The Telephonic Health Coaching Intervention (THC) Toolkit is a direct education intervention designed to:

• Increase frequency of eating all five food groups
• Increase frequency of eating a variety of fruits and vegetables
• Increase whole fruit consumption by at least half a cup per day
• Increase vegetable consumption by at least half a cup per day
• Increase frequency of intake of fat-free or low-fat dairy including (dairy/nondairy) and yogurt, and decrease frequency of intake of full fat dairy (milk/yogurt)
• Increase frequency of whole grains and decrease consumption of refined grains
• Increase frequency of lean proteins and decrease frequency of high fat proteins
• Decrease sugar-sweetened beverage intake
• Increase frequency of low sodium foods
• Increase minutes of daily physical activity

In order to achieve these goals, the THC intervention provides material to train SNAP-Ed educators to be health coaches that engage with clients by telephone and use behavior change techniques to craft individual goals related to healthy eating and physical activity. The increased intensity, duration and personalization of the THC intervention improve the likelihood that persons eligible for SNAP will make healthy food choices and choose physically active lifestyles consistent with the current USDA Dietary Guidelines for Americans.

Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time

Intervention Type: Direct Education

The THC intervention targets SNAP-Ed participants at all direct education sites, as well as solicits participants within the community partner network. The THC assists the SNAP-Ed target population to establish healthy eating habits despite a limited budget and to promote physically active lifestyles that prevent or postpone the onset of disease. THC’s health coaches guide the participants through client-centered conversations that promote the implementation of the current USDA Dietary Guidelines for Americans. Even though there is ample evidence that low-income communities derive benefits from health coaching programs like THC, economically disadvantaged populations remain with limited access. Additionally, these populations face barriers to health care, including long work hours, transportation issues, and lack of access to adequate health care providers. THC offers a convenient and accessible modality that aims to ameliorate some of these social disparities. 

Setting: Community (Live), Other: Telephonic administered intervention

Target Audience: Parents/Mothers/Fathers, Adults, Older Adults

Race/Ethnicity: No special focus

THC incorporates the use of self-discovery with client-centered and client-selected goals in order to motivate clients to embrace health behavior changes. All health coaches receive basic training in coaching methods and philosophy. The initial training can be conducted one-on-one or in small groups, in approximately eight to ten hours, with continuing supervision and support. Brief training updates are held biannually, along with bimonthly coaching “huddles,” which provide time to problem solve and share ideas with other coaches.

Trained health coaches engage with clients by telephone for approximately thirty minutes every week, for a six-week period, and use behavior change techniques to work on individual goals related to healthy eating and physical activity. To document behavior changes, the health coach gathers information about the client’s overall health behavior during the first and last health coaching sessions. For each client, the coach also completes a program evaluation tool that contains:

• Pre/post behavior questions
• Overall goal/vision and topic code
• Goal set and topic code
• Confidence level (self-efficacy score) for goal(s) set
• Percent goal attainment.

Overall, the basic coaching procedure outlined in the Toolkit should be followed to maintain program integrity, such as conducting 30-minute telephonic coaching sessions for six weeks and completing the behavior questions, as well as tracking goal topics, goal attainment, and self-efficacy scores.

The available are:

• Telephonic Health Coaching Intervention Toolkit
• Health Coaching Sign-up Form/Information Sheet*
• Health Coaching Receipt of Information*
• Health Coaching Program Welcome Brochure*
• Health Coaching Session Evaluation Tool*
• Health Coaching Certificate of Completion*

*Also available in Spanish

For access to intervention materials, please contact Elizabeth Boucher.

Materials available at no cost.

The THC Toolkit contains the Health Coaching Evaluation Tool (in the Appendix) which includes the pre/post behavior questions, overall goal/vision and topic codes, goals set and topic codes, confidence level (self-efficacy score) for goals set, and percent goal attainment. Between 2016-2018, there was a statistically significant change in all of the behavior questions that were analyzed (18/19), and in 2019, there was a statistically significant change in 18 of the 25 questions (p< 0.05). All questions showed positive trends, indicating an increase in healthy eating behaviors and a decrease in unhealthy eating behaviors. Additionally, the clients’ most frequently self-selected goals, categorized by topic based on the current USDA Dietary Guidelines for Americans, were to increase physical activity, increase fruit and vegetable intake, and follow a healthy eating pattern with an appropriate calorie level by using the MyPlate Plan. Furthermore, physical activity increased from 25.4 minutes per day at baseline to 39.4 minutes at the end of the program, a nearly 60% increase. Lastly, behavior change was measured by the client’s self-reported goal attainment (from 0%-100%) for the two goals set at each session and the pre/post behavior questions. For Goal 1, attainment rates increased from 71% in session two to 82% in session six, and for Goal 2, attainment rates increased from 65% in session two to 74% in session six.

The preliminary results of THC were disseminated in two poster presentations:

• Telephonic Health Coaching: An Innovative Method to Promote Health Behavior Change among Participants in Supplemental Nutrition Assistance Program-Education (SNAP-Ed)
• Telephonic Health Coaching (THC) Promotes Health Behavior Changes among SNAP-Ed Participants

The unintended benefits of the intervention include:

• Participants showed significant changes in health behaviors that were not specifically chosen as goal topics
• The program was highly regarded by the clients, and some asked to continue coaching beyond the six sessions
• Participants referred friends and families to the THC program

The challenges include:

• Client recruitment and retention
• Maintaining well-trained staff including a bilingual health coach

Strategies to address the above include:

• Building greater interest during direct education for recruitment and retention of clients
• Sending clients a welcome packet and reminder of sessions
• Training all the nutrition educators to provide health coaching so that rapport building can start with the direct education process

Evidence-based Approach: Practice-tested

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

	Readiness and Capacity – Short Term (ST)	Changes – Medium Term (MT)	Effectiveness and Maintenance – Long Term (LT)	Population Results (R)
Individual		MT1, MT3
Environmental Settings
Sectors of Influence

MT1: Healthy Eating

• There was a statistically significant change in the following behaviors:
  • Increase in consumption of low-fat (1%) or fat free milk (p-value = 0.026)
  • Increase in consumption of low-fat or non-fat yogurt (p-value = 0.008)
  • Decrease in consumption of whole or 2%: Milk (p-value = 0.044)
• There was a statistically significant change in the following behaviors:
  • Increase in consumption of brown rice (p-value = 0.001)
  • Increase in consumption of whole grain pasta (p-value = 0.002)
  • Increase in consumption of whole grain bread (p-value = 0.002)
  • Increase in consumption of whole grain cereal (p-value = 0.008)
  • Decrease in consumption of white rice (p-value < 001)
  • Decrease in consumption of regular pasta (p-value = 0.003)
  • Decrease in consumption of white bread (p-value < 001)
  • Decrease in consumption of refined grain cereal (p-value = 0.019)
• Statistically significant increase in cups of fruit consumed per day (p-value < 0.001).
• Statistically significant increase in cups of vegetables consumed per day (p-value < 0.001)

MT3: Physical Activity and Reduced Sedentary Behavior

• Statistically significant increase in daily physical (p-value < 0.001)

The Toolkit provides the Health Coaching Sessions Evaluation tool for the health coach to record the client’s responses during each session. The evaluation tool includes key demographic and pre/post behavior questions, as well as overall goal/vision and topic codes, goals set and topic codes, confidence level (self-efficacy score) for goals set, and percent goal attainment.

Telephonic Health Coaching Initiative:

https://snaped.fns.usda.gov/success-stories/telephonic-health-coaching-initiative

 

Website: The THC Toolkit website includes the Telephonic Health Coaching (THC) Intervention Toolkit, and the following documents is English and Spanish Health Coaching Sign-Up Form, Health Coaching Receipt of Information, Health Coaching Program Welcome Brochure, Health Coaching Sessions Evaluation Tool, and Health Coaching Certification of Completion.

Contact Person(s):
Elizabeth Boucher
Phone: 860-231-5302
Email: eboucher@usj.edu