Engaging Consumers in Health and Wellness

Earlier this week, I had the privilege of presenting at the North Carolina Association for Healthcare Quality (NCAHQ) Annual Conference in Durham. I have been a member of NCAHQ since 2004 and I served on the Board of Directors from 2011-2018. It was fun to attend the conference as a member as well as one of the invited speakers.

As many of you know, my education and training are rooted in health education. However, I spent most of my career working in healthcare quality improvement before returning to my health and wellness roots about five years ago when I became a health coach.  I have sometimes struggled to figure out how to meld the two worlds I’ve lived in professionally for the past 20 years, but I think I managed to do so with my presentation topic: Innovative Ways to Engage Consumers in Their Health and Wellness. I thought I would share some of the highlights from my presentation.

Health 2.0: Consumer-Driven Health Market

My presentation began by making the business case for the rise in consumerism in healthcare. As just about everyone knows, the US spends more money on healthcare (as a percentage of the gross domestic product or GDP) than most developed nations YET we have some of the worst health outcomes, including life expectancy. In addition, about 80% of the spending in healthcare is tied to the treatment of chronic conditions that are rooted in lifestyle choices. You know the list: heart disease, stroke, Type 2 diabetes and of course, obesity. These conditions are the most common and costly – but also the most preventable – of all health conditions.

With the rise of high deductible healthcare plans, which many employers are now turning to as a way to help reduce healthcare costs, consumers are now feeling the pinch in their own pockets. A physician office visit that may have incurred just a $25 copay in the past may now cost upwards of $100. This shift in the health insurance industry has been a wake-up call for many consumers to take a more active role in managing their overall health and wellbeing. We are also seeing the rise of “lifestyle medicine” – the use of evidence-based lifestyle approaches (e.g., a healthy diet, regular physical activity, adequate sleep, etc.) to prevent, treat and in some cases reverse the progression of the chronic conditions noted above. Healthcare is shifting (albeit much slower than many of us would like) from a sick-care model to one with a greater emphasis on promoting health and wellness through preventive services – with individuals taking a more proactive role in their health and wellness decisions.

Consumer Engagement Strategies

I prefaced my presentation by noting that my own passion for health and wellness grew out of my experience being overweight in my youth. It wasn’t until a good friend encouraged me to play sports in high school that I lost weight, gained confidence and realized that my behavior choices could directly impact my health – positively or negatively. This epiphany turned into a desire to help others on their own health and wellness journey. However, I also shared one of the first (and hardest) lessons I learned from my early days as a health educator – that not everyone is intrinsically motivated to make healthy choices or take care of themselves. Sometimes it takes a little extra incentive to get them engaged in the behaviors we know are linked to better health outcomes. I chose to share some of the more innovative strategies being used to help engage consumers in healthy lifestyle behaviors:

  1. Wearable Technology: A blanket term for electronics that can be worn on the body either as an accessory or as part of the material used in clothing. The most common format is the ubiquitous fitness tracker, such as a Fitbit or Apple Watch. However, there are some new products on the market including the Spree Smartcap and the Hexoskin Smart Shirt. The major selling feature of all of these items is the ability to connect to the internet, enabling the exchange of data between the device/product and a network. This has resulted in the user having access to a whole range of information about their health, such as steps taken, calories burned, heart rate, and sleep, at the touch of a button.


  1. Gamification: Essentially, the application of gaming elements and digital game design techniques to everyday problems including business dilemmas, social challenges or lifestyle behaviors. The idea is that gamified services tap into our natural desires for competition, achievement and status – and of course, the desire to have fun! One of the more common formats is smartphone apps and I chose to highlight a few including Plant Nanny (to help increase water intake), mySugr (to help diabetics manage blood sugar levels), and Stop, Breathe and Think (to support one’s meditation practice). All of these apps strike a balance between information and entertainment, but most importantly, are designed to help the user achieve sustainable change around the desired health behavior.


  1. Wellness Incentive Programs: Many employers and health insurance companies have been offering wellness programs for a long time so the idea itself may not be that innovative, but what has evolved are the types of incentives offered to individuals. In the past, employees or customers were often rewarded with small, health and wellness-related products such as water bottles, sweat towels or exercise bands. Then, many programs shifted to rewarding participants with gift cards to their favorite retailers. Today, we are seeing the rise of benefits-based incentives, where achieving a certain level of points for engaging in wellness activities or programs translates into a reduction in health insurance premiums and/or an employer contribution to Health Savings Accounts (HSA). Although these benefits-based incentives are considerably more expensive to implement, studies indicate that they do increase employee engagement in wellness programs.

Helping Individuals Find Their “Why”

I was the final speaker at the two-day conference and in years past, the final presentation has traditionally served as a way to end the conference on a positive note and provide attendees with some inspiration as they return to the workplace. Knowing how hard healthcare quality and safety professionals work every day, I wanted to give them a chance to focus on their own health and wellbeing. Thus, I dedicated the last 15 minutes or so of my presentation to lead attendees through the vision and values exercise I use with my coaching clients. Although we did not have time to take a deep dive into this exercise, I wanted to at least get them started thinking about their own vision of optimal health and wellbeing. Oftentimes, healthcare professionals tend to neglect their own health as they are so focused on taking care of others. This was a gentle reminder of the need to take care of themselves first so that they can continue to take care of others.

If you work in healthcare in North Carolina and are not already a member of NCAHQ, I encourage you to visit their website to learn more about the association and the work of its members to promote excellence, professionalism and continuous improvement in healthcare quality across the state.

ncahq new logo

Desire and Discipline

This week, I had a meeting of the Mastermind group I belong to with three other health coaches. Last summer, we participated in a visioning retreat in which I unearthed this creative itch that needed to be scratched and it manifested as the desire to engage in creative writing. The coach I paired up with during the retreat noted how passionate I was when I spoke about writing…and so I decided it was time to do something about it.

To make a long story short, I spent several months last fall diving into the writing process. I compiled all of my ideas and inspirations into one notebook. I choose one of the story ideas and I started writing. I blocked time on my calendar each week to do so. I was going strong for a while and then things slowed down over the holidays. Things picked up again for a short time in January after one of the other health coaches turned me on to Masterclass.com and I signed up for the writing class with author Judy Blume. I was inspired by her story and appreciated her advice about the writing process. But gradually over the next month or so, I found myself devoting less and less time to writing. There was always some other pressing project or assignment that needed to be worked on and I stopped making time in my schedule for writing.

I shared my lack of progress with my Mastermind group this week and lamented the fact that my writing had pretty much ceased, although I was not ready to give up on it completely. I questioned though how something for which I had displayed so much passion last summer could fizzle so quickly. One of the other coaches gently shared with me that in her experience with creative professionals, including writers, it takes both desire and discipline to accomplish their creative pursuits. And that it is the discipline that keeps things going when the desire may be lacking.

Ping! The light bulb went off and I realized I had completely lost the discipline when it came to my writing. I was not carving out protected time to devote to this endeavor. In fact, it made me realize that I have not been doing a great job in general with time management, particularly on the days when I don’t work at my part time job. Those days are supposed to be for my other professional pursuits, including my private wellness business, my writing, and my Nia practice. I had started to let personal appointments and errands creep into those days instead of waiting until the weekend. Fridays, which are typically open for me and a great day to devote to creative pursuits like writing, had gradually started to look like Saturdays. I might catch up on email and perhaps draft a blog post, but I’d pretty much call it a day by lunch time and essentially waste the rest of the afternoon tooling around on social media or watching reruns of Friends with my daughter after she got home from school. Not that spending time with my daughter isn’t a good thing, but the TV could wait until after I finished my work.

What I am essentially trying to say is that when I take a good, hard look at my schedule, I have the time to focus on my writing. I just haven’t made it a priority. I have been letting the desire (or recent lack thereof) drive the process, rather than building in the discipline to help sustain my effort regardless of whether the desire is present or not. One of the suggestions I have seen is to write every day, even if it’s just a bunch of gibberish or a stream of consciousness. Oftentimes, we may not feel motivated to work on a task but once we get going, the inspiration comes.

The discussion about my writing was a good wake-up call for me. I am going to take a step back and re-evaluate how best to use my time in order to accomplish all of the things that I have said are important to me, including writing. It may be that I am trying to do too much and if that is the case, I will need to reprioritize and choose the ones that mean the most. Or I may find that there is ample time for all of my pursuits once I establish a little more structure to my schedule and remove some of the “time sinks” that have derailed my efforts in the past. Either way, I am feeling renewed excitement about the possibilities.








It’s really not that bad…

March is Colon Cancer Awareness Month and I am writing today to try to convince those of you who have been putting off your colonoscopy that it is really not that bad. It is a relatively simple procedure that could save your life – the minor inconveniences involved with the prep will be worth the peace of mind if you are able to prevent or catch colon cancer in its early stages.

A few quick facts about colon (or colorectal) cancer:

  • Colorectal cancer is the second leading cause of death in men and women.
  • One in 20 people will be diagnosed with colorectal cancer.
  • One in three people are not up to date on their screenings.
  • Family history is a strong risk factor.
  • Colon cancer is preventable and treatable if detected early.
  • If you are at least 50 years old with no symptoms, your screening is normally covered by insurance.

(Source: https://www.cdc.gov/cancer/colorectal/pdf/no_pocket_brochure.pdf)

Personal experience

I will be 46 in June and have already had three colonoscopies, so I am speaking from personal experience. My first one was at age 34 and came about as a result of some concerning symptoms (blood in my stool) and a family history of colon cancer (maternal grandfather). I saw my primary care physician first and given the above factors, she sent me to a gastroenterologist. Both physicians suspected that it was just hemorrhoids, but my GI doctor recommended a colonoscopy due to my family history. Sure, I was a little apprehensive at first, but I wanted to be sure that it was not something serious.

I’ll spare you most of the details but as you’ve probably heard, the prep is the worst part. You have to avoid certain foods a few days prior to the procedure and then fast starting around noon the day before your procedure. Then you have to drink a large volume of the prep solution over several hours to help clear out your system. I can say that the manufacturers are working to make it taste better – the solution I used for my most recent screening last year was the best of the three that I have had. They are also working to make the prep easier – there are several options including oral medications and a “split” prep process where you drink some of the solution the night before and finish it the next morning.

The colonoscopy itself is rather simple. Most patients are sedated for the procedure – the anesthesiologist gives you a nice dose of propofol or similar sedative in your IV and you are out before you can count to five. Next thing you know, they are waking you up and bringing you to the recovery area. Your gastroenterologist will likely provide you with a procedure report including some pictures of your colon (I personally think it’s kind of cool to see what it looks like inside!). If there were any polyps that needed to be biopsied, you may need to wait a week or so to get the results back.

Most people need a colonoscopy every 10 years, but it may depend on what the physician finds. In my case, I was advised to come back in five years after the first one as I had some benign polyps (and the family history risk factor). The same thing happened after my second one. But at my last one in 2018, I was polyp free and thus, can wait 10 years before my next one (unless of course I have any symptoms or warning signs that would warrant coming in sooner). As much as I might fuss about the inconvenience of the prep process, it really is worth it knowing I am doing everything I can to help prevent colon cancer or increase my chances of survival if I were diagnosed with it.

A quick note about your colon cancer screening options:

There are stool-based tests that are non-invasive and do not require any special diet or bowel preparation. These tests are usually recommended for people who have an average risk for colorectal cancer: no personal history of pre-cancerous polyps, no colorectal cancer that runs in the family, or no other risk factors. However, if the test shows abnormal signs of blood or a possible cancer or pre-cancer, a colonoscopy will be needed anyway to confirm the result and to remove any abnormal findings or polyps. Thus, it might be best to skip the stool-based test and just have the colonoscopy. Bottom line: consult with your health care provider to determine the best screening test for you.

Now if you’ll excuse me, I need to go remind my husband, who just turned 50 at the end of February, that it is time for his annual physical and a referral for his first colonoscopy!



Maintaining the gains

As I discussed in my previous post, the path to change is seldom straight and easy. Even after a client has succeeded in sustaining their chosen health behavior over a period of months, they may still be susceptible to lapses or minor slips. During those times, it is critical for a coach to continue offering support and help the client determine what they have learned from their experience.

Maintenance occurs when a client has been regularly practicing the new behavior or action with no more than a few lapses or an occasional relapse after which they quickly and successfully return to regular practice. What started out as a goal has become a new habit. At that time, there are a few pathways for the client to consider:


  • The client may be ready to explore deeper commitment in the same focus area. For example, a client who went from being inactive to walking 3 days/week may wish to increase that practice to walking 5 days/week. Or they may choose to register for an activity such as a charity 5k walk.


  • The client may be ready to take on a new goal in a completely different area. Success in small goals often gives the client confidence to tackle more challenging behavior changes. For example, a client who is a casual smoker who increases their physical activity level may decide to quit smoking completely. Or a client who successfully reduces the amount of meat they consume may decide to go further and adopt a vegetarian or vegan diet.


  • The client may choose to complete coaching at this point now that they are able to successfully maintain the behavior change. Of course, the door is always open for them to return to coaching in the future if and when they want to take on a new focus area. However, I believe that the coaching process can also equip the client with the skills necessary to address future changes on their own. The skills they learn through the coaching process can be transferred to any habit or behavior they wish to change.


In the end, coaching is really a journey of self-discovery and exploration that empowers you, the individual, to achieve your highest level of health and wellbeing. There is no greater gift of self-love.

I hope you have enjoyed this series about the stages of the coaching process. Stay tuned for future posts about your favorite health and wellness topics!




Assessing Action

When the client is in the action stage, they are doing and learning and adjusting action steps based on that learning. They may face challenges or obstacles, some of which they may overcome, others which may trip them up at least temporarily. The path to change is rarely a straight one so support and encouragement are critical to helping clients along this journey.

The next step in the coaching process is to help clients assess their progress and determine how to continue moving forward. Some key tasks include:

  • Acknowledging client successes
  • Helping the client learn from their experience, whether they were fully successful, partially successful or not successful
  • Supporting the client in identifying any barriers to change and strategies to address those barriers
  • Determining how the client wants to move forward (e.g., initiating new actions or refining current action steps)

I typically encourage clients to fill out and return a brief coaching session prep form prior to their session. This form allows them to capture successes, challenges, lessons learned and what they want to focus on in their session. It helps both of us prepare for an effective session and gives us both insight into potential areas to address during the session.

At each session during the action stage, I typically check in with the client about how things went since the last session. There are usually three possible outcomes:

  • Action was completed successfully
  • Action was partially completed (some lapses occurred)
  • Action was unsuccessful (client was unable to accomplish plans or relapsed)

The approach I take with the client depends on the outcome achieved. For example:

If action was completed successfully, I typically:

  • Acknowledge the client’s success and help celebrate little or big “wins”
  • Explore what the client learned through their successes
  • Review where the client is in the process of reaching their long-term goal/outcome and their vision of optimal health and wellbeing
  • If client goal/outcome is not yet met, determine additional action steps needed to keep the client moving forward

If action was partially completed or some lapses occurred, I do most of the above but also:

  • Help the client explore what was different on the days they were successful and the days they were not
  • Review action steps to see if any adjustments need to be made
  • Explore with the client what they will do if they encounter similar barriers or obstacles again

If action was unsuccessful in terms of the client’s plans and intent, I will:

  • Acknowledge the client’s attempts (if applicable) while recognizing the lack of meeting their goals
  • Assess what they learned from the experience and how to use that information going forward
  • Ask questions to determine whether we need to return to an earlier stage in the process (e.g., revisiting readiness to change or doing further work in preparing for action)


As I stated earlier, the path to change is seldom straight and easy. There will be twists and turns as well as successes and setbacks. A client may start off strong and then find themselves struggling when they face an unexpected obstacle. Another client may initially struggle to get momentum but then soar once they hit their stride. Each client is unique and thus, the process will be different for each one. It is my job as the coach to help the client navigate along this winding path, sharing in the peaks and valleys, reminding them that they have the power to change and make the choices necessary to reach their vision of health and wellbeing.





Preparing for Action

When it comes to behavior change, setting a goal and identifying action steps is not always enough to ensure a client’s success. An often-overlooked step is helping the client prepare to take action. Taking the time to consider how and when a client will engage in their desired changes will increase the likelihood of the client successfully completing their action steps.

There are four primary strategies that I use when helping clients prepare for action including:

  • Exploring a typical day or week
  • Exploring potential barriers or challenges
  • Creating back-up plans
  • Establishing accountability

Let’s look at how each of these can help a client be as successful as possible.

Exploring a typical day or week

It is often easy for clients to articulate action steps when they are discussing the desired changes in general terms. However, we know that making changes in real life is not always as easy as it sounds. This is the main reason I often ask clients to get down into the details and think about what their schedule typically looks like, so they can realistically determine when and how they will complete their action steps. This allows the client to take a closer look at what is possible and what may need to change to allow for success.

For example, if a client would like to exercise more often, I might ask them to think about their current schedule and identify what days of the week would be best to add in the activity. Once they determine which days are best, we might delve in further to figure out what time of day will work best and/or where they will exercise. Exploring in detail like this often helps a client determine what is most realistic in accomplishing their action steps.

Exploring potential barriers or challenges

I have often found that this is one of the most helpful strategies to prepare clients for change. Many clients are excited to make changes and often assume that things will go according to their plan. But as we are all well aware, life often gets in the way and unexpected obstacles may arise. If the client does not prepare for these obstacles, their efforts may get sidetracked and they may get discouraged if they do not successfully complete their action steps.

After the client has identified their action steps, I will often ask something as simple as “What potential barriers or challenges could arise that might get in your way?” I may also explore what has kept them from succeeding in the past, if they have attempted this change before. Sometimes a perceived barrier may be a competing value. For example, a client may want to exercise at the gym after work but feel guilty that it will take time away from their family. If spending time with family is more important to the client, we might then explore how they can engage in physical activity that would involve the family, such as the whole family going for a walk after dinner.

Creating back-up plans

Once clients have identified potential barriers or obstacles to completing their action steps, it can be very helpful to establish back-up plans. Identifying a “Plan B” can help the client think through what they might do if they are not able to complete their action steps as intended. For example, the client who plans to walk with their family after dinner might need an alternative action if the weather is not conducive to being outside. They may want to have a family-friendly activity they can do inside, such as dancing to their favorite music.

Establishing accountability

A final key strategy in preparing for action is helping the client commit to taking action within a specific period of time and identifying the best way to hold themselves accountable to their plan. Many clients will rely on the coach as their accountability partner, but they may also have a friend, coworker or family member who can serve in that role. I typically ask the client how they want to be accountable to themselves and may inquire as to what worked well for them in the past.

Some clients choose to write things down and check them off once they’re completed. Others may want to track their progress on a calendar or even perhaps in an app. Still others may choose to reward themselves for accomplishing short- and long-term goals and actions. It is really up to the client to determine what will work best and they may want to experiment with different approaches until they find the method that works best. Going back to the client who plans to exercise with their family, they may find that keeping track of their activity on the family calendar is a fun way to get everyone engaged and also hold themselves accountable to their plan.

Once the client has thought through potential barriers, identified back-up plans and established accountability, it is time to take action. This is where the rubber hits the road! Next time, we will explore what happens once the client is in the action stage and reports back on their progress.





Goal Setting and Action Steps

Once a client has selected a focus area and together we have determined that they are ready to make a change, we move into the goal setting stage. Setting goals is a critical part of the coaching process and one that deserves to be addressed thoroughly in order to help clients be successful. If this stage is not done thoroughly, the goals and actions the client chooses may not be appropriate for where they are in the change process. This can result in failed action and discouragement.


Typically, goals are set with a 3-6-month time period in mind. In this case, when we reference goals, we are talking about the desired outcome(s) clients hope to accomplish in that time frame. Research has shown that it typically takes about 3 months to make significant progress in changing behavior. This gives clients enough time to begin forming new and lasting changes in health behaviors yet is a short enough time frame to motivate them to make changes now.

Sometimes clients want to work on more than one goal at a time. It is important to help the client decide when they may be attempting to do too much. Clients may want to focus on one goal at a time in order to experience maximum success.  It is also important to help the client set goals that are a reasonable stretch. If it is too easy, the client may become bored and lose motivation. However, goals that are too difficult may lead to frustration and discouragement at the inability to change. An easy way to assess the right stretch is to gauge the client’s confidence around achieving the goal – ideally we want them to rate it between a 6-8 on a 10-point scale.

Action Steps

Many clients confuse their goals and desired outcomes with a plan or action steps. The goal or outcome is the destination. The plan is a series of specific action steps to help the client reach that destination. Once a client sets a goal, we then work together to identify the smaller steps necessary to achieve the larger goal. Many times, the action steps build from week to week with the client adding new action steps as they experience success and progress toward the goal.

Both the goal and action steps should follow the SMART formula and meet the following criteria:

Specific – the goal and action steps should be clear and concise. If they are too general or vague, it is difficult to know when they have been completed.

Measurable – the goal and action steps should be measurable so clients can track their progress. The client needs to have clear criteria for progress and completion. Monitoring progress on goals and action steps can be inspiring and motivating for many clients to continue with their changes.

Action-oriented (or Achievable) – the goal and action steps should be changes that are within the client’s ability to change and/or control. Otherwise, the client may struggle and become discouraged at the lack of progress.

Realistic – the goal and action steps should be largely within the client’s reach. It is best to work on small behavior or lifestyle changes.

Timed – the goal and action steps should be tied to a timetable for completion.

The best way to illustrate the SMART formula is with an example, such as a client who wants to lose weight. Setting a generic goal of “I want to lose weight” is not going to help the client move forward. There are too many unanswered questions – how much weight? By when? It may also make it harder to identify the action steps that will be necessary to achieve the goal.

A better example of this goal and potential action steps using the SMART formula might be:

Goal/desired outcome: I want to lose 15 pounds in 3 months.

Action step 1: I will schedule an appointment with my physician next week to ensure it is safe to start an exercise program.

Action step 2: I will purchase new sneakers next weekend so I can begin walking.

Action step 3: I will walk for 30 minutes in the morning 3 days a week.

Action step 4: I will drink 48 ounces of water per day.

In this scenario, the client would continue to modify and/or add action steps as they progress toward their goal. For example, if the client is successful at walking three days a week for a month, they may decide to increase that to five days a week and then eventually every day. Or they could choose to increase the duration of their walk to 45-60 minutes. On the other hand, if they have not exercised in some time and they find it difficult to walk for 30 minutes, they may need to cut back to 10 or 20 minutes until they build up their endurance.

The client may identify one or more actions steps to work on as part of their plan. It is up to the client to determine which steps should be done when. They may want to start with one action step that they are excited to take on. Or they may choose the action step that will have the greatest impact on achieving their goal. Some clients may want to start with one action step and achieve an easy “win” to build confidence, whereas others may be willing and able to take on more than one action at a time.

Once a goal and action steps are identified, it is important to help the client prepare for action in order to be as successful as possible. We will explore this critical step next time.