranging from (1) no burnout symptoms to (5) feeling complete burnout.

The Stanford PFI is a 16-item self-report instrument that has been shown to have internal consistency, test–retest reliability construct validity, and criterion validity for assessing two domains related to burnout and one domain related to fulfillment among HCWs, with Cronbach’s alphas ranging from .86 to .92 and test–retest reliability scores ranging from .71 to .82 in one physician sample (Trockel et al., 2018). The PFI is designed to assess changes following intervention and to include both positive and negative aspects of clinicians’ work, and therefore, was selected as suitable for this study. Participants were asked to rate their feelings in the past week in three domains: (a) work exhaustion assessed with four items (e.g., emotional /physical exhaustion at work) scored from (1) not at all to (5) extremely; (b) interpersonal disengagement with six items (e.g., empathy and connectedness with others) scored from (1) not at all to (5) extremely; and (c) intrinsic rewards assessed with six items (e.g., meaningful/satisfying work) scored from (1) not at all true to (5) completely true.

Wellness practices were assessed by asking participants how often in the past week they practiced meditation, yoga, or another mind-body practice, prayer, reflection, or mindfulness. They were asked about stress frequency and also answered four items from the validated Patient Health Questionnaire for Anxiety and Depression (PHQ-4; Kroenke et al., 2009) about feelings such as nervousness or depression in the past week. All items were scored from (1) not at all to (4) nearly every day. Using the eight-item PROMIS Sleep Disturbance Short Form (Yu et al., 2011), participants were asked to rate their sleep difficulties (e.g., “I had difficulty falling asleep”) over the past week, from (1) never to (5) all the time.

Physical activity was assessed by asking participants how many days in the last week they did moderate intensity activity (e.g., brisk walking, swimming) for at least 30 minutes and how many days they did muscle-strengthening activities (e.g., heavy gardening, weight-lifting, strenuous yoga). To assess nutrition status, participants were asked to estimate how many cups of fruit (e.g., small apple, large banana) and vegetables (e.g., medium potato, cooked beans) they ate on a typical day. Brief assessments of physical activity and nutrition were used because the goal was to assess changes rather than make precise estimates about exercise duration and nutritional intake.

Intervention Coaching

The intervention structure and strategies for change were guided by Social Cognitive Theory (Bandura, 1986), the Transtheoretical Model of Change (Prochaska & Velicer, 1997), and essential coaching and motivational interviewing strategies (Simmons & Wolever, 2013). Coaches were trained to use a coaching guide to implement evidence-based coaching practices that were adapted from existing coaching curricula (Bodenheimer & Ghorob, 2014; International Coach Academy, 2014). The coaching guide presented a similar structure for each 20-minute weekly session, included weekly objectives, and offered specific questions for coaching that centered on goal setting and monitoring, assessing progress and confidence in achieving goals, and problem-solving to address challenges (L’Engle et al., 2023). Participants set goals to improve their health and well-being during the first session in collaboration with their coach and subsequently worked with their coach to assess and modify goals if needed as coaching progressed. Motivational interviewing techniques such as asking open-ended questions, reflective listening, and making affirming statements were used by coaches to elicit and reinforce motivations for change and to support collaborative problem-solving (Simmons & Wolever, 2013). For example, the Week 1 objective was goal setting, using questions such as, “What do you want to work on and why is this important to you?” The Week 3 objective was overcoming barriers, with questions such as, “What challenges have you faced in meeting your goals? How can we modify your goal to make it more achievable for you?” In each session, coaches asked a question about the digital messages to support the weekly coaching objective, such as, “How have the digital messages motivated you this week?” In addition, coaches asked participants to assess their confidence in meeting goals each week and employed a variety of strategies for change to increase participants’ self-efficacy and success in achieving goals (Bandura, 1986; Prochaska & Velicer, 1997).

Digital Health Messages

Every morning for 6 weeks, participants received an automated text or multimedia wellness message sent to the mobile phone. Message development was informed by resources for stress management and well-being for HCWs (e.g., Kelly et al., 2021; Murthy, 2022). Each message fell into one of the five domains: joy at work, strengthening connections, stress management, healthy behaviors, and spirituality, with each week including messages from different domains. Strategies for change, such as prompting motivation, increasing skills and self-efficacy, and goal orientation and action, were highlighted in digital messages and complemented and reinforced weekly coaching. Messages were sent on a fixed schedule, were the same for all participants created specifically for this study, and designed to be stand-alone communications that did not require participant response (Table 1). Daily messages were written entirely in English or a combination of English and Spanish, with participants choosing their preference for language at enrollment. Messages were tailored for HCWs and were affirming (“you are important”), encouraging (“you can do this”), collective (“together we can”), and warm (“hi friend”) in tone.

Table 1.

Digital Messages for Healthcare Worker Well-Being

Domain	Example message	Strategies for change
Joy at work	What are you proud of in your job? You are necessary, important, and strong. Be kind to yourself. You are enough. We see you and we appreciate you! Remember why you became a healthcare worker. A strong sense of purpose = better health. Be proud of yourself and the people you help everyday at La Clinica.	• Increase motivation • Focus on strengths • Dramatic relief
Strengthening connections	Who helped you today? Send a note of gratitude and give thanks. Reach out to someone you are grateful for. You both will feel good! Get to know your coworkers. Start a plant swap. Share a snack, cultural dishes, music. Ask about their workspace. Social connections = better health & wellbeing.	• Emphasize benefits • Helping relationships • Practice gratitude
Stress management	Bedtime routines = better sleep. Write down what’s on your mind. Do meal prep for tomorrow. Plan for the next day. Speak a positive affirmation. Sleep well! Reminder: move more and sit less—every little bit of activity helps. Get exercise when you can—stretch at your desk, take short walking breaks, spend time outdoors. Enjoy your body! Where are you feeling stress today? Do a quick body scan. Drop your shoulders, unclench your jaw, roll your neck. It feels so good to decompress!	• Feasible steps • Develop skills • Increase self-efficacy • Prompt self-care
Healthy behavior	Healthy lunch habits = better day. Prepare a healthy lunch. Eat lunch with a coworker. Practice mindful eating. Your body will thank you! What did you do for your health today? Remember the goal you set with your coach. Every step you take gets you to better health & happiness.Si se puede!	• Increase self-efficacy • Goal orientation • Action
Spiritual health	When do you spend time in reflection, community, or prayer? Make a weekly goal to spend time in a calm or spiritual setting. You’ll feel grounded and peaceful. Be still and reflect. How did your values, beliefs, strengths, or faith bring you to this moment? Keep going!	• Reflection • Self-re-evaluation

Data Analysis

Descriptive statistics were used to describe the study sample at baseline (n = 34) and the analytic sample who completed the follow-up survey (n = 17). To create scaled scores for outcome measures, all items in the scale were summed and averaged. Scales demonstrated adequate reliability (Cronbach’s alpha measures of internal consistency ranged from .77 to .94). The Wilcoxon matched pairs signed-rank test, a non-parametric test suitable for comparing paired data points in small samples, was conducted to determine whether there were significant changes from baseline to follow-up on study outcomes. The test first calculates the differences between baseline and follow-up scores for each participant and then tests whether the median of these differences differs from zero. Data analyses were conducted using SPSS v27 (IBM Corp, Armonk, NY, USA). Statistical significance was defined as p < .05; p < .10 findings are also reported given the pilot status of this research.

Results

Sample Characteristics

The final sample included 34 enrolled participants, of whom 17 completed all coaching sessions and the follow-up survey. As shown in Table 2, participants enrolled at baseline were overwhelmingly female (91%), 36 years old on average, and majority Hispanic (77%). Most participants worked 40 hours per week (83%) and represented a variety of positions at the FQHC. At baseline, 45% of enrolled participants (n = 15) and 59% of completed participants (n = 10) reported burnout symptoms. Although a variety of job titles were represented among participants, eight providers and registered nurses completed follow-up (47% of completed participants) compared to nine who enrolled at baseline (26% of enrolled participants). Conversely, only one medical assistant completed follow-up (6% of completed participants), although seven enrolled at baseline (20% of enrolled participants). All completed study participants said they would recommend the Examen program to other staff.

Table 2.

Baseline Characteristics of Enrolled and Completed Participants

Characteristic	Enrolled at baseline (N = 34)	Completed follow-up (N = 17)
Female	32 (91%)	15 (88%)
Age (average, range)	36 (20-61)	39 (26-61)
Identify as Hispanic	27 (77%)	12 (71%)
Married or living w/partner	19 (54%)	10 (59%)
Work 40 hours/week	29 (83%)	12 (71%)
Job title
Manager	8 (23%)	4 (24%)
Medical assistant	7 (20%)	1 (6%)
Provider	6 (17%)	5 (29%)
Other office support	2 (6%)	1 (6%)
Clinical office assistant	3 (9%)	2 (12%)
Health educator	5 (14%)	0
Registered nurse	3 (9%)	3 (17%)
Human resources	1 (3%)	1 (6%)
Time working at FQHC
<1 year	9 (26%)	5 (29%)
1–5 years	12 (34%)	5 (29%)
6+ years	14 (40%)	7 (42%)
Self-reported burnout^a	15 (45%)	10 (59%)

Burnout is defined as ≥3 (Dolan et al., 2015) using a single measure of burnout.

Changes in Study Outcomes

Results from Wilcoxon matched pairs signed-rank tests comparing baseline and follow-up intervention scores for participants who completed the follow-up survey (n = 17) showed some improvements in measures of burnout and professional fulfillment (Table 3). On the single item assessing participants’ level of burnout, there was a significant reduction in symptoms reported at baseline compared to symptoms reported at follow-up (z = −2.00, p = .046). Work exhaustion also decreased from baseline to follow-up (z = −2.493, p = .013). However, feelings about interpersonal disengagement and intrinsic rewards at work did not change.

Table 3.

Changes in Burnout, Wellness, and Health Behaviors From Baseline to Follow-Up (N = 17)

Variable (range)	Baseline median (IQR)	Follow-up median (IQR)	Z-score	p (Wilcoxon test)
Burnout (%)	59%	35%	−2.000	.046
Work exhaustion	3.00 (2.00-4.00)	2.50 (2.00-3.13)	−2.493	.013
Disengagement	2.00 (1.08-3.08)	1.50 (1.17-2.67)	−1.262	.207
Intrinsic rewards at work	3.00 (2.42-3.75)	3.33 (2.92-3.83)	1.408	.159
Wellness practices	1.00 (1.00-2.00)	2.00 (1.50-3.00)	2.415	.016
Stress	3.00 (2.00-4.00)	2.00 (2.00-3.00)	−2.310	.021
Anxiety and depression	1.75 (1.25-2.50)	1.50 (1.25-2.50)	−0.810	.418
Sleep problems	3.00 (2.34-3.71)	2.79 (1.89-3.29)	−2.706	.007
Days of moderate activity	2.00 (2.00-3.50)	3.00 (2.50-4.00)	2.652	.008
Days of muscle-building activities	2.00 (1.00-3.00)	2.00 (2.00-3.00)	1.930	.054
Healthy eating	3.00 (3.00-4.00)	4.00 (4.00-4.00)	2.121	.034
Cups of fruit	2.00 (2.00-3.00)	3.00 (1.50-3.00)	1.604	.109
Cups of vegetables	2.00 (2.00-3.00)	3.00 (2.00-3.50)	0.587	.557
Overall health	2.00 (2.00-3.00)	3.00 (2.50-4.00)	2.495	.013
Apps for health (%)	29%	59%	2.236	.025

Note: Median (interquartile range) for study outcomes at baseline and follow-up. Comparisons were made with a non-parametric Wilcoxon matched pairs signed-rank test. Bold indicates p < .10.

Daily wellness practices increased from baseline to follow-up (z = 2.415, p = .016). Stress (z = −2.310, p = .021) and sleep difficulties (z = −2.706, p = .007) significantly decreased at follow-up, although there was no significant change in anxiety or depression. At follow-up, participants reported more days of moderate exercise (z = 2.652, p = .008) and muscle-building activities (z = 1.930, p = .054) compared to baseline. Although there were no significant changes in reported fruit or vegetable consumption from baseline to follow-up, participants felt they were eating healthier on a daily basis at follow-up (z = 2.121, p = .034). Overall self-reported health (z = 2.495, p = .013) and having apps for health and wellness on one’s phone (z = 2.236, p = .025) also increased at follow-up (Table 3).

Discussion

The Examen Tu Salud/Examen Your Health program encouraged self-care and stress management practices to enhance feelings of well-being and healthy habits, as well as to reduce burnout among FQHC healthcare staff. The 6-week program successfully provided remote coaching and digital support to HCWs serving low-income patients and communities, was rated highly by participants who completed the program, and may help meet a significant need for interventions to reduce stress and burnout in healthcare settings (Pollock et al., 2021). Statistically significant reductions in self-reported burnout, work exhaustion, stress, and sleep problems, and improvements in healthy behavior and wellness practices following program participation were observed. The combination of health and wellness coaching with standardized and automated daily digital messages was novel and may have increased the impact of implementing only one of these intervention approaches to supporting HCWs (Chatterjee et al., 2021).

With increased mental health concerns such as stress, anxiety, depression, and sleep difficulties reported among all levels of HCWs during the COVID-19 pandemic (Leo et al., 2021; Murthy, 2022; Søvold et al., 2021), interventions addressing burnout and wellness are needed, especially given there is limited knowledge of effective workplace interventions for a broad range of HCW employees (Pollock et al., 2021). Most research has focused on burnout among medical providers, such as doctors and nurses, but burnout is also experienced among those in non-clinical roles (Hall et al., 2016; Prasad et al., 2021). Studies suggest that stress and burnout are higher among HCWs who are younger versus older, female versus male, and Black and Latino versus White, as well as worse in nursing and medical assistants and social workers in comparison to other HCW roles such as physicians and physical therapists (Leo et al., 2021; Prasad et al., 2021). Burnout and stress may be especially prevalent in environments that serve complex patient social and clinical needs, such as FQHCs (De Marchis et al., 2019). Accessible programs like the Examen intervention described here may prove beneficial.

This study was conducted as an academic-practice collaboration, and graduate students in public health provided coaching to HCWs in the FQHC. Coaching is increasingly employed in diverse settings, for varied needs, and with different training approaches (Boet et al., 2023; Chatterjee et al., 2021; Simmons & Wolever, 2013). The Examen intervention was developed initially for young adult Latinas who were university students; Latina graduate students provided peer-to-peer coaching that promoted healthy eating, exercise, spiritual health, and reduced stress and anxiety (L’Engle et al., 2023). The adaptation and positive results from implementing the program for HCWs in the current study suggest that coaching can be provided successfully in diverse settings (e.g., clinics, universities), with different relationships between coach and participant (e.g., student to staff, peer-to-peer), and for distinct populations (e.g., HCWs, Latinas). Leveraging community partnerships and innovative methods of program delivery offer promising and affordable opportunities for increasing HCW health and well-being (Taylor et al., 2021). With respect to cost, the only direct intervention cost was the texting platform, with indirect costs consisting of FQHC staff time for program promotion and participation, and university faculty and student time for program adaptation, implementation, monitoring, and data collection and analysis.

Study results showed that burnout symptoms and work exhaustion were significantly reduced among participants, although professional fulfillment and interpersonal disengagement did not improve following the intervention. A similar pattern of results has been observed in other interventions designed to reduce HCW burnout (Boet et al., 2023; Monfries et al., 2023). In the current study, participants may have prioritized and set goals for stress management and thus, successfully lowered feelings of exhaustion and general burnout. Joy at work, connecting with coworkers, and reflective questions about values that motivated working in healthcare were emphasized in digital messages but may not have been enough to improve professional contentment. A more intentional focus on workplace happiness during coaching sessions should be explored to substantially impact other elements of burnout. Alternatively, system-level effects of organizations may influence these domains to a greater extent. While the Examen program showed positive impacts on HCW self-care and stress management, it is essential to address systemic factors that are major contributors to burnout in healthcare such as stigma against reporting mental health issues, excessive workload and work hours, and providing appropriate capacity for patients’ social needs (De Marchis et al., 2019; Murthy, 2022; Søvold et al., 2021). Social, cultural, structural, and organizational factors limit HCW ability to regularly practice high-quality self-care behaviors—and improved self-care will not make burnout disappear. This has been investigated extensively elsewhere (Shanafelt & Noseworthy, 2017) and a likely solution to burnout will require both system and individual interventions and collaboration.

Limitations

There are limitations in making study conclusions because of the single-group pretest–posttest study design, the small sample, and the brief follow-up period. A larger sample and a randomly allocated study design with a control group would increase the strength of results. Only half of the enrolled participants completed the program, although all said they would recommend it. Further understanding why participants had partial completion may help improve the messaging or format. In addition, the data collected were self-reported and may be subject to recall bias and social desirability bias, which may have impacted lower reporting of burnout symptoms in particular. The single item asking participants to rate their level of burnout based on their personal definition (Dolan et al., 2015) may underestimate burnout in the study sample or be interpreted in ways inconsistent with accepted definitions (Knox et al., 2018; Trockel et al., 2024). The single-item burnout question aligns well with measures of emotional exhaustion but may be less suggestive of other types of burnout such as interpersonal disengagement (Brady et al., 2022; Trockel et al., 2024). Nevertheless, this pilot study suggests that combined remote coaching and digital messaging may reduce stress and burnout among HCWs. Combined with results from an earlier study (L’Engle et al., 2023), complementing remote coaching with digital support may lead to more impactful interventions that are accessible and personalizable (Chatterjee et al., 2021) to many categories of HCWs in varied community and healthcare settings.

Future Research

Given the positive impact of the Examen pilot program on burnout, well-being, and health behaviors and the paucity of effective interventions addressing stress and burnout in the healthcare environment (Boet et al., 2023; Leo et al., 2021; Pollock et al., 2021; Sanchez-Reilly et al., 2013; Tamminga et al., 2023), a larger controlled trial with a longer follow-up period is merited. Short-term success was observed in this study, but future research should investigate the sustainability of program effects and maintenance of behavior change over time. Additional measures and multi-item scales should be used in future research to mitigate some of the limitations of the current study such as using a brief measure of burnout and simple assessments of healthy eating and wellness practices assessed with consistent definitions. Future research also should investigate which aspects of the program were most impactful, such as coaching versus daily messages or comparisons between message domains and strategies. Personalization and interaction are core elements of health coaching (Chatterjee et al., 2021; Simmons & Wolever, 2013), so it would be worthwhile to evaluate the application of additional tools for digital coaching such as electronic chatbots or an app that provides a more interactive experience than the daily messages used in the current program. Research should additionally explore the impact on participation and well-being outcomes from adding a system-level intervention to the Examen individual-level intervention. One reasonable approach is to allow Examen program participants to engage in weekly coaching during their regular workday rather than as voluntary time to demonstrate that leadership values the program and the health, well-being, and happiness of their employees (Søvold et al., 2021).

Implications for Occupational Health Practice

Programs to support HCWs at all levels of staffing are urgently needed. The findings of this study suggest that a coaching and a brief digital intervention approach is feasible in a healthcare setting, engaging to participants, and potentially effective in improving health, wellness, and enjoyment at work. These results have the potential to influence workplace policies and procedures. Healthcare organizations can make use of these results to create a work environment that emphasizes peer-to-peer coaching among coworkers or by creating custom coaching programs for staff with external partners. Emphasizing social connection in coaching and digital messages likely increased participants’ engagement at work and encouraged coworkers to share information and strategies to help each other manage burnout and achieve their goals. However, a longer controlled trial with a larger sample is necessary to confirm these findings.

Applying Research to Occupational Health Practice

Reducing burnout for all cadres of HCW staff is essential for high-quality care and longevity of the workforce. Reducing stress and burnout is one of the main benefits of coaching. HCWs who receive coaching report lower levels of stress and burnout, and benefits may be further enhanced by providing digital messages and assistance designed specifically for HCWs. Our study provides preliminary evidence that a brief digital coaching and messaging intervention approach may reduce burnout, stress, and sleep problems and increase wellness practices and healthy behaviors for HCWs in community health settings. It makes sense for individuals and organizations to engage in digital coaching to alleviate HCW burnout. Health coaching complemented by health messaging may assist HCWs in enhancing their well-being and carrying on with providing their patients with high-quality care by assisting them in developing healthy habits, stress management practices, and a positive outlook on life.

Supplemental Material

sj-docx-1-whs-10.1177_21650799241291874 – Supplemental material for Digital Coaching to Address Health, Wellness, and Burnout Among Healthcare Workers: Pilot Study Results

Supplemental material, sj-docx-1-whs-10.1177_21650799241291874 for Digital Coaching to Address Health, Wellness, and Burnout Among Healthcare Workers: Pilot Study Results by Kelly L’Engle, Evelin Trejo and Anastasia J. Coutinho in Workplace Health & Safety

Footnotes

Acknowledgements

The authors gratefully acknowledge all of the staff who participated in the study and selflessly care for our community members every day. The authors also thank the students who capably served as coaches during the study period.

Author Contributions

Kelly L’Engle is a health behavior scientist and director of the MPH-Behavioral Health program at the University of San Francisco. She designed the intervention, drafted the manuscript, and analyzed the data. Evelin Trejo is a Clinical Researcher and behavioral epidemiologist at the University of San Francisco California. She codesigned the intervention, trained the student coaches, and critically reviewed the manuscript. Anastasia J Coutinho is a family physician at La Clinica de La Raza and serves as the organizational Wellness Champion. She made substantial contributions to adapting the intervention for healthcare workers, study design and data interpretation, and she critically reviewed the manuscript. All authors approved the final manuscript and are accountable for all aspects of the study.

Conflict of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the University of San Francisco and through University Faculty Development Funds to the first author. The FQHC, La Clinica de La Raza, provided support for the digital messaging platform.

Human Subject Review

The study was approved by the La Clinica de La Raza Quality Assurance Committee on May 20, 2022, and the University of San Francisco Institutional Review Board on August 13, 2022 (Protocol #1806). Informed consent was obtained from all individual participants included in the study.

ORCID iD

Kelly L’Engle

Supplemental Material

Supplemental material for this article is available online.

References

Bandura

(1986). Social foundations of thought and action: A social cognitive theory. Prentice Hall.

Bodenheimer

Ghorob

(2014). Health coaching curriculum. Department of Family and Community Medicine. University of California: Center for Excellence in Primary Care. https://cepc.ucsf.edu/content/health-coaching-curriculum

Boet

Etherington

Dion

P. M.

Desjardins

Kaur

Denis-LeBlanc

Andreas

Sriharan

(2023). Impact of coaching on physician wellness: A systematic review. PLOS ONE, 18(2), e0281406. https://doi.org/10.1371/journal.pone.0281406

Brady

K. J. S.

Carlasare

Shanafelt

T. D.

Sinsky

C. A.

Linzer

Stillman

Trockel

M. T.

(2022). Establishing crosswalks between common measures of burnout in US physicians. Journal of General Internal Medicine, 37(4), 777–784. https://doi.org/10.1007/s11606-021-06661-4

Chatterjee

Gerdes

Prinz

Martinez

(2021). Human coaching methodologies for automatic electronic coaching (eCoaching) as behavioral interventions with information and communication technology: Systematic review. Journal of Medical Internet Research, 23(3), e23533. https://doi.org/10.2196/23533

De Marchis

Knox

Hessler

Willard-Grace

Olayiwola

J. N.

Peterson

L. E.

Grumbach

Gottlieb

L. M.

(2019). Physician burnout and higher clinic capacity to address patients’ social needs. Journal of the American Board of Family Medicine, 32(1), 69–78. https://doi.org/10.3122/jabfm.2019.01.180104

Dolan

E. D.

Mohr

Lempa

Joos

Fihn

S. D.

Nelson

K. M.

Helfrich

C. D.

(2015). Using a single item to measure burnout in primary care staff: A psychometric evaluation. Journal of General Internal Medicine, 30(5), 582–587. https://doi.org/10.1007/s11606-014-3112-6

Hall

L. H.

Johnson

Watt

Tsipa

O’Connor

D. B.

(2016). Healthcare staff wellbeing, burnout, and patient safety: A systematic review. PLOS ONE, 11(7), e0159015. https://doi.org/10.1371/journal.pone.0159015

International Coach Academy. (2014, June 16). How to structure a coaching session. https://coachcampus.com/resources/how-to-structure-a-coaching-session/

10.

Kelly

L. A.

Schaeffer

Roe

Buchda

V. L.

(2021). Using text messages to support nurse well-being. Nursing Administration Quarterly, 45(4), 338–345. https://doi.org/10.1097/NAQ.0000000000000490

11.

Knox

Willard-Grace

Huang

Grumbach

(2018). Maslach Burnout Inventory and a self-defined, single-item burnout measure produce different clinician and staff burnout estimates. Journal of General Internal Medicine, 33(8), 1344–1351. https://doi.org/10.1007/s11606-018-4507-6

12.

Kroenke

Spitzer

R. L.

Williams

J. B.

Löwe

(2009). An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics, 50, 613–621. https://doi.org/10.1176/appi.psy.50.6.613

13.

L’Engle

Trejo

Landeros

Zúñiga Sandoval

Jauregui

Yang

(2023). Brief peer coaching complements daily digital messages for chronic disease prevention among young adult Latinas. Translational Behavioral Medicine, ibad036. https://doi.org/10.1093/tbm/ibad036

14.

Leo

C. G.

Sabina

Tumolo

M. R.

Bodini

Ponzini

Sabato

Mincarone

(2021). Burnout among healthcare workers in the COVID-19 era: A review of the existing literature. Frontiers in Public Health, 9, 750529. https://doi.org/10.3389/fpubh.2021.750529

15.

Maslach

Jackson

S. E.

Leiter

M. P.

(1997). Maslach burnout inventory: Third edition. In Zalaquett

C. P.

Wood

R. J.

(Eds.), Evaluating stress: A book of resources (pp. 191–218). Scarecrow Education.

16.

Monfries

Sandhu

Millar

(2023). A smartphone app to reduce burnout in the emergency department: A pilot randomized controlled trial. Workplace Health & Safety, 71(4), 181–187. https://doi.org/10.1177/21650799221123261

17.

Murthy

V. H.

(2022). Addressing health worker burnout—hhs.gov. U.S. Department of Health & Human Services Office of the U.S. Surgeon General. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf

18.

Pollock

Campbell

Cheyne

Cowie

Davis

McCallum

McGill

Hagen

McClurg

Torrens

Maxwell

(2021). Interventions to support the resilience and mental health of frontline health and social care professionals during and after a disease outbreak, epidemic or pandemic: A mixed methods systematic review. Cochrane Database of Systematic Reviews, 11, CD013779. https://doi.org/10.1002/14651858.CD013779

19.

Prasad

McLoughlin

Stillman

Poplau

Goelz

Taylor

Nankivil

Brown

Linzer

Cappelucci

Barbouche

Sinsky

C. A.

(2021). Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: A national cross-sectional survey study. eClinicalMedicine, 35, 100879. https://doi.org/10.1016/j.eclinm.2021.100879

20.

Prochaska

J. O.

Velicer

W. F.

(1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12(1), 38–48. https://doi.org/10.4278/0890-1171-12.1.38

21.

Rohland

B. M.

Kruse

G. R.

Rohrer

J. E.

(2004). Validation of a single-item measure of burnout against the Maslach Burnout Inventory among physicians. Stress and Health, 20(2), 75–79.

22.

Søvold

L. E.

Naslund

J. A.

Kousoulis

A. A.

Saxena

Qoronfleh

M. W.

Grobler

Münter

(2021). Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. Frontiers in Public Health, 9. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.679397

23.

Sanchez-Reilly

Morrison

L. J.

Carey

Bernacki

O’Neill

Kapo

Periyakoil

V. S.

Thomas

J. D.

(2013). Caring for oneself to care for others: Physicians and their self-care. Journal of Supportive Oncology, 11, 75–81. https://doi.org/10.12788/j.suponc.0003

24.

Shanafelt

T. D.

Noseworthy

J. H.

(2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129–146. https://doi.org/10.1016/j.mayocp.2016.10.004

25.

Simmons

L. A.

Wolever

R. Q.

(2013). Integrative health coaching and motivational interviewing: Synergistic approaches to behavior change in healthcare. Global Advances in Health and Medicine, 2(4), 28–35. https://doi.org/10.7453/gahmj.2013.037

26.

Tamminga

S. J.

Emal

L. M.

Boschman

J. S.

Levasseur

Thota

Ruotsalainen

J. H.

Schelvis

R. M.

Nieuwenhuijsen

van der Molen

H. F.

(2023). Individual-level interventions for reducing occupational stress in healthcare workers. The Cochrane Database of Systematic Reviews, 5(5), CD002892. https://doi.org/10.1002/14651858.CD002892.pub6

27.

Taylor

N. K.

Aboelata

Mahoney

Seay-Morrison

Singh

Chang

S. I.

Asch

S. M.

Shaw

J. G.

(2021). Building bridges between community health centers and academic medical centers in a COVID-19 pandemic. Journal of the American Board of Family Medicine, 34(Suppl.), S229–S232. https://doi.org/10.3122/jabfm.2021.S1.200182

28.

Trockel

Bohman

Lesure

Hamidi

M. S.

Welle

Roberts

Shanafelt

(2018). A brief instrument to assess both burnout and professional fulfillment in physicians: Reliability and validity, including correlation with self-reported medical errors, in a sample of resident and practicing physicians. Academic Psychiatry, 42(1), 11–24. https://doi.org/10.1007/s40596-017-0849-3

29.

Trockel

M. T.

West

C. P.

Shanafelt

T. D.

(2024). Comment on study by Hagan et al.: The single-item burnout question. Journal of General Internal Medicine. Advance online publication. https://doi.org/10.1007/s11606-024-09016-x

30.

World Health Organization. (2022). WHO guideline on self-care interventions for health and well-being (Report no. CC BY-NC-SA 3.0 IGO). https://iris.who.int/bitstream/handle/10665/357828/9789240052192-eng.pdf?sequence=1

31.

Buysse

D. J.

Germain

Moul

D. E.

Stover

Dodds

N. E.

Johnston

K. L.

Pilkonis

P. A.

(2011). Development of short forms from the PROMIS™ sleep disturbance and sleep-related impairment item banks. Behavioral Sleep Medicine, 10(1), 6–24. https://doi.org/10.1080/15402002.2012.636266

Supplementary Material

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