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In response to the growing burden of chronic disease, health coaching interventions targeting lifestyle management have become widely adopted among health systems and organizations. Motivational interviewing, a patient centered health coaching approach, has been shown to be effective in improving a number of health behaviors such as physical activity, nutritional habits, weight loss, and smoking cessation. Traditionally, health coaching has relied on patient self-report of behavior and activity patterns to guide coaching practices. The availability of commercial activity trackers and mHealth applications to capture health behaviors offers an objective view of daily activity not previously available.
Methods: The health coaching intervention was part of a randomized clinical trial in which intervention participants were assigned a nurse health coach and given a Fitbit One, a commercially available physical activity and sleep tracking sensor to wear over a three month period. Through bi-weekly telephone calls, the nurses utilized motivational interviewing techniques to support patients in setting health goals and to make sense of their PGHD passively collected by the Fitbit sensor. Two participants from the study, a 53 year old Latino woman (participant ML) and a 53 year old mixed race male (participant OB), were selected to illustrate two examples of how PGHD and mHealth technologies can be utilized to inform and improve health coaching and health behavior change.
Results: Throughout the intervention ML and OB set bi-weekly goals related to their physical activity (steps, stairs, active minutes), nutritional habits (calories consumed), and sleep (quality, duration) in an effort to improve their overall health and fitness. ML and OB reached varying degrees of success in accomplishing their self-identified goals. By the end of the three month intervention, both participants achieved meaningful improvements to their anthropometric measurements, cardiovascular fitness and exercise habits. Visualization of participants’ PGHD demonstrated the increased level of weekly physical activity had improved over the course of the intervention. Both participants also self-reported higher quality of life and health status ratings through questionnaires.
Conclusion: Emerging mHealth technologies and other health applications can track relevant information to assist individuals in making and sustaining lifestyle change. Integrating PGHD and mHealth technologies into health coaching practice allows nurses to perform meaningful analysis and correlate patient data with health behaviors to evaluate patient goal progression and provide timely and personal feedback based on their health goals. These case studies highlight the positive outcomes of two individuals who participated in a clinical trial, suggesting that the addition of sensor data adds value to nurse health coaching practice. However, further research is necessary to determine the generalizability and effectiveness of pairing mHealth technologies with evidence-based nurse coaching interventions among larger numbers of diverse subjects.