Understanding Participant Perspectives of

Workplace Wellness Coaching

Jennifer L. Ridgeway, MPP
Aimee K. Hubbard, BA
Julie C. Hathaway, MS, LPC
Jason S. Egginton, MPH
Heather R. Preston, MS
Karleah L. Bradley, BS
Emily A. Mettler, BA
Kerry D. Olsen, MD
Matthew M. Clark, PhD
Kristin S. Vickers, PhD, LP
Objective: This study aimed to understand participant perspectives of a workplace wellness
coaching program. Methods: Semi-structured interviews were conducted with participants (N
= 27) who had completed a 3-month program. Results: Qualitative analysis identified themes
around the coaching relationship (value of personal connections, collaboration, and account-
ability), as well as attitudinal and behavior changes attributed to coaching. Additionally, the
data revealed variable initial participant expectations. Conclusion: This study adds to the litera-
ture participants’ perspectives on what aspects of coaching are most valued and how coaching
may impact behavior change. It also uncovered issues around expectations. These findings can
inform wellness coach training, and they may also indicate the need for additional measures of
coaching effectiveness that include employee-important outcomes.

Key words: health behavior, occupational health, wellness coaching

Health Behavior & Policy Review. 2014;1(3):218-228
DOI: [Link]

P
remiums for employer-sponsored health motion programs were wellness newsletters (45%),
plans continue to rise, albeit at a more moder- Web-based resources (45%), smoking cessation
ate pace in recent years.1,2 As these costs have programs (30%), on-site exercise facilities (29%),
risen, so has the prevalence of employer-sponsored weight loss programs (27%), classes in nutrition
wellness programs that target risk factors like stress, or healthy living (24%), and lifestyle or behavioral
excess weight and obesity, and lack of exercise— coaching (22%).2
factors that have been shown to increase employer With growth in the prevalence of workplace
health care expenditures.3-5 In 2012, more than half wellness programs comes the need to assess pro-
of employers offering health benefits offered some gram value, most commonly measured as changes
type of wellness program,2 up from 27% in 2006.6 in physical activity level, improvements in diet,
In 2012, the most prevalent worksite wellness pro- changes in negative health behaviors like smok-

Jennifer L. Ridgeway, Senior Health Services Analyst, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery;
Aimee K. Murry, Wellness Coach, Healthy Living Programs; Julie C. Hathaway, Patient Education Specialist, Research Program, Section of Patient
Education; Jason S. Egginton, Senior Health Services Analyst, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care
Delivery; Heather R. Preston, Manager, Patient Wellness Program, Healthy Living Programs; Karleah L. Bradley, Health and Wellness Coach, Dan
Abraham Healthy Living Center; Emily Mettler, Health and Wellness Coach, Dan Abraham Healthy Living Center; Kerry Olsen, Consultant, De-
partment of Otorhinolaryngology; Matthew Clark, Consultant, Department of Psychiatry and Psychology; and Kristin Vickers, Consultant, Depart-
ment of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN.
Correspondence Dr Vickers; [Link]@[Link]

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ing, and decreases in weight or body mass index. tive in-depth interview study exploring the client
Because these health promotion initiatives are ex- perspective of workplace wellness coaching. This
pected to have a financial impact on health care study was part of a larger mixed methods study
costs, employers are also interested in their return of wellness coaching outcomes including quanti-
on investment. Several studies have shown a posi- tative measures of changes in health behaviors. In
tive effect of wellness programs on weight or other addition to providing a rich understanding of the
biometrics, diet, exercise, and even financial im- participant perspective, these findings may also
pacts like reduced absenteeism and cost-effective- inform understanding of these and other mixed-
ness, although in some cases changes were only methods evaluations and provide insight on areas
modest.7-12 Systematic reviews of existing evidence for future research.
highlight the need for more research using rigorous
study design to assess outcomes, including the use METHODS
of control groups.8,9,13,14 Population and Setting
One popular worksite wellness approach is well- Interviews were conducted with adult employ-
ness coaching. Wellness coaching typically involves ees (age 18 or older) of Mayo Clinic Rochester
conversations that evoke an individual’s motiva- who had completed an individual wellness coach-
tion for health behavior change and a collaborative ing program at the Dan Abraham Healthy Living
plan for change within personally-relevant wellness Center (DAHLC), an on-site health, wellness and
areas. Evaluations of wellness coaching suggest it exercise facility (Rochester, MN). Participants
may be a promising approach to helping employ- met with wellness coaches weekly to discuss goals
ees improve physical and mental health outcomes and barriers using motivational inquiry tech-
and for increasing motivation.7,15-17 These studies niques as described by Mettler et al.15 Comple-
stress the importance of the personalized nature tion was defined as attendance at 9 or more of
of coaching and the use of goal-setting, reflection, 12 in-person wellness coaching sessions over the
and motivational interview techniques to engage 3-month period.
participants in change. Further study of wellness
coaching programs, using rigorous quantitative
methods, may provide further evidence of their ef- Data Collection
fectiveness, including which aspects or components There were 100 participants in the larger study
of the wellness coaching experience promote long- of wellness coaching outcomes. To gain in-depth
term change. Currently, there is also a paucity of understanding of participant perspectives on
research aimed at understanding how participants coaching, we invited a sample of 30 participants
perceive the wellness coaching experience, in par- to participate in a 15-30 minute semi-structured
ticular their view of how program factors support interview conducted in-person or by phone. To
or hinder positive personal change. provide information about potential differences
Qualitative methods are especially well suited between women and men, men were over sampled.
for understanding healthcare intervention process- Qualitative content saturation, which is the point
es of change from the participant perspective,18,19 at which no new themes are emerging in the analy-
and for assessing whether behavioral interventions sis, was achieved with the interview results reported
are designed, delivered, and received as intended here, so additional samples were not required.
(ie, treatment fidelity).20 Qualitative methods also Participant interviews were conducted by a
inform quantitative research questions,21 which in trained interviewer. To ensure objectivity, the se-
this case may mean uncovering participant-impor- lected interviewer was someone not directly in-
tant outcomes associated with wellness coaching volved in the wellness coaching program. The
that have yet to be included in quantitative stud- interview guide is included in Table 1. Its develop-
ies measuring coaching outcomes. Whereas exist- ment was informed by the objectives of wellness
ing research22 provides insight into how coaches coaching, including increased motivation and con-
describe the coaching relationship, as well as fidence and behavior change, as well as the study
participant satisfaction with coaching,23 to our aim to understand participant perspectives of the
knowledge the present study is the first qualita- program. Semi-structured interviews were used

Health Behavior & Policy Review. 2014;1(3):218-228 DOI: [Link] 219

Understanding Participant Perspectives of Workplace Wellness Coaching

Table 1
Interview Guide
1. What impact did wellness coaching have on you, if any?
2. What was most helpful about participating in wellness coaching?
3. What was least helpful about participating in wellness coaching?
4. Describe your relationship with your coach.
5. How has wellness coaching impacted your ideas about wellness?
6. How has wellness coaching impacted your health behavior?
7. Has wellness coaching impacted your motivation?
8. Has wellness coaching impacted your confidence in your ability to make change related to wellness?
9. Now that you are finished with wellness coaching, what will happen?
10. What would you say to someone considering participating in wellness coaching?

because they allowed the interviewer to probe for RESULTS

greater understanding of responses. Demographics
Participant demographics were collected from a Twenty-seven of the 30 invited participants
questionnaire completed by all participants in the completed an interview (90% response). All inter-
wellness coaching program. Electronic medical views were completed in person. Characteristics of
record review was used to determine participants’ people who completed the interview did not differ
medical diagnoses. from those who did not complete an interview (in-
cluding both those in the larger study not invited
Data Analysis to an interview and the 3 individuals who declined
Demographic characteristics and health condi- an interview), as shown in Table 2. Despite ef-
tions of participants interviewed in this qualitative forts at oversampling among male participants, the
study were compared with those of participants vast majority of people interviewed were women
in the larger wellness coaching study who did not (88.9%), which is reflective of the composition in
complete an interview, and differences were as- the overall coaching study. The mean age of the
sessed using paired methods. Interviews were audio interview group was 42.9 years and all interview
recorded, transcribed verbatim, and de-identified. participants held at least a college degree. Seventy
Two investigators with extensive experience per- percent were married or living with a partner. More
forming qualitative data analysis analyzed tran- than 3 out of 4 interview participants were over-
scripts using coding and categorizing techniques weight or obese, and 25.9% had a diagnosis of high
and thematic analysis. 24,25 They began by indepen- blood pressure at the time of the study.
dently reviewing each transcript and developing a
list of categories that described the data. Within Interview Results
these categories they developed codes to classify Analysis of the interview data provided in-depth
and organize text. Independent coding results were information about how participants viewed the
compared and themes that represented key findings coaching relationship, how participation changed
across the interviews were identified. Consensus on their approach to wellness, and the impact it had
key findings was achieved by the qualitative study on attitudes and behaviors. Themes that represent
team (the 2 investigators along with the principal the most salient findings within these domains are
investigator and the interviewer), and a multidis- reported in detail below and summarized in Table
ciplinary study team involved in the larger mixed 3. Representative quotes are identified by the par-
methods study gave feedback on a summary of ticipant’s study number and sex.
findings.
QSR International’s NVivo9 qualitative data Domain: Wellness Coaching Relationship
analysis software (QSR International Pty Ltd. Ver- Theme: Interpersonal behaviors or character-
sion 9, 2010) was used to aid in data organization istics of wellness coaches created a positive ex-
and analysis.

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Table 2
Characteristics of Wellness Coaching Participants by Interview Participation
Interviewed Not Interviewed Total
(N = 27) (N = 73) (N = 100) p-value
Age (mean) 42.9 41.5 41.8 0.63a
Sex (% women) 24 (88.9%) 66 (90.4%) 90 (90%) 1.00b
Race (% white) 27 (100.0%) 67 (91.8%) 94 (94%) 0.19b
BMI (mean) 33.1 32.0 32.3 0.54a
BMI categories 0.85c
Normal 5 (18.5%) 17 (23.3%) 22 (22%)
Overweight 6 (22.2%) 17 (23.3%) 23 (23%)
Obese 16 (59.3%) 39 (53.4%) 55 (55%)
Marital Status (% married/living with partner) 19 (70.4%) 46 (63%) 65 (64.1%) 0.49c
Educational attainment 0.802
    High school 0 (0.0%) 4 (5.5%) 4 (4%)
    College/University 16 (59.3%) 43 (58.9%) 59 (59%)
    Graduate school 10 (37.0%) 22 (30.1%) 32 (32%)
    Post-graduate 1 (3.7%) 4 (5.5%) 5 (5%)
Diabetes (% yes) 3 (11.1%) 3 (4.1%) 6 (6%) 0.39b
High blood pressure (% yes) 7 (25.9%) 13 (17.8%) 20 (20%) 0.48c
Sleep apnea (% yes) 6 (23.1%) 12 (16.4%) 18 (18.2%) 0.27c

Note.
a Unequal variance t-test    
b Fisher’s exact test    
c Chi-square test

perience and for some an unexpected personal there to help... If I did go two steps back, we talked
connection. Wellness coaches were often described about three steps forward. She was very positive,
as kind, professional, knowledgeable, and good lis- upbeat and very pleasant.
teners. They encouraged participants and coached [#14, male participant]
without judgment, and participants felt they could
trust them. These behaviors or characteristics were For some people, the relationship and coaching
important because they made the experience a communication was unexpectedly personal and
positive one, even when participants experienced evocative. Participants were able to share their ex-
setbacks. periences and insights, trusting these conversations
were confidential.
Her encouragement, the way that she would be
my cheerleader when things went well and at the I felt like I could open up and say a lot of things. It
same time, if something didn’t go well, she always felt ‘therapeutic’ but it wasn’t ‘therapy’ if you know
had new suggestions and a positive attitude. And what I mean. It was much more than personal
she believed in me. training. She didn’t shy away from discussing dif-
[#17, female participant] ficult stuff. She was so qualified.
[#9, female participant]
She had a good sense of humor, and she didn’t
come across as judgmental. She was definitely (Coach) made it very simple. I had my weekends

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Understanding Participant Perspectives of Workplace Wellness Coaching

Table 3
Interview Domains and Themes
Domain Theme
Wellness Coaching Interpersonal behaviors or characteristics of wellness coaches created a positive
Relationship experience and for some an unexpected personal connection
Wellness coaches fostered collaboration and active participation
Participants were motivated by feelings of accountability to their wellness coaches
Expectations and Impact The collaborative approach to wellness coaching was not what some participants
of Wellness Coaching expected
Outcomes varied from person to person and were cognitive and interpersonal as well
as behavioral
Changing Attitudes and Participants gained confidence to become healthier, learned to set attainable goals,
Approach to Wellness and became more compassionate with themselves
Participants were able to reprioritize their wellness
Some participants expanded their definition of wellness

that were awesome and then I’d have a poor week- I think we are probably close to the same age and
end and we’d talk about that and how to deal had similar things going on in our lives. So it was
with it. I don’t feel bad about telling her that I very helpful to be able to relate to one another.
regressed. [#11, female participant]
[#24, male participant]
I felt if we had not met in wellness coaching, we
I swear she was more psychologist than wellness would probably be friends. I think that having
coach. Just helping me sort through the clutter of that, along with her being able to coach me and
my life to find what is most important and go be professional, it was such a nice mix for me be-
from there. cause not only did I respect her on a professional
[#13, female participant] level but I felt like I liked her.
[#17, female participant]
Implicit content on the coaching relationship
and personal connections suggests that participants I was worried at first because she’s so young but
thought the relatability of the coach (ie sharing a she was very professional and approachable. I did
common perspective based on factors like age and think that if I had someone older that maybe that
sex) was going to be necessary to ensure under- person would be able to identify more or be more
empathic, or that sort of thing. But, it didn’t mat-
standing and empathy. However, for some partici- ter at all.
pants who were assigned a coach of a different sex
or age, the matches were successful when respect [#26, female participant]
and sincere attention from the coaches still allowed
a personal connection. Theme: Wellness coaches fostered collabora-
tion and active participation. Unlike traditional
I would say that we connected, not only with my coaching models where the coach tells a student
physical well-being and nutrition, but spiritu- what to do, wellness coaches were there to guide
ally, too. Not that we talked about religion but and offer help, and most participants came to value
we both want to be in a good place with that and the 50/50 collaborative approach in which coach
with ourselves. I’d say we developed a really strong and participant worked hand in hand. Participants
bond. felt like they were encouraged to move the conver-
[#10, female participant] sation in the direction they wanted it to go and ul-

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timately were responsible for decision making, but so that was good motivation. As someone that I
the coach was there to guide and help. had a relationship with, I didn’t want to let them
down.
It wasn’t like he was setting my goals, or he was [#23, female participant]
telling me, “This is what you need to do.” It was
always,“This didn’t work for you. What do you Domain: Expectations and Impact of Wellness
think will work for you?” Coaching
[#3, female participant] Theme: The collaborative approach to wellness
coaching was not what some participants expect-
I had to make the decision, I was in charge, but ed. For some participants, this type of collaborative
she gave me gentle guidance. relationship with a wellness professional was new
[#5, female participant] and unexpected. When they enrolled in the coach-
ing program they envisioned a sports coach and
I felt like it was a 50/50 partnership. We both being paired with someone who would tell them
said what we wanted to say, and then she gave what to do. Instead participants were expected to
her feedback or ideas or suggestions. It wasn’t one be in charge. Whereas some participants said they
sided by any means. eventually grew to value the collaborative approach,
[#14, male participant] others said they wanted more direction. Several
participants suggested expectations be clearer at
the start of the program, ensuring both parties are
Theme: Participants were motivated by feelings
in agreement on how to help the participant reach
of accountability to their wellness coaches. One
his or her goals.
of the most common terms used by participants
to describe what they liked about wellness coach-
ing was accountability, which they described as I guess I would say to be clear on what it is you
an investment by both parties in the relationship. want to accomplish. I don’t think that I had clar-
Participants felt like their coaches wanted them to ity. They kept saying to me “What changes do you
want to make?” And I was looking for someone to
be successful, and they did not want to disappoint suggest some changes for me.
them. Regular check-ins provided motivation to
stay on track. Some participants said they plan to [#2, female participant]
keep in touch with their coaches as a way to stay
motivated, noting that motivation is harder with- I think it was challenging to be the leader of the
out that accountability. discussion. They were really there listening and
helping to make sure that I came to the conclu-
sions that are most beneficial to me, but they didn’t
I was motivated because I guess I didn’t want to necessarily tell me what the conclusions should be.
disappoint her or myself. I wanted the coaching to
help me keep on track, and so having to meet with [#1, female participant]
her every single week was a motivation in itself.
[#10, female participant] When I think of coaching, I think of sports-related
coaching, so I was expecting a little bit more, “You
need to do this.”
I think about having somebody to be accountable
for some things. Since I’m by myself, I live alone, [#23, female participant]
I don’t have anyone to go home to that’s going to
support you with that. I think maybe one of the things that could be
[#15, female participant] incorporated more towards the beginning of the
process is finding out from the person what they
think coaching is and whether they are the kind
I definitely felt that we were a team and I had of person that responds well to just encouragement
points along the way where I was doing things or if they need some more aggressive interaction.
specifically because I didn’t want to let her down,
[#23, female participant]

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Understanding Participant Perspectives of Workplace Wellness Coaching

Theme: Outcomes varied from person to per- It just proved to me that I can do it. That maybe
son and were cognitive and interpersonal as well it didn’t work the first time but to come up with
as behavioral. Participants did not report a single ways to make it realistic, make it doable.
outcome, such as weight loss, as being associated [#11, female participant]
with wellness coaching. Outcomes were individu-
alized and included cognitive and interpersonal or Ultimately, I think I got a more realistic perspec-
behavioral outcomes. Several participants talked tive of what I could expect of myself…I was al-
about wellness coaching as a catalyst for behavior ways feeling guilty because I wasn’t working out
change or how wellness coaching helped them gain all the time or I wasn’t working out long enough,
new knowledge or perspective so they could ap- or I would eat really well and then I’d have a
proach diet or exercise differently. For participants snack. I had unrealistic standards.
who had failed to meet exercise or diet goals pre- [#3, female participant]
viously, they say this change was helping them be
more successful going forward. Some participants’ efforts at behavioral change
were previously derailed when setbacks occurred.
I’ve lost a significant amount of weight, I exer- Wellness coaching helped them develop a more
cise regularly, eat a whole new way, and I think positive thought process about behavior change
coaching was kind of my catalyst for jumping into and be more compassionate and forgiving toward
that change and maintaining it through the 12 themselves when goals were not met, rather than
weeks. giving up (relapse prevention).
[#7, female participant]
We did a lot of talking about my talking to myself
My big goal was I’d been working on my eating in my head…I gained more confidence on how
habits. I was really able to talk about what it is to answer some of those messages and how to turn
that was holding me back from losing the weight them around and become more confident.
I wanted to get to. [#29, female participant]
[#24, male participant]
Now, forgiving myself is OK. If you slip up once,
I’ve become more outspoken and more willing just start over again. Go back to it instead of just
to say no when it comes to eating out. I’m more giving up the whole thing.
aware and more conscious of what I’m doing and [#15, female participant]
what I shouldn’t be doing when it comes to food
and exercise.
[#8, female participant] The other thing that was really helpful was I’m
just so self-critical. So, probably learning to cut
myself some slack when it doesn’t all go perfectly.
I’m eating a lot better, more mindfully. I listen to [#21, female participant]
my body more.
[#28, female participant]
Any time that I started to talk negatively about
myself or failures that I’ve had, he always spun it
Domain: Changing Attitudes and Approach to around to be a more positively thing. If I had not
Wellness exercised for the week like I had hoped, he’d say,
Theme: Participants gained confidence to be- “Well, what made you do that?” And then we’d
come healthier, learned to set attainable goals, talk about that. It’s not a failure but maybe just a
and became more compassionate with themselves. learning lesson.
Through wellness coaching, participants learned [#12, female participant]
how to set realistic goals. When participants learned
to set attainable goals, they proved to themselves that
they could achieve success. Achieving those goals Theme: Participants were able to reprioritize
increased confidence and therefore motivation. their wellness. Several participants described previ-

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ously putting wellness on the bottom of their list of that work together to make you a happy and
priorities. When they failed to meet wellness goals healthy person.
it was often because other life demands were more [#5, female participant]
pressing. Through coaching they were able to un-
derstand how wellness could come first—and how I think it broadened my definition of wellness as
putting wellness first was not a selfish or unreason- being more than just being healthy physically in a
able approach. medical sense. That wellness incorporates the men-
tal healthiness and supporting the physical body
You know, it’s so easy, you put all this other stuff on and just the holistic approach to wellness. It was
the back burner and really, are you doing things body, mind and spirit and that’s how I am well
today. It broadened that.
that you really want to do to change your lifestyle?
I think just bringing it back to forefront is like, [#7, female participant]
OK, I have my new priorities and I need to take
care of myself. DISCUSSION
[#10, female participant] Wellness coaching, like many workplace wellness
initiatives, is growing in popularity and several stud-
It helped me to put me in the forefront and helped ies have demonstrated improvements in health and
me realize that sometimes putting me first can mental health outcomes. 7-12 However, there is little
help. published research on how participants perceive the
[#11, female participant] wellness coaching experience and what program
factors support or hinder positive personal change.
Qualitative methods can assist in identifying par-
It moved me more towards thinking of myself and
what my needs are as opposed to thinking of ev- ticipant-important aspects of wellness coaching that
erybody else first and finally getting around to me. are currently understudied and determine how the
It gave me permission to do what I needed to do program is received. Capturing the participant per-
for me. spective was the aim of this study.
[#26, female participant] Participants in this study attributed success-
ful experiences to factors including personal con-
nections with their wellness coaches that fostered
Theme: Some participants expanded their
trust. Successful relationships were collaborative,
definition of wellness. Through coaching, many
with the wellness coach offering guidance but the
participants came to rethink what constituted well-
participant able to share openly, fully engaged in
ness. They began the coaching program thinking
the process, and in charge of decisions. Participants
wellness meant losing weight, but through the pro-
learned to find their own motivation and set real-
gram they began considering factors like sleep hab-
its and relationships with loved ones that improved istic goals, but accountability to wellness coaches
also provided motivation and follow-through.
wellbeing.
These findings are in line with those of Wolever
et al22 who found that (integrative health) coaches
It’s made me feel better about myself because, fo- saw themselves as confidants and allies. They are
cusing just on exercise, I would say I was a failure, also consistent with the spirit and foundational
so to speak. But realizing that because I have a processes of motivational interviewing: engaging,
spiritual grounding and good family relationships
and stuff like that, I realize that I’m not as bad off guiding, evoking, and planning.26
as I thought I was….It has made me think about Although it appears that this wellness coaching
wellness as a whole. program was delivered and received as intended,
[#23, female participant] our results demonstrate that participants’ initial
expectations of the program sometimes differed
I think it really broadened my perspective that from the intention of a wellness coaching model
wellness isn’t just one thing but it’s a lot of things of behavior change. Some participants initially ex-

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Understanding Participant Perspectives of Workplace Wellness Coaching

pected a more directive or sports-related (eg, like results may also not generalize to coaching pro-
a personal trainer) coaching experience, anticipat- grams of differing intensity, such as fewer or briefer
ing that the coach would explicitly tell them what sessions, or other delivery modes like telephonic
to do to make health changes. Most participants or web-based coaching. Finally, interviews took
eventually viewed the program as effective be- place just after completion of the program. Data
cause of the personal connections they made with showing whether these perceptions changed in the
their coaches. However, there is a greater need for weeks and months following program completion,
coaches and participants to openly discuss expecta- as well as data on participants who dropped out
tions and roles at the start of the program and for of coaching without completing the program, were
coaches to continuously elicit feedback throughout not collected. Future research should consider the
the program about the balance of directive versus perceptions of those who did not engage in well-
collaborative communications. Failure to do so ness coaching or who failed to complete the full
could result not only in decreased satisfaction but program. Despite these limitations, results of this
also limited engagement and motivation—key fac- study provide key information on participant per-
tors in behavior change.26-28 ceptions of wellness coaching currently missing
People enter wellness coaching for many dif- from the literature.
ferent reasons, and goals often change during the In summary, these results suggest that the core
wellness coaching experience. Therefore, it is not spirit and content intended for wellness coach-
surprising that expectations around outcomes var- ing were well received by participants, and par-
ied. Participants in our interviews went beyond ticipants valued the program, even if this type of
reports of outcomes like weight loss to emphasize collaborative approach was initially unfamiliar to
the program’s impact on attitudes, motivation, and them. However, our results emphasize the impor-
processes of behavior change such as goal setting, tance of having upfront conversations with partici-
cognitive change in mindset, and overcoming bar- pants on expectations for the coaching relationship
riers. Our finding is in contrast to Mettler et al,15 and process. Also important to note is that some
who conducted a study of wellness coaching at participants attributed behavior change to well-
this institution and reported a specific behavioral ness coaching, but they also described changes in
outcome (ie weight loss) as an initial priority for attitudes and approaches to wellness, including
coaching, although in that study participants rank increased self-efficacy and problem solving strate-
ordered wellness goals and this study used open- gies. Based on other behavioral research, these are
ended interviews to solicit information. For some important initial mediators of behavior change.
participants, changing attitudes meant rethinking 27-29
These types of outcomes are different from
their priorities and redefining their perspective on traditional biometric or financial outcomes that
wellness. Part of this process was learning not only underpin many program evaluation designs, and
to set realistic goals but to learn self-compassion they present opportunities for future research as
for set-backs. These findings suggest new methods employers seek evidence that wellness coaching is
of assessing goals and outcomes may be needed to making a positive difference in employee health.
supplement those traditionally measured by re- Future research should also include longitudinal
searchers and expected by employers sponsoring assessment; participants emphasize the importance
worksite programs, such as weight loss. of the coaching relationship, and it is vital to un-
Several limitations of the current study should be derstand what happens when that relationship ends
considered. Despite attempts to oversample men, and whether changes can be sustained.
the majority of participants were educated white
women, limiting ability to generalize results to IMPLICATIONS FOR HEALTH BEHAVIOR
more diverse employee populations. Further, our OR POLICY
participants had self-selected for participation in a Our findings suggest that wellness coaches should
12-week, no-cost wellness coaching program. Con- receive training not only on strategies to enhance
sequently, our participants may differ from employ- motivation and behavior change, but also skills for
ees receiving incentives for coaching participation transparent and informative conversations, held
or those required to pay for wellness coaching. Our

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at the initiation of coaching. These conversations Promot. 2000;15(1):45-52.

should include all aspects of the coaching relation- 4. Goetzel RZ, Pei X, Tabrizi MJ, et al. Ten modifiable health
risk factors are linked to more than one-fifth of employer-
ship and intervention, and wellness coaches should employee health care spending. Health Aff (Millwood).
elicit client expectations for coaching so that the 2012;31(11):2474-2484.
coach and client have a shared understanding of 5. Kowlessar NM, Goetzel RZ, Carls GS, et al. The relation-
the client’s priorities. For instance, our data show ship between 11 health risks and medical and produc-
tivity costs for a large employer. J Occup Environ Med.
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Mayo Clinic Institutional Review Board and all ising practices in promotion of healthy weight at small
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