An Email Coaching Option Increases Participant Program Utilization and Coach Productivity

Purpose

HealthPartners population well-being health coaching program provides coaching to manage weight, nicotine use, sleep, stress, back health, family health, high blood pressure, high cholesterol, and physical activity. All health coaches are certified as wellness and health coaches and some are also certified by the National Board for Health and Wellness Coaching. Depending on the level of support requested by the participant, sessions are held every 1–6 weeks. Initial phone sessions are 30 min in length; subsequent sessions are 15 min. The HealthPartners program allows participants to meet with the same coach for all their sessions. Most participants can qualify for a health insurance benefit if they participate in at least 3 coaching sessions.

As the COVID-19 pandemic disrupted in-person consultations in 2020, digital health care interventions expanded, ¹ and patients increasingly sought on-demand, remote interactions. ² It has been long observed that learning preferences differ,^3,4 and expecting that adding a coaching modality would increase participation rates is consistent with the experience in smoking cessation interventions.^5,6

Because many of our own participants were giving us feedback that they would prefer writing, rather than talking, to their coaches, in May 1 through August 31, 2020 we tested whether:

(1) Participants who used the email option when we offered it would have a higher likelihood of completing 3 sessions by the benefit qualifying deadline than participants who did not use the email option when offered;

Email coaching sessions addressed the same questions and asked for the same information as phone coaching sessions and were offered after an initial phone-based session. Both coaching modalities required that the participant set vision and action steps. As with their phone coaching, our coaches provided customized messages when responding by email. Other than responding to participants when appropriate, coaches’ responsibilities were unchanged. Here, we report the association of email coaching with participant rate of completing 3 sessions—both of participants who used email and of all participants--participant feedback, and the number of participants each coach could support when the email option was offered.

Methods

Results

During 2019 and 2020, 10 790 unique individuals scheduled at least one coaching session; 53% of the participants were women, and the median age was 50 years. 78% of the participants self-identified as White, 4% as Asian, 7% as Black, and the remaining 11% self-identified as multiracial, another race, or chose not to answer. 6% self-identified as Hispanic or Latinx. 56% had a college degree.

When we offered the email option in May through August 2020, 6624 participants completed at least one coaching session; of these, 1962 used the email option for at least one session. The percent of participants who completed at least 3 sessions before their employer’s benefit qualification deadline was 96.5% for those who used email for at least one session and was 92.0% for participants who did not complete any email sessions (P < .0001). Participants who used email completed a slightly greater number of sessions (3.72 vs 3.45; P < .0001). The proportion of participants who completed at least 3 coaching sessions during the 4 months that we offered email coaching in 2020 (73%) was significantly higher than the proportion (67%) during the corresponding period in 2019 (P < .0001). 13% of the participants who used email coaching submitted surveys. Each survey statement was endorsed with agreement by at least 85% of the respondents. Of the 60 free-text comments, 90% were positive. Comparing the months when email coaching was offered to the other 20 months in the period of observation, each coach was, on average, able to simultaneously provide service to 43% more participants (340 vs 486 per month; P < .0001).

Discussion

When we offered an email coaching option after an initial phone session, participants who used the option were more likely to complete 3 sessions; the overall proportion completing 3 sessions, relative to the respective period in the prior year, was higher; and, each coach was able to support a larger number of participants. This suggests to us that all of the coaching stakeholders benefit from an email coaching option.

Because the study participants tend to be highly educated from a localized area and employed, the results may not generalize to individuals with other attributes. Using email was optional, so we do not know whether the results would be similar if email were the required method of communication. We also do not know at this time whether the email option was more effective, less effective, or equally effective in promoting goal achievement as phone coaching.

The extent to which unhealthy lifestyles burden the health of individuals, increase health care costs for all stakeholders, and reduce productivity makes clear the need for lifestyle intervention programs that are effective and reach individuals. While evidence suggests that text-based coaching produces outcomes comparable to telephone-based coaching, ⁸ other evidence suggests that email gives participants more flexibility to elaborate on their concerns and activities. ⁹ We have not found reports of trials that compare the impact of email vs phone coaching on goal achievement.

We postulate that giving participants an email coaching option increased participation rates for at least two other reasons: The participant can use email regardless of the time of day or day of year, and it better meets the needs of participants who are more comfortable with email than phone. The reason that our coaches could simultaneously support nearly half again as many participants when we offered email was because they were able to compose email consultations between phone calls and when a participant was a “no show” for a scheduled call. The only reference to coach productivity we were able to find in the literature is a qualitative statement that, “In general, text-based coaching uses less coach time…” ⁸

In conclusion, our experience suggests that offering an email coaching option, partnered with phone-based sessions by a live coach trained in behavior change techniques, has the potential to reduce costs while maintaining or increasing participant program utilization—a winning result for all stakeholders in a coaching program.

So What?

• What is already known on this topic?

There is evidence that increasing the number of ways in which a behavior change program is offered (touchpoints via text, email, and phone calls) increases the likelihood of success. While phone-based health coaching is a well-established modality to support behavior change, the effectiveness of coaching through email is less well documented.

• What does this article add?

When an email option is added to phone coaching, coaches can support more participants, participants who use the option are more likely to complete 3 sessions, and the overall percentage of participants who complete 3 sessions is higher.

• What are the implications for health promotion practice or research?

Our experience suggests that offering an email option to phone-based coaching can reduce program costs by increasing coach productivity. It can also increase participant utilization. Whether the option increases goal attainment remains to be documented.