International Journal of Evidence Based Coaching and Mentoring
2024, Vol. 22(2)

Academic Paper

The Potential of Human Positive Health Coaching Through a Digital Health Platform to Prompt Reflection and Engagement in Behaviour Change

R. O’Donovan (Centre for Positive Health Sciences, Royal College of Surgeons in Ireland)
C. Loughnane (Centre for Positive Health Sciences, Royal College of Surgeons in Ireland)
C. Van Nieuwerburgh (Centre for Positive Health Sciences, Royal College of Surgeons in Ireland)
A.P. Duggan (Communication Department, Boston College)
P.J. Dunne (Centre for Positive Health Sciences, Royal College of Surgeons in Ireland)

Introduction

A recent shift towards digital platforms for positive health coaching has brought many benefits including being more affordable and easily accessible to participants without having to physically move geographical location (Borghouts, Eikey, Mark, De Leon, Schueller, Schneider & Sorkin, 2021; van Coller-Peter & Manzini, 2020). Despite this, there is limited knowledge of how human coaches and technology can work together to deliver more effective and efficient coaching services (Araujo, 2018; Gao, Galley, & Li, 2019; Lovejoy, 2018; Sasaki, Ihaya, & Yamada, 2017). Human-led positive health coaching through digital platforms has the potential to integrate the inherently human aspects of supportive human dialogue with digital tools to prompt new ways of understanding and engaging with the behaviour change process. Human-led positive health coaching can create a partnership between coaches and participants to prompt reflection while also promoting changes in attitudes and behaviours toward better health and wellbeing. This paper argues that human positive health coaching through digital platforms can prompt reflection in conversation that facilitates new perspectives and that helps people to overcome limiting beliefs to get unstuck. Reflection connects what people know explicitly with a quest for better explanations, increased understanding, and capacity for envisioning a different way forward (Vicini, Duggan, & Shaughnessy, 2022). Reflection involves conscious and deliberate energy to explore one’s understanding of a problem rather than simply trying to solve the problem. Reflection involves developing self-knowledge and improving self-awareness beyond just thinking about an event or a desire. Reflection involves metacognition to evaluate an experience and explore the underlying assumptions behind measures of explicit attitude or behaviour change (Shaughnessy, Allen, & Duggan, 2017). We suggest that the full impact of positive health coaching through digital platforms exceeds participants’ measures of attitude or behaviour change, such that digital health coaching can prompt reflection for better awareness, and that better awareness can help people envision opportunities to get unstuck. We describe reflective capacity in terms of the Partnership Principles (Knight, 2011) that underpin positive health coaching (van Nieuwerburgh & Knight, In press) examining text conversations from the digital platform of a human-led positive health coaching intervention.

This paper will draw on data collected during the RCSI (Royal College of Surgeons in Ireland) Coach Connect study. This was a controlled study which intended to impact positive health by mitigating burnout and enhancing wellbeing among hospital workers in Ireland through a coach-led digital health platform.

This technology mediated approach to coaching can add flexibility and expand reach through overcoming financial, geographical and physical barriers (Kanatouri, 2020). However, it is important to understand how technology as a mediator affects the coaching conversation. We argue that the Positive Health Coaching (PHC) through digital technology provided on this platform, prompted reflection that has the potential for positive outcomes beyond what the initial objective measures indicated. The platform called “RCSI Coach Connect” includes conversations that have led to important but limited changes in well-being (as measured by the PERMA-NHL profiler) and burnout (as measured by the Oldenburg Burnout Inventory) (O’Donovan, in preparation). In this paper, we document how the human coach-led digital platform prompted participants to reflect, and envision potential for positive change. We provide qualitative evidence for the ways in which RCSI Coach Connect created space for participants to realise what their health goals are, to facilitate an awareness of possible change in participant mindsets and behaviour, to show participants that they were capable of improving their health, and to spark realisation of potential in participants. These changes indicate reflection and the human capacity for reflective learning. These changes indicate potential beyond the objective measures of increased well-being and decreased burnout in this project. Thus, this paper documents the ways in which the coach-led digital health platform prompted the positive outcome of reflection, and how the conversation between coach and participant can prompt that reflection through the partnership principles (Knight, 2010). Conversations provided evidence for new ways of seeing how to engage with behaviour change process that went beyond what the outcome measures indicated. Conversations between coach and participant indicate potential for positive change in participants' lives by indicating metacognition and reflection to explore underlying assumptions; this is consistent with research on reflection in medical education that indicates intended behaviour change attention does not necessarily require explicit goals (Shaughnessy et al, 2017).

Our approach to coaching is informed by the Partnership Principles (Knight, 2011). The partnership principles underpin the relationship between coach and clients in Positive Health Coaching (PHC). PHC is a form of Positive Psychology Coaching (PPC) that adopts a dialogical approach (van Nieuwerburgh & Knight, In press). The dialogical approach posits that the coach can share information with clients within the scope of a non-directive, non-prescriptive conversational intervention (Van Nieuwerburgh, Knight, & Campbell, 2019). The 7 partnership principles underpin the dialogical coaching intervention, placing client autonomy and humanity at the centre of the coaching conversation (van Nieuwerburgh & Knight, In press). The principles are Equality, Choice, Voice, Dialogue, Reflection, Praxis and Reciprocity (Knight, 2011). In this paper, we will illustrate how human-led positive health coaching using a digital platform provides opportunities for awareness of the potential for change. We present evidence that draws on examples from RCSI Coach Connect to illustrate through the partnership principles the potential of the digital health intervention to create momentum for positive change in participant lives.

Methods

Participants

The participants in this study were acquired from an anonymous needs assessment survey which was conducted using secure Microsoft Forms survey links and delivered by email through human resources departments and department heads across three Irish hospitals. This survey asked participants about their needs in relation to well-being and the results were used to prepare online support content for the RCSI Coach Connect digital support platform. The last question of the survey invited respondents to declare interest in a subsequent online pilot project (RCSI Coach Connect). Twenty-six participants were recruited from a sample of 119 hospital workers who completed the needs assessment survey. Two participants dropped out prior to randomisation. One did not give a reason for dropping out and the other dropped out due to personal circumstances. The remaining 24 participants were randomly stratified into wait-list control and (n=13) and intervention (n=11) groups based on gender, role and age. The random allocation sequence was generated using Research Randomizer (Network, 2022), a free online resource for assigning participants to experimental conditions. Both the intervention and control group completed the same coaching intervention and, therefore, the results from both groups are presented together in this paper.

RCSI Coach Connect Digital Support Platform

Consenting participants were onboarded onto the digital support platform managed by our technical partner and commercial company, Empeal (Wind of Change Ltd.). Intervention group participants were onboarded onto the support platform in September 2021 and were assessed over a 12-week period culminating in December 2021. Wait-list control participants were onboarded onto a restricted smartphone app with access to online surveys only, in September 2021. The same participants were subsequently provided with full access to the coach and smartphone app for 12 weeks between January and April 2022. Survey assessments were conducted at three time points (T): T1 September 2021, T2 (January 2022) and T3 for wait-list control participants only (April 2022) to measure changes in well-being, burnout and perception of Lifestyle Medicine (LM)-based vital signs (sleep, eating well, physical activity, stress management, managing alcohol and tobacco consumption and cultivating positive relationships) (ACLM, 2022). All data was stored securely on Amazon Web Services platforms based in Dublin, Ireland. Coaches and participants had access to pre-developed evidence-based content (in video, audio and pdf format) related to LM vital signs. Promoting engagement with LM vital signs in conjunction with positive psychology-based interventions has been shown to promote flourishing among active participants (Burke & Dunne, 2022).

Coaching Conversations

The text-based conversations analysed in this article were gathered during the RCSI Coach Connect study. From text-based conversations between coach and clients, this paper examines the communication messages that indicate increased awareness or that facilitate positive and sustainable lifestyle changes for healthy living or that promote thriving in participants. More broadly, we focus our approach on Positive Health Coaching (van Nieuwerburgh & Knight, In press), and we used a digital platform for the coaching conversations between coach and participants.

An online human coach conducted goal setting with each participant via the chat messaging function on the digital support platform. This goal setting was informed by participants’ wellness assessment scores and following goal setting, the coach chose relevant evidence-based content (video, audio and pdf format) related to well-being, burnout and perceived lifestyle vital signs. Participants could then attend review sessions once every two weeks to review their progress and refine their goals.

In this paper, we will present the analysis of the text-based coaching conversations that occurred on the digital platform. Fifteen conversations between the coach and participants were analysed. These conversations included initial goal setting, review sessions and any other check in conversations that occurred between the goal and participant.

Data Analysis

Conversations were analysed using thematic analysis. In the early stages of analysis, two researchers individually read the coaching conversations to identify instances where partnership principles (Equality, Choice, Voice, Dialogue, Reflection, Praxis and Reciprocity) were used. This approach recognises the expertise of researchers and also allows for latent and manifest content and explanations to emerge from the data (Graneheim & Lundman, 2004; Kennedy & Lingard, 2006). Identifying where the partnership principles were being used within the coaching conversations provided an opportunity to understand and operationalise the mechanism for change that was not captured in the measures of well-being and burnout collected during the project. All data sources were coded by one researcher, who focused their analysis on instances where at least one of the partnership principles were being used. Coding occurred at each “meaning unit” defined as a data segment, which contains one idea or theme and is comprehensible outside its context (Boyatzis, 1998). Codes were then categorised according to the partnership principles they represented. Analysis was supported by using the data management programme NVivo 12 (QSR International, 2015).

Ethics

Ethical approval was obtained from the RCSI Research Ethics Committee; GDPR (General Data Protection Regulation) guidelines were adhered to throughout the study. Anonymity was maintained by the coach and participants, who used pseudonyms only. Communication between coach and participant was only via text/chat through the smartphone app. Only the coaching side of the conversation is included in this paper in order to protect participants from being identified.

Findings

Results provide evidence for potential to engage in reflection and future behaviour change processes. We describe examples of potential for change in the context of the partnership principles for dialogical coaching (van Nieuwerburgh & Knight, In press). See Table 1 for additional evidence / information from the coaching conversations.

Equality

When coaches adopt the principle of equality, they believe that every individual person has equal dignity and value. Based on this, they listen to their clients, let them speak without interruption and refrain from moralistic judgements of them.

In the coaching conversations, equality was established through the coach responding to participants with non-judgemental reflections and showing compassionate understanding of their experiences. In response to one participant who had not been able to make time for exercise in the past 2 weeks, the coach reflected their understanding of how busy the participant’s life had been and reassured them that these kinds of setbacks are normal:

Coach: It sounds like you've had some major challenges the last couple of weeks between visitors staying and looking after your son. Honestly, [participant pseudonym name] with all this going it's completely normal for these exercises to have taken a back seat. If you like we could explore what would help alleviate some of the pressure you've been feeling with all this going on and change the goals to fit better into your hectic routine at the moment. How does that sound?

The coach discussed the areas where participants were struggling or had lower scores openly and without judgement, participants were encouraged to set goals in relation to these areas and to keep moving forward with them.

Coach: That's a very good point! It may well be the negative perception of yourself that has scored these areas lower. Mental Health sounds like a great place to start in that case, and as you begin to make progress in that we can move onto relationships. How does that sound?

The coach celebrated participants’ strengths and what was going right for them, while also acknowledging the areas they wanted to improve.

Coach: That is some really great insights. I can tell you've been working on your mental health and it's great to see you're prioritising self-care and your own health. But the burnout and juggle work, school, and social commitments (namely social commitments) are creating strain on your mental health. Would that be right?

The coach also provided reassurance when the participants needed it and helped them to think of ways they could adapt their goals to make them more achievable.

Coach: Okay, so while you have been achieving your goal you haven't been able to follow through with your reward of going to a cafe and enjoying a coffee. That makes sense considering you have been feeling run down. How would you feel about changing your reward to something smaller and with less commitment that would bring you the same enjoyment?

Choice

By adopting the principle of choice, coaches recognise that autonomy is a necessary component of motivation (Deci & Ryan, 1985) and create conditions so that their clients evaluate options and choose their own plan of action. In the coaching conversations, the coach always let the participants choose their goal, how they wanted to measure it and what reward they would like. The coach also regularly asked the participant if they were on the right track with what they were working on. The participant was placed in the driving seat for all decisions being made.

Coach: I can see you scored high on relationships, movement and exercise and substance control, which is amazing to see! I also noticed that you scored lower for mental health and eating well. Is there one of these you'd like to work on first?

Voice

When aligned with the principle of voice, coaches believe their client opinions matter. They engage in behaviour that communicated this to their client, including: asking good questions; listening effectively; and engaging in non-verbal communication that shows that they are interested in, and care about, what their client is saying.

In the coaching conversations, the coach asked open questions and gave the participants space to share their experiences.

Coach: Tell me about your sleeping patterns currently?

The coach demonstrated that she was listening effectively to participants by giving summary reflections on what had been said.

Coach: It sounds like you have a lot of responsibilities, and are struggling to juggle everything between work, family and your own self-care time! I imagine that is extremely stressful.

Dialogue

Coaching that encourages dialogue includes a back-and-forth conversation where all parties in a conversation share what they think, listen effectively, and approach each other with the courage to be shaped by new ideas and options. This can create dyadic learning experiences that occur between people. The dialogue which occurred during the coaching conversations enabled the coach and participant to exchange ideas and opinions that helped the coach gain a better understanding of participant experiences and needs.

Coach: As you start to achieve your goal, it's important to build in a reward to reinforce the habits you are building. What could be your reward for achieving your short-term goal of practicing mindfulness on the way home from work?

*Participant responds*

Coach: If you feel dark chocolate as a treat for practicing mindfulness coming home from work will help kickstart this habit, that's more than okay. This can always be changed during our bi-weekly review sessions

*Participant responds*

Coach: Amazing [participant pseudonym name]. Sounds like dark chocolate will act as a great reward and is within your diet, so even better! Another aspect of achieving goals is to track your progress.

*Participant responds*

Reflection

Coaches operate from the principle of reflection by withholding advice during coaching in order to encourage clients to do their own thinking. To do so, coaches ask questions that invite their client to think deeper, rather than try to move their client toward a predetermined direction they have chosen or share advice. The coach encouraged participants to think more deeply during the coaching conversations by asking open questions.

Coach: Before we dive into the goals, could you tell me a bit about your current movement and exercise routine/status?

*Participant responds*

Coach: I imagine it's extremely difficult to get yourself moving after a physically and mentally exhausting day at work [participant pseudonym name], but your motivation to try and incorporate some walking into your routine is amazing! If you could think of your ideal exercise and movement routine (taking away any barriers in place at the moment) what would that look like for you?

*Participant responds*

Praxis

When coaches work from the principle of praxis, they realise that their role involves translating research and evidence-based practice into actionable knowledge. They work in partnership with their clients to help them learn, apply new ideas and to adapt new knowledge in a way that allows them to make progress. In the coaching conversations, the coach translated research and evidence-based practice related to behaviour change and implementing new habits to participants informally through their dialogue:

Coach: Piggybacking a new habit with another is always a great way to keep motivated. So using your journal to reflect and keep track of your progress is a great idea, and could be useful to reflect on what works and what doesn't.

However, the main way that research and evidence-based practice was communicated to participants was through the coach sending them resources such as evidence based videos explaining topics and techniques that were relevant to the goals they were working on. This was done within the digital support platform itself. The coach informed participants what resources they were sending and where on the app they could find them.

Coach: It can be difficult to reduce these types of food when they are a relief when you’re stressed or bored. It sounds like this feeds into your motivation of trying to break this negative cycle. I actually have some content on emotional eating and eating when stressed, if you'd like me to start sharing some of these with you to get started on breaking this cycle?

Participant 122: yes I would love that

Coach: Great, I will upload these to your nutrition tile after this session.

Reciprocity

Coaches who engage with the principle of reciprocity expect to learn from their clients; no matter how unskilled in a particular topic their clients might be, they see their clients as learning partners. Throughout the coaching conversations, the coach engaged with participants in order to learn more about them and their needs. The participants directed where they wanted the goal setting process to go and the coach facilitated this by gaining an understanding of their needs.

Coach: Of course, that makes sense. Your main focus here is stress management so mindfulness exercises are so important in this area. Of course, I have some great meditation exercises on compassion which is great for feeling compassion for those around you and yourself. I can add this to your tile and anything else I feel would be useful, so you can use them over the next two weeks.

The coach learned from each participant and brought insights forward into conversations with all participants. For example, if one participant had positive results from using a certain reward for their behaviour, such as dark chocolate, the coach could share this strategy with another participant who was trying to identify an effective reward for their behaviour.

Discussion

By drawing on the partnership principles, we describe how the coach on the RCSI Coach Connect study built strong relationships with participants and that prompted reflection in action. A central component of the coaching process is creating a safe reflection space for the client. This process of cultivating and creating space for reflection is an important and often underrated skill of coaches (Van Nieuwerburgh, 2020). By applying the partnership principles such as reflection and voice, the coach can create a space for this reflection to occur (Van Nieuwerburgh, 2020; van Nieuwerburgh & Knight, In press). The coach can encourage reflection through paraphrasing and summarising, which allows the client to hear back what they have said. For example, within the principles of Equality, Reflection and Voice, the coach asked questions that invited the client to think deeper and provided the client with non-judgemental reflections on what they had said. This process of hearing what you have said from someone else’s perspective can support the creation of a reflective space for the client (van Nieuwerburgh & Knight, In press). This reflection can help clients to align what they know explicitly with their desire for better explanations and a deeper understanding. Ultimately, it creates capacity for clients to envision a new way forward through increased self-awareness and understanding (Shaugnessy, 2017; Vicini, Duggan and Shaughnessy, 2022).

Attentiveness to the coaching conversation process can prompt reflection that allows for both the coach and participant to start to think about things differently or to begin to take action that was not previously accessible. This is done through engaging with the partnership principles to create conversations that prompt capacity for change. In this way, coaching conversations can lead to shifts in mind-sets, attitudes and motivation that facilitate better health, well-being and decreased burnout. By harnessing the partnership principles, a coach can engage with a “coaching way of being” (Van Nieuwerburgh, 2020) that fosters reflection in themselves, as well as their client. Attentiveness to the coaching conversation process prompts reflection for both. While this manuscript is focused on the process of a coach engaging with participants, there is potential for future research to explore how the coach is learning during the coaching conversations. Raising the coach’s awareness of their use of partnership principles in their coaching conversations could trigger an intense level of engaged learning for coaches that is more valuable than them initially “getting it right” (Duggan, Bradshaw, & Altman, 2010).

Coaching should take a collaborative approach, rather than a prescriptive or directive one. The coaching conversation should stimulate reflection and positive behaviour change by focusing on how clients can grow as autonomous experts in their own well-being and success (Moore, Jackson, & Moran, 2016). By using the partnership principles, coaches can encourage clients to discover their own path forward and to have a sense of autonomy and control over what that looks like. Within this approach, the coach acts as a catalyst, but not the driver, of change. This approach to conversation assumes a dialogical approach to coaching (Van Nieuwerburgh et al, 2019) or a co-created conversation that allows for genuine dialogue to emerge (Duggan, 2019). The co-created conversation is dyadic in nature such that both people engage in shared meaning and in mutual goals; two people find ‘shared space’ or the ‘we’ or shared understanding. Both of these approaches to coaching are grounded in the fundamental assumption that more meaningful and growth promoting coaching conversations occur when we are attentive to the particular conversation, the timing, and the interpersonal context(s) including relationships, social support, and ‘way of being’ of people. This approach to coaching is also captured by the theory of relational flow (Moore, Drake, Tschannen-Moran, Campone & Kauffman, 2005). Relational flow is a co-created relational dynamic between coach and client when they are both in sync and in a zone where they are being fully challenged at a high level of skill and awareness, while engaged in a generative interdependent dialogue (Margaret Moore et al., 2005). It is an intuitive state that fosters an awareness of what can be observed and discovered empirically and of what can be directly experienced. The theory of relational flow is an extension of Flow Theory (Csikszentmihalyi, 1990). In flow, what happens in any moment of the coaching conversation is a response to what happened immediately before, rather than being dictated by a pre-existing intentional structure. Being in this relational flow increases the potential for clients to make their desired changes.

This paper highlights the potential for human-led positive health coaching on digital health platforms. By drawing on the partnership principles, we have illustrated the ways in which human-led positive health coaching on a digital health platform can facilitate an inherently human connection between coach and participants that can facilitate and prompt reflection. The strength of delivering coaching through digital platforms includes adding flexibility and expanding the reach of coaching interventions, regardless of geography and time zone (Kanatouri, 2020). This paper adds to this by outlining how using that partnership principles can ensure that digital health coaching is also impactful through triggering reflection for growth and change.

Considerations for Future Research

Future research in this area should include biological and physical assessments that confirm the impact of positive health coaching (face-to-face or digital) on the coach and the coaching participant. Physiological parameters that examine the mind-body interfaces (Dunne & Schubert, 2021) can be used to determine the strength of developing relationships, by providing subjective measurements of positive engagement for each member of these dyadic relationships. For example, we know that high parasympathetic (vagal) tone is indicative of a calm and receptive individual, especially when coupled with the production of the neuropeptide, oxytocin (Isgett, Kok, Baczkowski, Algoe, Grewen & Fredrickson, 2017). Furthermore, positive emotional reciprocity, trust and cooperation in dyadic partners is reflected in the production of oxytocin (Spengler, Scheele, Marsh, Kofferath, Flach, Schwarz, Stoffel-Wagner, Maier & Hurlemann, 2017). Positive vagal tone can be assessed indirectly by measuring heart rate variability using commercial wearable devices (Dunne, Lynch, Prihodova, O’Leary, Ghoreyshi, Basdeo, Cox, Breen, Sheikhi, Carroll, Walsh, McMahon & White, 2019), while oxytocin concentration can be measured in saliva or urine (Isgett et al., 2017; Spengler et al., 2017). Coupled with reflective practices by coaches and self-reported quantitative and qualitative measures conducted by coaching participants, this integrative approach will advance our understanding of what makes truly impactful coaching.

Finally, we believe that the online digital space offers additional opportunities for coaching. Digital coaching has the capacity to provide a much needed support service for human beings on the margins. Vulnerable communities such as individuals from lower socio-economic backgrounds, citizens who live alone, those with physical or mental health impairments as well as people disadvantaged by geographical location, will be able to access digital coaching in the future.

Conclusion

In this paper, we have outlined how the RCSI Coach Connect coach drew on the partnership principles of Equality, Choice, Voice, Dialogue, Reflection, Praxis and Reciprocity to build a relationship with participants and prompt reflection in action. We provide evidence of how this was achieved through text-based coaching on a digital platform and outline implications for practice and future research.

Notes

Conflict of Interests: The authors collaborated with a digital platform developed by a private, for-profit company (Empeal; Wind of Change) to deliver online coaching to HWs. This relationship is a potential source of bias, however, deliberate efforts were made to explore and understand the negative and positive elements of the Empeal platform.

Ethical Approval: Ethical approval was obtained from the RCSI, University of Medicine and Health Sciences Research Ethics Committee.

Author Contributions: PJD planned and conceived this study. ROD was involved in study design, study management, analysis and wrote the first draft of the manuscript. CL was involved in study design and delivery. CVN contributed to manuscript development. APD contributed to data analysis and manuscript development. All authors reviewed and edited the manuscript and approved the final version of the manuscript.

Acknowledgements

Participating staff, based at the RCSI Hospital Group; Technical partner Empeal (Wind of Change Ltd.); Joanna Zawadzka (RCSI Quality Enhancement Office); Dr Gozie Offiah (RCSI and Beaumont Hospital; Prof Siobhan Gormally (Group Clinical Director for Quality & Patient Safety RCSI Hospital group); Management and Human Resource Departments at Beaumont, Our Lady of Lourdes Hospital Drogheda, Louth County, Cavan General and Monaghan Hospitals (RCSI Hospital Group)

Funding

Co-funded by the RCSI University of Medicine and Health Sciences and the Charitable Infirmary Charitable Trust.

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About the authors

Dr Róisín O’Donovan is working as a post-doctoral researcher at the Centre for Positive Psychology and Health at the Royal College of Surgeons In Ireland (RCSI). In her current role, she is managing the RCSI Coach Connect project. This is a controlled research project which uses a coach-led digital support platform to reduce burnout and enhance the quality of life among healthcare practitioners. Róisín completed her PhD research in the School of Nursing, Midwifery and Health Systems at the University College Dublin (UCD). This research focused on understanding and improving psychological safety in healthcare teams and was funded under the Irish Research Council Employment Based Postgraduate Programme and the Ireland East Hospital Group. She is passionate about using research as a tool for positive change and about applying the results of this research to teaching in order to ensure that students are informed by emerging trends and developments in practice.

With a background in Psychology, Croia Loughnane continued her education in Personal and Management Coaching. She is a fully accredited coach with the EMCC. Croia also has extensive experience delivering eHealth interventions as a crisis volunteer, a platform supervisor for 50808 (Crisis Textline), and the RCSI Coach Connect project lead coach. More recently, Croia has been awarded the IRC Employment-based Ph.D. Program. Her project focuses on the feasibility of, and the fair and equitable use of AI and Machine Learning in digital health coaching. This project is funded by the IRC and in partnership with Empeal Ltd. And RCSI.

Loughnane

Prof. Christian van Nieuwerburgh (PhD) is an academic, consultant and executive coach. He is Professor of Coaching and Positive Psychology at the Centre for Positive Health Sciences at the RCSI University of Medicine and Health Sciences (Ireland), Global Director for Growth Coaching International, a provider of coach training and consultancy for the education sector, Principal Fellow of the Centre for Wellbeing Science at the Melbourne Graduate School of Education of the University of Melbourne (Australia) and Honorary CollectivEd Fellow of the Carnegie School of Education at Leeds Beckett University (UK). He is a certified executive coach (Master Practitioner with the European Mentoring and Coaching Council and Professional Certified Coach with the International Coaching Federation). Christian has written extensively in the fields of coaching and positive psychology and is the author of An Introduction to Coaching Skills: A Practical Guide (now in its third edition) and other books. His most recent publication is From Surviving to Thriving: A Student’s Guide to Feeling and Doing Well at University (co-edited with Paige Williams). Christian is passionate about the integration of coaching and positive psychology to improve outcomes and enhance wellbeing in educational, health and corporate settings (@christianvn on Twitter). He enjoys spending time with family, travelling, writing and riding his Harley Davidson (@coachonamotorcycle on Instagram).

Ashley P. Duggan (Ph.D., University of California, Santa Barbara 2003) is a Professor in the Communication department at Boston College where she teaches Health Communication, Research Methods, Relational Communication, and Nonverbal Communication. Her research is grounded in social science and addresses the intersections of nonverbal and verbal communication processes, health, and relationships. She holds additional appointments as adjunct faculty in Public Health and Community Medicine and in Family Medicine at Tufts University School of Medicine, where her connections allow for interdisciplinary research involving large-scale analysis the development of reflective capacity in medicine, the ways reflective practice connects to communication processes in provider/patient interactions, and the ways communication predictors of health disparities vary across patient populations.

Dr Pádraic Dunne (PhD) is an immunologist, practicing psychotherapist, accredited senior coach and certified lifestyle medicine professional, based at the Centre for Positive Health Sciences (CPHS). As a Senior Lecturer, and lead researcher of the Digital Health Research Group, Pádraic is interested in the development of health coach-led health and wellbeing programmes for the public. Online health coaching platforms have the capacity to deliver motivational and educational support to citizens, in conjunction with existing community-based services like Slaintecare Healthy Communities and Healthy Ireland. Pádraic is also a co-director of the Centre's MSc in Positive Health Coaching.

Table 1: Additional evidence from coaching conversations

Additional Evidence from Coaching Conversations
Partnership PrincipleExtract
EqualityCoach: “I understand, it's really great to work out all the things in your daily routine that are creating challenges to exercise. So from what I'm hearing is that with everything up in the air and your routine changing week to week joining a gym or a group is out of the picture until these things settle. And with appointments with your Acupuncturist and I imagine work and family time that evening are a challenge as well after an exhausting day. Since there's a lot going on for you at the moment, it might be useful to start really small in relation to your movement and exercise that will still give you a sense of accomplishment. With that in mind what is the smallest thing you could do around exercise that feels manageable to you?”
Coach: “Okay, so there is a few things I'm hearing from this. First off, it sounds like there's some issues around food preparation for work, as well as for family meals (planning weekly food shop), healthy food choice, consistent meals, and vegetable intake, You have incredible awareness of the areas you would like to work on and have provide some great places to start!”
*Participant responds*
Coach: “It makes sense that compassion is lacking towards yourself. We can be our own worst critic and it's always easier to feel compassion to others than yourself! Hopefully the compassion meditation video I will send after will help. I would love to hear how you find it!”
Coach: “That's such an important attitude to have Freya. It will help your progress in the long run if you have that flexibility in your goal that even if you have plans to go for a walk or do an exercise but something comes up, that you say "you know I had planned on doing some movement today, but this is more important and that's okay". That you can allow yourself to make that decision to put other responsibilities first. Like I said that 70 - 80% achievement is the goal! I'm excited to see your progress Freya and we will review your progress in 2 weeks (around February 9). If anything comes up in the meantime or your coming across any difficulties, I'm here.”
Coach: “If you feel dark chocolate as a treat for practicing mindfulness coming home from work will help kickstart this habit, that's more than okay.”
ChoiceCoach: “So let’s move onto tracking your goals. How could you measure your short-term goal?
Coach: “Now, as you start to achieve your goals it's important to build in a rewards. What do you think you could rewards yourself with for setting aside 10 minutes to prepare your lunch for work?”
VoiceCoach: “Great, so can tell me about your mental health at the moment?”
Coach: “Great, so could you tell me a bit more about your current work related stress?”
Coach: “that's incredible! It sounds like you've achieved far beyond what you set out to during our goal-setting chat, and it's great to hear that you're feeling good about prioritising yourself without guilt. It also looks like you've overcame hurdles like the commitments you already agreed to”
Coach: “I understand, so it's not so much the amount of sleep but the ability to get to sleep and stay asleep throughout the night, would that be right?”
DialogueCoach: “Fantastic! So am I right in saying that at the moment there is no real routine around exercise bar walking to and from work?”
*Participant responds*
Coach: “Good to know. So let's starting creating some goals around your activity and exercise. To do this we will use the SMART goal setting template that I sent you earlier. This involves creating small, medium, and long terms goal so we can start small and work towards bigger goals. Let’s start small, what do you think your short term goal could be? (i.e. achievable over the next two weeks)”
*Participant responds*
Coach: “Sounds great, it's also useful to be as specific as possible. So could you tell me what we will consider 30 minutes of exercise? (i.e. walking, running, cycling, swimming, etc.,)”
Coach: “Before we dive into the goals, could you tell me a bit about your current movement and exercise routine/status?”
*Participant responds*
Coach: “I imagine it's extremely difficult to get yourself moving after a physically and mentally exhausting day at work Cricket, but your motivation to try incorporate some walking into your routine is amazing! If you could think of your ideal exercise and movement routine (taking away any barriers in place at the moment) what would that look like for you”
*Participant responds*
ReflectionCoach: “Great, sounds like this short-term goal will fit really well into your current routine. Now last thing I would like to explore is how you are feeling about the goals we set. Do you think they are realistic?”
Coach: “Sounds like a great goal to work towards. So to get started on this we will use short, medium, and long-term goals. By breaking up the goal into three stages, it can be more achievable. We will start with your short-term goal. Take a moment to think about your current experience with exercise. Based on this what do you think your short-term goal could be? (i.e. a goal that could be achieved over the next two weeks?)”
PraxisCoach: “Amazing, How are you finding the videos so far?”
Coach: “To help with the areas that you scored lower in like negative emotions, loneliness, and engagement, I have put a video onto your ‘Stress’ tile that you can go through in your free time. I have also put up a video on managing burnout to help with the exhaustion you’re feeling.”
Coach: “A nice coffee or your favourite tea is a great rewards for doing a mindfulness exercise before work. As well, if coffee or tea is something you usually have before work it can be a great to 'piggyback' your exercises onto this habit”
ReciprocityCoach: “Great. So for now we will focus on your short-term goal since this is the first one you will be working on. Looking at your current routine and lifestyle, how realistic do you feel this goal is?”
Coach: “So would I be right in saying that it is frustration and boredom that causes this rut with the added pressure and responsibility of taking care of the kids that impacts this demotivation and rut even further?”
*Participant responds*
Coach: “Okay, so there's a few things that play a role in this rut. That's great to know. Usually we start with exploring short-term goals first. But before we do that, I'd like to know what it would look like to move out of this rut?”
*Participant responds*

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  • Owner: Hazel King
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