Academic Exchange Quarterly Summer 2010 ISSN 1096-1453 Volume 14, Issue 2
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Using Service-Learning to Teach Health Coaching
Thomas M. Brinthaupt,
Sheehan-Smith, EdD, RD, LDN is an Associate Professor and the Director of the Didactic Program in
Dietetics in the Department of Human Sciences. Brinthaupt, PhD, is a Professor in the Psychology
A service-learning project was used to teach health coaching during a medical nutrition therapy course.
Students (N=16) served as coaches for a 4-month program called Discovering Healthy Families (DHF).
Evaluation of the project indicated benefits for both students and DHF participants. The students’
knowledge of coaching was higher at the end of the program and DHF participants were very satisfied
with their coaches.
“Coaching is unlocking a person’s potential to maximize their own performance” (1). Health coaching provides people with information that will enable them to make informed decisions and to lead healthier lives. Thus, the coaches serve as facilitators, assist with goal development, and offer strategies for accomplishing goals (2). Health coaching is a relatively new career opportunity for dietetics professionals. It differs from medical nutrition therapy (MNT) because its focus is on advice for achieving health-related goals, while MNT focuses on disease treatment (3). In light of this career opportunity, dietetics educators have the challenge of incorporating health coaching instruction into an already full didactic program. Due to the unique nature of health coaching, traditional classroom instruction cannot provide adequate preparation. However, the incorporation of service-learning into an existing MNT course provides students with both didactic instruction and the opportunity to practice coaching skills in a community setting.
Service-learning is a type of experiential education where learning occurs through a cycle of action and reflection (4). Students and faculty collaborate with community partners to address problems and issues relevant to the community. There is equal emphasis placed on helping the community partner and on providing a valuable learning experience for students.
In this paper, we illustrate how health coaching instruction can be integrated into an existing medical nutrition therapy course in order to incorporate a service-learning component. We report assessments of the program from the perspectives of both the students and the community participants. The data from those assessments add to research on the use of service-learning in dietetics education. We also document the contribution the students’ health coaching efforts made in the community-based program, Discovering Healthy Families.
Review of the Literature
A recent review of the service-learning literature indicates that it can be integrated into a variety of dietetics courses and is a beneficial tool for enhancing the learning experience. Kim and Canfield (5) and Ash (6) incorporated service learning into life-cycle nutrition courses. Kim and Canfield found that the service-learning component was associated with better retention and internalization of subject matter, and the desire by many students to continue volunteering after the class ended. The 18 students in Ash’s course evaluated its service learning component at the end of the semester. Students strongly agreed with the items pertaining to taking the course with the service learning component and for recommending the course to others. Students cited the areas in which they experienced the greatest learning in the course. Personal growth was cited by 47% of students, while 33% indicated civic engagement, and 17% noted academic enhancement.
Camel taught a community nutrition course in which students were engaged in service learning projects at three different agencies (7). Agency feedback about the students’ participation was positive. In addition, Camel indicated that service-learning was an effective teaching tool due to how it enriched her students’ learning, as well as the lasting impact it should have on the students’ future role in dietetics and society.
Lastly, Fontenot and O’Neil incorporated service-learning into an MNT course (8). Eleven students presented lessons to a diabetes education class. The outcome of the course was assessed in terms of benefits to the community and to students. Patients (N =18) in the classes showed a 24% increase in knowledge level from pretest to posttest. According to the authors, the overall student ratings indicated that the use of “service-learning projects present dietetics students opportunities for personal and professional development, practical application of classroom learning, and increased self-confidence.”
In general, previous studies suggest that many benefits can result from incorporating service-learning into dietetics courses. The primary aim of the present study was to assess the validity of teaching health coaching as part of an upper-level MNT course using a service-learning project as the tool for hands-on experiential education.
Sixteen students participated as health coaches in a privately-funded program called Discovering Healthy Families (DHF). The 4-month DHF program was a partnership between our university, a local children’s discovery museum, and a regional medical center. The unique feature of this program was its family focus. Its aim was to empower families to take control over their eating and exercise habits with the goal of increasing their overall health and well-being. Families attended 4 special, evening events at the museum where they received an educational notebook, recorded fitness measures, and worked with their health coach to set family goals. During each of the program’s special events, the students had 30-minute coaching sessions with their assigned families. At the first event, the students coached the participants on determining their family-based nutrition and exercise goals and the actions to assist with achieving those goals. At subsequent events students met with their families to answer questions, provide requested nutrition and exercise information, and assist with adjusting goals and determining new actions for accomplishing goals. To support program participants between the monthly events, the students also provided their assigned families with coaching via the telephone or electronic mail.
Students received training on health coaching prior to the start of DHF and during the program. Before DHF kicked off, the three 2-hour training sessions included topics such as the difference between health coaching and providing MNT, characteristics of effective coaches, coaching skills, assisting clients with goal development, and accurate progress note documentation. During these sessions students participated in role playing to practice their coaching skills. The week following each special event, a one-hour training session was conducted to provide students with additional time for developing coaching skills, and to discuss and assess their coaching sessions.
Health Coaching Knowledge Assessment. At the beginning of the first training session and at the end of the DHF program, students completed a health coaching knowledge assessment. The knowledge test consisted of 13 factual statements pertaining to the purpose, goals, and responsibilities of health coaches. These statements were drawn from published recommendations for health coaching and nutrition counseling, and were created specifically for this project (2, 3, 9-11). Coaches used a true-false response format. Sample items included “Effective health coaches do not need to be self-aware” and “Mirroring is an effective response to let the client know you are listening.” Possible scores ranged from 0-13.
Coaching Skills Self-Assessment. At the end of the first and last program events, coaches completed a coaching skills self-assessment created specifically for this project. This measure included 10 items pertaining to specific behaviors and skills demonstrated during the coaches’ first and last meetings with their assigned families. Coaches rated the items using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Sample items included “I was comfortable with my family” and “I am satisfied with the listening skills I used.” Cronbach’s alpha internal consistency scores for this measure were acceptable at both administrations (αs = .86, .82). Therefore, a total coaching skills index was computed by summing the ratings of the 10 items, providing a score with a possible range between 10-50.
Parental Assessment of Coaches. At the end of the program, parents (N = 19) completed a 6-item assessment of their family coach. The items (listed in Table 1) were rated using a 5-point scale (1 = strongly disagree, 5 = strongly agree). Parents also indicated, in an open-ended format, what they most liked and most disliked about the DHF program.
Coaching Progress Reports. During the program, students maintained progress reports to document each coaching session they had with their families. The form provided columns to record: (a) the nutrition and exercise issue that was being addressed; (b) the planned actions that both coach and family would take; (c) anticipated goal/outcome; and (d) level of goal achievement. The rating for goal achievement was based on a 5-point scale (1 = strongly disagree, 5 = strongly agree). Both the coach and the family rated goal achievement at special events 2-4.
Coaching Reflection Measure. At the conclusion of the program, students also completed a reflection measure of their experiences. Students responded to three questions: “What were your initial reactions about getting involved in the program and serving as a health coach?” “Did you have to deal with any barriers when coaching your family?” and “What lessons did you learn about coaching?”
The DHF program, including all study procedures and measures, was approved by the university’s
Institutional Review Board prior to the start of the program. All participants provided written informed
Results and Discussion
Health Coaching Knowledge Assessment. Student coaches showed higher knowledge scores at the end of the program (M = 11.00, SD = 1.10) than at the start of the program (M = 10.63, SD = 1.36)., although this difference was not statistically significant, t(15) = 1.00, p > .30. This finding may have been result of a ceiling effect on the knowledge test, given that it have been too easy. Many of the items were of a general nature. Since the students were seniors some of the concepts addressed in the test may have been discussed in other dietetics courses.
Coaching Skills Self-Assessment. Table 1 presents the descriptive statistics from the start and end of the program. None of the pretest/posttest means differed significantly. Students’ total coaching skills index scores were similar at the start of the program (M = 43.69, SD = 4.08) and the end of the program (M = 43.84, SD = 4.40), t(15) =.18, n.s. Despite students’ initial nervousness and apprehension about being a health coach as reported in their coaching reflections, the initial self-assessment result, which was obtained after the students’ first coaching session, indicates a high level of confidence in their coaching abilities. This might be due to their general optimism, the training provided to the students, or a reflection of what they have learned during their program of study.
Table 1. Student Coaches’ Skill Self-Assessment Ratings
I was comfortable with my family 4.56 (0.51) 4.75 (0.45)
I was comfortable with the subjects 4.31 (0.79) 4.50 (0.82)
I avoided imposing my values on my family 4.44 (0.73) 4.25 (0.78)
I remained objective during the coaching session 4.38 (0.50) 4.38 (0.62)
I am satisfied with the listening skills I used 4.25 (0.68) 4.31 (0.48)
I focused on the family, not just on the 4.38 (0.50) 4.50 (0.52)
process of coaching
I used effective nonverbal behavior skills 4.19 (0.75) 4.38 (0.50)
My family determined a specific goal for 4.69 (0.48) 4.44 (0.63)
improving their eating habits
I feel my family’s action plan will help them 4.31 (0.70) 4.22 (0.98)
accomplish their goal for improving their
I am pleased with the coaching skills I exhibited 4.19 (0.40) 4.13 (1.09)
Note. N = 16; coaches used a 5-point rating scale (1 = strongly disagree,
5 = strongly agree); standard deviations appear in parentheses; none of the
means were significantly different.
Parental assessment of Coaches. Table 2 presents the descriptive statistics from the parents’ ratings of the coaches at the end of the program. As the table shows, parents were very satisfied with their health coaches and the exercise and nutrition information that they provided. In addition, parents felt that their families needed the coaches and they were satisfied with their ability to contact the coaches.
Table 2. Parent Ratings of Family Health Coaches
I was satisfied with our family health coach 4.89 (0.32)
I was satisfied with the exercise information provided
by our family health coach 4.63 (0.50)
I was satisfied with the nutrition information provided
by our family health coach 4.79 (0.42)
Our family didn’t really need our health coach 1.63 (0.68)
It was easy for us to contact our family health coach 4.53 (0.70)
Note. N = 19; parents used a 5-point rating scale (1 = strongly disagree,
5 = strongly agree); standard deviations appear in parentheses;
all means were significantly different from the scale midpoint (3) at p<.001.
Open-ended comments provided by parents support the statistical results. Adjectives used to describe the coaches included very knowledgeable, sincere, caring, helpful, wonderful, awesome, and encouraging. One parent stated, “She helped our family live better”. Another said that “as a result of M__’s efforts and concern, we have a solid structure for healthy living.”
Both quantitative and qualitative results from the parents’ assessment of the coaches are a very strong indication of the benefits derived from a service-learning project for both the community and the students. The nature of these findings is similar to those reported by Camel (7). The students in her community nutrition course received positive feedback from participating agencies.
Coaching progress reports. The progress reports indicated that the number of coaching sessions provided to families ranged from 2-10 during the 4-month DHF program. Coaches (M = 3.74, SD = 0.47) and their families (M = 3.67, SD = 0.51) generally agreed that the families had achieved their goals during the program. These findings suggest that the students served as capable coaches by assisting their families with goal development and providing strategies for accomplishing goals.
Coaching reflections. The most common initial student reactions about getting involved with the DHF program included apprehension, nervousness, excitement and the desire to obtain coaching experience. As one student stated, “I was excited and a little hesitant, but I was really interested in gaining the experience.” Ten (63%) students indicated they dealt with barriers during their coaching sessions. The two most common barriers included the need for parents to watch their children during coaching sessions at the museum and the lack of commitment by families. The students learned many important lessons due to their coaching experience. The three most commonly reported lessons included the importance of listening skills, the need to be patient, and the need to be understanding. Other students’ lessons included, “pay attention to the small details,” “you cannot force anyone to do anything that they aren’t ready for,” “you can’t do it for them,” and “always encourage and never discourage.” These comments mirror findings from previous service-learning studies (6-8). The students learned valuable lessons about health coaching that could not have been learned in the traditional classroom setting. Students also had the opportunity to engage in a community setting that many were unfamiliar with prior to this project. They learned about the diversity of their community and how to interact with people with real health-related needs.
Though informative, the study does have its limitations. The sample sizes for both students and parents were relatively small. The short duration of the program may not have provided adequate time for developing strong working relationships between the students and their families, or to affect nutrition and exercise habits. Lastly, the results obtained from the health coaching knowledge assessment indicate that a new tool may be needed and validated.
In light of the results of this study and previous studies, the use of service-learning in dietetics
education appears to be an effective pedagogy. To better prepare our dietetics students for future career
opportunities, a new course specifically covering coaching and counseling skills is being developed.
This service-learning course offered in conjunction with the second semester of medical nutrition
therapy will provide the optimal educational environment for participation in hands-on community
programs like Discovering Healthy Families.
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