Healthcare workers’ experience of a coach-led digital platform for better well-being

ABSTRACT

This study aimed to use a coach-led digital health platform to mitigate burnout and enhance wellbeing among hospital workers. Individual interviews were conducted with 11 healthcare workers to explore their experiences of working with a coach through text-based communication on a digital support platform. Interviews were analysed using thematic analysis. Three overarching themes were identified: (1) Human-centred Conversation, Facilitated Awareness, (2) Learning and Growth, (3) Forward Momentum in the pillars of Lifestyle Medicine. Participants had a positive human-centered connection with their coach and felt safe to communicate openly with her via online chat messages. The coach facilitated participants’ awareness, learning and growth by helping them to identify the goals they wanted to achieve. Participants experienced forward momentum in the pillars of Lifestyle Medicine, including sleep, relationships, meaning and purpose in life, exercise, eating well, along with reduced loneliness and burnout. This study found that participants can experience an inherently human-centred connection through text-based communication with an online coach. There were some limits to this connection, including individual preferences and beliefs in relation to the digital means of communication. Participants felt connected to their coach and experienced benefits that extended beyond achieving individual goals to improving their lifestyle and wellbeing.

KEYWORDS:

• Positive health coaching
• digital platform
• healthcare workers
• wellbeing

Practice points

• Participants can experience an inherently human-centred connection through text-based communication with an online coach. This highlights the impact that coaching through digital platforms and using text-based communication can have on coaching clients.

• Coaching delivered through online text-based communication can produce positive changes for healthcare workers in the pillars of Lifestyle Medicine, including sleep, cultivating relationships and having a sense of meaning and purpose in life.

• Findings highlight the benefits of coaches offering participants a tailored approach to working with their coach online.

Introduction

Wellbeing and burnout among hospital workers

Healthy hospital workers (HWs) are needed to have an effective, efficient and compassionate healthcare service. However, there is often poor wellbeing, high levels of work-related stress and burnout among HWs (Dunne et al., 2019; Johnson et al., 2018; O’Connor et al., 2020). which has been exacerbated during the COVID-19 pandemic (Wilbiks et al., 2021; Zhou et al., 2022). This has led to a second and equally serious pandemic of poor mental health among this group (Søvold et al., 2021). The chronic exposure to stress that HWs experience can lead to burnout, defined as a state of depleted psychological resources (Di Trani et al., 2021), which can exert a subsequent detrimental impact on wellbeing (Lapa et al., 2017).

In order to address these concerns, there is a need to find approaches to improve HW wellbeing (National Academies of Sciences & Medicine, 2019). Self-care practices have been recommended as the first line of defence for healthcare workers (Heath et al., 2020; Waris Nawaz et al., 2020) in order to build upon routine practices towards positive health. There is a wide variety of self-care strategies including spiritual practices, relaxation techniques, gratitude, ensuring adequate sleep, regular exercise, fostering hobbies and practising meditation (Dunne et al., 2019; Lynch et al., 2018; Mahmoud & Rothenberger, 2019; Strauss et al., 2021). For example, exposure to an 8-week modified mantra-based meditation practice (Attention-based Training) conducted with 25 emergency department staff at a large urban hospital in Ireland has reduced burnout, improved sleep, heart rate variability and immune functioning (Dunne et al., 2019). Furthermore, self-care and self-compassion for HWs has been shown to protect against burnout and lead to improved physical, mental and emotional wellbeing (Mills & Chapman, 2016; Müller et al., 2023). Practising self-care can also help HW create structure and predictability which helps them to manage the high levels of stress, and uncertainty they often experience at work (Søvold et al., 2021).

Digital health technologies for improved wellbeing

Digital health technologies, such as smartphone apps, are becoming increasingly important as tools to promote healthy habits (Wannheden et al., 2021). Søvold et al. (2021) highlight the opportunity for digital technology to ensure access to support and guidance for HWs. During the COVID-19 pandemic, a telemedicine platform was successfully used to provide frontline doctors with psychological counselling via videoconferencing (Wang et al., 2020). Human coaches can play an integral role in creating behaviour change by providing feedback based on individual circumstances, motivating, encouraging, challenging, and building rapport and trust (Beun et al., 2016; van Coller-Peter & Manzini, 2020). Using a digital platform to deliver health coaching can offer significant benefits to the field of coaching by facilitating scalability through reduced costs and increasing the accessibility and availability of health coaching, regardless of geography and time zone (Graßmann & Schermuly, 2021; Kanatouri, 2020). Since the COVID-19 pandemic began, there has been an accelerated trend towards delivering coaching online, which has led to benefits for both coaches and their clients (Bassi et al., 2022; Dol et al., 2021; Lo et al., 2021; Passmore et al., 2021). Furthermore, delivering coaching via text messages has the advantage of being widely accessible and available (Mitchell, 2021).

Positive health coaching

Positive Health Coaching (PHC) coaching combines evidence-based Lifestyle Medicine, Positive Psychology and Health Psychology-informed interventions and educational support. This approach to coaching helps individuals navigate a path to good health by encouraging autonomy, self-motivation, confidence and resilience (Moore & Jackson, 2014). The areas of lifestyle that coaches and participants explore include the pillars of Lifestyle Medicine: exercise (daily activity), eating well, stress management, adequate sleep, avoiding risky substances and cultivating positive relationships (ACLM, 2022). While traditional coaching approaches take a facilitative approach, PHC acknowledges the empowerment of providing the skills and knowledge people need to take ownership of their health and make positive changes to their health and wellbeing (van Nieuwerburgh & Knight, 2023). To do this, PHC uses a dialogical approach that lies between facilitative and directive in it’s conversational approach. The health coach’s role is to elicit ‘personal responsibility, focus, and clarity, self-discovery, inspiration and self-efficacy’ from participants to support sustained change for good (Moore & Jackson, 2014, p. 349). In a growth-promoting relationship, the coach works with individuals to develop health goals and establish behaviours, knowledge and skills needed to create a healthier and happier lifestyle. The coach strives to create an environment that allows participants to find their own answers, possibilities and responsibility for their goals rather than an expert driven agenda (Moore & Jackson, 2014).

Delivering PHC via a digital platform

There are challenges associated with delivering coaching via a digital platform, such as establishing rapport with clients and a lack of nuance leading to disconnection, misunderstandings and frustration (Mitchell, 2021). Traditionally, building rapport involves physical, or non-verbal factors such as body language or gestures and quality or tone of voice (Tickle-Degnen & Rosenthal, 1990; Van Nieuwerburgh, 2020), factors that can be challenging to use when coaching through virtual messages (van Coller-Peter & Manzini, 2020). However, rapport can still be established via digital technology platforms (Asri et al., 2020). The language used during the coaching process as well as an individual’s beliefs and values also play an important role (Van Nieuwerburgh, 2020). This is illustrated by participants who report being able to communicate more openly during virtual coaching sessions as compared to face-to-face sessions (Frazee, 2008; van Coller-Peter & Manzini, 2020).

Online social presence is a complex construct and involves the feeling of ‘being together’ in Computer Mediated Communication (CMC) (Hwang & Park, 2007; Short et al., 1976). CMC can include any electronic message system, which can be supplemented by audio and video (Derks et al., 2008). Generally, messages delivered through CMC are typewritten and can be synchronous (e.g., chat) or asynchronous (e.g., email) (Adrianson, 2001; Adrianson, 2001; Derks et al., 2008). A sense of ‘being together’ in CMC be achieved through co-presence, mutual awareness and connectedness. Social presence involves the feeling of co-presence that happens when individuals feel as if they are in the same environment (Hwang & Park, 2007). This happens when individuals sense that they can perceive others and that others can perceive them. Both individuals also need to have mutual awareness of their co-presence and attend to the sensory experiences of one another. Achieving and being aware of one's co-presence with another fosters a sense of connectedness, which is one of our basic human needs and plays a fundamental role in cultivating belonging in social relationships and facilitating motivating social behaviour (Hwang & Park, 2007).

Text-based communication meets the conditions for social intervention when both relational partners are jointly attending the interaction (Hall, 2018). While Instant Messaging (IM) chats can provide anonymity in interpersonal encounters, it also allows individuals to learn about others in private and creates a personal online space for them to develop intimate relationships (Gibbs et al., 2006; Grebe, 2009). Limitations associated with these kinds of online interactions include the absence of nonverbal behaviours, instant feedback and natural spoken language (Baron, 2010). However, the theoretical frameworks of Social Information Processing (SIP) Theory (Walther & Burgoon, 1992) and the hyperpersonal model (Walther, 1995) highlight that once there is careful crafting and interpreting of messages, relationships initiated through online communication have the potential to develop intimacy like in-person relationships.

Current research project: RCSI coach connect

This article reports on the findings from the RCSI Coach Connect project. This project is a controlled study to function as a pilot for larger scale positive health coaching through digital platforms. The RCSI Coach Connect project was a 12-month project that intended to impact positive health by mitigating burnout and enhancing wellbeing among hospital workers in Ireland through a coach-led digital health platform. This project was a wait-list randomised control trial. Participants were randomly stratified into wait-list control and (n = 13) and intervention (n = 11) groups based on gender, role and age. Each group were given access to the coaching intervention for 12 weeks each (the intervention group received access in September 2021 and the control group received access in January 2023). In this paper, we focus on HWs experience of working with a human coach via a digital support platform.

Materials and methods

Research setting and participants

Eleven participants took part in this study over a period of eight months. All participants were hospital workers, recruited from across the RCSI hospital group in Ireland. They were recruited from the sample of participants who took part in the RCSI Coach Connect Study. All participants from the RCSI Coach Connect study were invited to take part in an individual interview on their experience during the study. The invitation was sent via email. Our goal was to conduct interviews with as many participants as possible in order to capture their experiences of the project. We continued to recruit participants until all Coach Connect participants had either not responded to our request or had declined to take part in an interview.

Six participants were part of the RCSI Coach Connect intervention group, recruited onto the Coach Connect digital platform in September 2021. They were interviewed in February 2022. The remaining five were wait-list control group participants who signed up to the platform in January 2022 and were interviewed in April 2022. Both groups were interviewed after they completed the coaching intervention and, therefore, their results are presented together in this paper. Participant demographics are presented in Table 1. Participants were representative of the overall cohort who took part in the RCSI Coach Connect project.

Table 1. Participant demographics.

Participant ID	Gender	Age	Role
Intervention group
103	Female	50–59	Health and Social Care Professional (HSCP)
111	Female	40–49	Medical Scientist
115	Female	30–39	HSCP
120	Female	50–59	Nursing
123	Female	40–49	HSCP
124	Female	30–39	Nursing
Control group
105	Female	50–59	Research Manager
107	Female	40–49	HSCP
108	Female	30–39	Nursing
122	Female	40–49	HSCP
126	Female	40–49	Medical Scientist

Ethics

Ethical approval was obtained from the RCSI research ethics committee before beginning the project. All participants gave informed consent to take part in the interview and were assigned a unique identifier to preserve anonymity.

Digital support platform

Our technology partners and commercial company, Empeal, provided the digital support platform used in this study. This platform includes a smartphone app that was available for participants to download on the App Store and Play Store. This app is a multisided platform that enabled chat-based digital communication between the coach and participants. The application platform also stored evidence-based content for participants to access when the coach sent them the content (in video, audio and pdf format) related to the pillars of Lifestyle Medicine (exercise and movement, eating well, sleep, mental health, relationships, meaning and substance control). The coach was able to send this content to participants, based on the goal they had chosen. The coaching intervention was developed by the RCSI Digital Health Research team.

Coaching approach

A Positive Health Coaching (PHC) approach was used to deliver coaching through an app-based technology. Positive Health Coaching (PHC) is defined as a ‘managed conversational process that supports people to achieve meaningful goals in a way that enhances their wellbeing’, p. 315 (Biswas-Diener & van Nieuwerburgh, 2021). PHC is dialogical in its approach, meaning that it lies between facilitative and directive conversational interventions (Van Nieuwerburgh et al., 2019). Dialogical coaching places client autonomy and humanity at the centre of the coaching conversation (van Nieuwerburgh & Knight, 2023). It draws on the partnership principles which are: Equality, Choice, Voice, Dialogue, Reflection, Praxis and Reciprocity (Knight, 2011). Equality involves the coach believing that every individual person has equal dignity and value. Choice means creating conditions for clients to evaluate options and choose their own plan of action. The principle of Voice involves the coach believing that clients’ opinions matter and communicating this to them. Dialogue means engaging in back-and-forth conversation where all parties in a conversation share what they think and listen effectively. Reflection required the coach to withhold advice during coaching in order to encourage clients to do their own thinking. Praxis requires the coach to translate research and evidence-based practice into actionable knowledge. Lastly, reciprocity involves seeing clients as learning partners.

Participants had access to the coaching intervention for a period of 12 weeks. During this time, they had the opportunity to engage in one goal setting session with the coach, and had up to attend five bi-weekly review sessions to discuss their progress. Sessions were scheduled by appointment and conducted live. The coach responded to participants messages within 4 minutes. Participants could also message the coach outside of scheduled sessions if they had an issue or a question to discuss. The coach would respond within 24 hours, between 9 am and 5 pm, Monday to Friday. One coach delivered the coaching intervention. The health coach on the platform is a fully qualified coach, accredited by the European Mentoring and Coaching Council (EMCC).

Data collection

Individual semi-structured interviews were conducted with each participant. This allowed the researchers to understand individual experiences of engaging with the RCSI Coach Connect project. Interviews were conducted by three independent researchers who were not part of the main study but who had experience and expertise with interviews (RK, LMC and JD). Another researcher (ROD) conducted three of the interviews. Interviews were conducted via a professional Zoom account. Both the interviewers and the participant kept their videos turned off throughout each interview. Interviewers remained anonymous, using the pseudonyms Interviewer 1 and Interviewer 2, while participants used their anonymous unique study identifier. Forty-five-minute interviews were recorded and transcripts were generated by Zoom.

An interview schedule was developed by the research team, which can be found in the supplementary material. The topics covered in the interview schedule were divided into questions on (A) the participant's experiences of direct engagement with the smartphone app, application as well as the coach and (B) explore reasons why HWs may not engage with self-care solutions. Topic B was included in order to better understand HWs experiences of barriers and facilitators of engaging in self-care solutions in general in order to understand ways in which HWs engagement can be supported in the future.

Transcribed interview text files were downloaded by researchers onto password-protected laptops and stored for processing and analysis. Audio interview files were permanently deleted once the transcribed interviews were checked and saved securely. The qualitative codes and final analysis were retained and stored on the researchers’ password-protected laptops.

Data analysis

Analysis of the RCSI Coach Connect project followed a mixed methods research design in accordance with the Mixed Methods Appraisal Tool (MMAT) (Hong et al., 2019). The current article describes the qualitative research component.

Thematic analysis

Interviews were analysed using thematic analysis. This involved ‘identifying, analysing, and reporting patterns (themes) within data’ (Braun & Clarke, 2006, p. 79). Themes were identified within individual interviews. These themes were then compared across individuals to search for consistencies and inconsistencies between individuals’ experiences. Each theme captured an important aspect of individuals’ experiences of engaging with the RCSI Coach Connect project. Thematic analysis facilitates participatory research where participants are viewed as collaborators in producing a qualitative synthesis (Braun & Clarke, 2006). Our approach to qualitative analysis is grounded in big tent criteria for evaluating quality (Tracy & Hinrichs, 2017) which provided conceptualisation that differentiates between end goals of qualitative research (universal hallmarks of quality) and the methods or means of research to achieve desired goals.

Coding process

Our process of analysis was informed by the approach outlined by Braun and Clarke (2006), Boyatzis (1998) and Miles and Huberman (1994). Analysis was supported by using the data management programme NVivo 12. The early stages of analysis involved gaining an overview of each interview and writing a brief summary of the topics discussed in order to establish consensus across coders.

Coding of each interview occurred at each ‘meaning unit’, where one idea or theme is presented and is comprehensible outside its context (Boyatzis, 1998). Two rounds of coding were conducted. The first round of codes were data driven and descriptive while the second round reviewed and refined these codes. One researcher (ROD) coded the complete dataset and eight interviews (75%) were independently double coded by second researchers (LMC and JD). The subset of data which was double coded was chosen at random and exceeds the typical 10–25% of data which is commonly double coded (O’Connor & Joffe, 2020). This process of double coding was used to identify and explore different facets of the research question and to challenge the lead researcher’s perceptions and ideas regarding the data in order to develop a more complex and in-depth understanding of participants’ experiences (Tracy, 2010). Two-hundred and eleven initial codes were generated. Examples of these codes include: ‘positive impression of coaching via text’, ‘motivated’ and ‘improved self-awareness’. The codes generated by each coder were compared and discussed. While there was variation in the specific labels given to codes, both coders agreed on the codes attributed to each piece of interview text.

Codes were then categorised into themes by grouping similar codes and exploring other connections between codes. This was conducted within and across each interview. Lastly, themes were defined and named, for all interviews by one researcher (ROD), to examine participants; experience of being part of RCSI Coach Connect.

Reflexivity

The researcher (ROD) is a female postdoctoral researcher with a background in psychology and was also managing the RCSI Coach Connect project. Therefore, she comes to the analysis with ideas of participants’ experiences before conducting the analysis. The interviewer addressed potential bias by comparing her initial results from her analysis to two other individuals who analysed the interviews independently. The second individual to identify themes (LMC) is a female medical student with an undergraduate degree in psychology. As a medical student with placements in hospital settings, LMC comes to the project with ideas about wellbeing and burnout among HW. The third individual to identify themes (JD) is a female PhD scholar with a background in psychology, who had practical experience of working in healthcare settings as part of multi-disciplinary healthcare teams. All interviews were completed via independent double coding with comparison of identified themes at multiple iterations until consensus was reached.

Results

Three overarching themes were identified: (1) Human-centred Conversation (2) Facilitated Awareness, Learning and Growth and (3) Forward Momentum in the pillars of Lifestyle Medicine. Each of these themes are presented below along with illustrative quotes from participants.

Human-centred conversation

Participants reported having a strong personal connection with their coach and being able to communicate well via online chat messages. Knowing the coach was important to participants; they experienced knowing their coach, and being known themselves, through text-based communication.

And that's because it was, I suppose, that personal experience, yeah, you feel you know the coach by the end of this (111)

They had a positive overall impression of their coach and the service the coach provided. Participants found their coach to be inclusive and warm. They commented that they felt safe communicating openly with the coach and allowing the coach to get to know them.

I suppose quite safe as well, even considering it’s over technology. But it felt quite supportive and you know, I didn't feel worried about maybe giving information. (115)

Participants were aware that the coach was a real human and not a chatbot; this supported a positive experience for them. They valued getting to know their coach. One participant commented on the positive effect of learning the avatar name for the coach and the coach sharing something personal about themselves. Knowing these personal details made it easier for them to connect with the coach.

I had a first name, whether that was real or not, it's nice to have the first name, and I know when we were sharing weekly gratitude examples, there was areas where she shared something that she was grateful for and that kind of just gave us an insight into the coach as a person, which was nice. (115)

Participants expressed surprise by how easy it was to communicate with the coach via online chat and commented on the benefit of communicating via messages. These participants felt safe to discuss emotional topics with their coach.

We're not hugely comfortable talking about our feelings. But in some ways it was easier because it was through the chat box … . It was just like texting a friend, really (111)

There were also exceptions to this felt sense of knowing and care. There was variation in participants’ preference for how they communicated with their coach, such as expressing a preference for verbal conversations.

I would have preferred maybe a check-in to talk to somebody, and that sort of way rather than just filling in an app. I’m the type person who likes to have interaction (120)

Participants felt that their interaction with the coach was limited by being conducted via the app because it ‘prevented the flow’ (105). However, they highlighted that their issues with not feeling connected to the coach were not reflective of the coach themselves but of the fact that the communication occurred via a digital platform.

Yeah. I liked my coach but it just felt very like it could have been a robot, even though I know it wasn't a robot. (107)

In contrast to participants who found it easier to discuss emotional topics via text messages, one participant found it challenging to communicate about emotional topics via chat.

to be maybe upset about something or to be happy about something it's hard to just type it in, you know (105)

Facilitated awareness, learning and growth

Participants recognised the coach's role in guiding their goal setting process. Working with the coach helped them to identify and prioritise the goals they wanted to achieve. They felt that the goal setting process was well structured and clearly explained. It gave them a focus and allowed them to structure their thoughts in relation to their goals.

she was helping me she was saying, how to start making your goal and how to achieve it … like the smart way of making goals (124)

I found it very easy to understand. Once I knew as I was working on and how to do it. (115)

While the coach led the goal setting process, participants expressed a sense of ownership over their goals. One participant explained how it facilitated their awareness by helping them think more clearly about what areas they wanted to work on and what their goals were.

Yeah, I find that very rewarding. I find the process of identifying myself, where my kind of major issues were or stressors were … it highlighted [them] and it was very crystal clear, and then the goals were very easy and they were very easy to implement and they made a big impact. (123)

The goal setting sessions helped participants to learn and become clear about their goals and to find ways of measuring and tracking their growth. Participants commented on the benefits of breaking their goals up into small, medium and long terms goals. This made their goals seem more manageable and gave them a sense of autonomy in achieving their goals.

It wasn't just, you know, kind of been dragged along with the flow and whatever. It fell like taking some control and it was a little bit of a realisation that like I knew [it] was all within my own power (123)

That was great because I didn't know how that would be explained as well. But when she went to us, it was crystal clear. And because she kept reiterating so let's just say this is your short term goal, this is your main goal this year long term. And, and then when we went back after two weeks, how did I do and all of that sort of things I thought that was very good.(105)

The coach was able to provide participants with individualised attention and guidance while conducting goal setting and this allowed them to generate goals that were suitable to their individual circumstances at that time.

I just have a lot of different things that really kind of high stress a lot of changes happening in our life … she's (the coach) like look let's just focus on small and medium term goals at the moment (108)

Although participants explained that the goal setting sessions helped them to become more focused and structured in relation to their goals, one participant found this process overwhelming.

I probably found it a little bit overwhelming at the start, because there was probably so much that I wanted to work on a lot more than I needed to work on that I didn't know about. So just trying to have a focus was probably a little bit overwhelming for me. (115)

Participants commented on how the goal setting and review sessions motivated them and gave them a sense of accountability. They reported feeling motivated after their sessions with the coach and that they could harness this motivation towards taking steps to achieve their goals. Working with the coach acted as a catalyst for motivation in the participants and this motivation extended into other aspects of their lives.

yeah honestly, it was like somebody lit a torch in me you know, what’s that when they light, is it torch paper … yes so it has triggered kind of motivation in me that I didn’t have before (122)

Participants who had less engagement with the coach, still commented that working with the coach served as a good reminder to them to continue to work towards their goal.

I did get into a good routine of coming into work that little bit earlier … But of course, it kind of slipped. And so, for the time when there was engagement, no it was it was a good prompt, it was a good prompt. (103)

The coach was a source of accountability for participants. This was particularly the case with the review sessions the coach conducted with participants on a biweekly basis. Review sessions reminded participants of their goals and encouraged them to refocus or keep working towards them.

it was good that they were set and I had to then have a review session, and I had to say, Yes, I have been following and my plan or reach the goals are No, I haven't. And I find that having a check in … basically it wasn't easy [to] just kind of forget. (123)

Participants valued the protected time that the coaching sessions gave them to engage with their goals and review their progress.

I feel like as healthcare workers we don't necessarily slot that time into her own daily life. So, I suppose the fact that it was, there was an hour session on a Monday morning … that you had to look at your goals and how they're doing (115)

Working with the coach helped participants to recognise and celebrate their achievements as they started to reach the goals they set.

it was a win, something that I would have dismissed before, would have been forgotten very quickly (105)

Forward momentum in the pillars of lifestyle medicine

Participants reported positive outcomes and progress following working with their online coach. They perceived improvement in areas including sleep, relationships, sense of meaning and purpose in life, exercise, eating well, along with reduced loneliness and burnout. Seven participants discussed their experience off improved burnout.

[I] compartmentalised work and life; so, [I experienced] less burnout … .. I wasn't just getting stressed about things, and I kind of said I can only do so much, I can't do everything (120)

Positive changes in one of their goals had a knock-on effect on other aspects of participants’ lives. Participants who perceived improvement in their goals related to sleep, exercise or eating well also commented that this improved their experiences in other areas, such as improving their mental health or reducing burnout.

And that just boosted my whole and like my mental health really, much happier than I was … So, [this] absolutely boosted my momentum and I was doing the right things. And it was small changes, small amount of time to make those changes. (123)

Another participant explained that by prioritising their sleep, they were then able to exercise more, which helped them with their stress management. These improvements also influenced their relationships and reduced their feelings of loneliness.

I do have more energy. So I am making more of an effort to meet up with people and, like, do things that I normally wouldn’t have done. So yeah, actually, that's had an impact on loneliness because I'm not as alone (111)

Working with the coach helped participants to take action on goals they had wanted to work towards in the past, when they had not been successful.

even though I was thinking of starting to go for a walk or starting to exercise for a long time … I never started doing it. But, when I made the goal setting with my coach. I started walking for like 30 minutes … because I made a contract with her (the coach). (124)

In addition to participants reporting changes in their behaviour, they also highlighted that working with the coach had changed their attitudes. One participant gave an example of their improved attitude towards sleeping and the way they coped when they were not sleeping.

one of my things was sleep and that has definitely improved … It's how I'm dealing with the panic of not sleeping and stuff like that. (105)

Participants commented that working with the online coach increased their level of self-awareness, made them more aware of their health and focused their attention on the goals they wanted to achieve. This process also increased participants’ self-compassion.

That negative voice has stopped and I think I really attribute that to some of the stuff that was said in the messaging about small wins and taking small changes, day by day and that kind of thing. (122)

Participants commented that they continued to work on their goals, even after they stopped working with their coach online. They expressed a continued sense of awareness and motivation to work towards their goals. One participant explained that they had made their goal part of their daily routine, which suggests that the work they did with the coach will have a long-term impact.

Yeah, so I'm still doing, I suppose I still have the goal; will kind of embed it in my daily routine. (115)

Discussion

The findings presented in this paper highlight that participants can experience an inherently human connection with an online coach using text-based communication. The theme of Human-Centred Conversation illustrated that participants had a strong personal connection with their coach. The theme of Facilitated Awareness, Learning and Growth, outlines how the coach helped participants to identify and prioritise their goals. This supported participants’ sense of motivation and accountability. Lastly, the theme of Forward Momentum in the Pillars of Lifestyle Medicine outlined that, by working with the coach, participants experienced improvements in sleep, relationships, meaning, exercise and eating well, along with reduced loneliness and burnout.

These findings highlight that conducting coaching via a digital platform can facilitate meaningful relationships between coach and client, along with increased awareness, learning and growth that can create forward momentum for wellbeing. Participants’ reports of feeling that they got to know the coach, along with the coach getting to know them, suggests that co-presence was achieved through their text-based communication (Hwang & Park, 2007). Despite previous concerns that conducting coaching online may lead to disconnection, misunderstandings and frustration (Mitchell, 2021), participants in this study reported a sense of personal connection and rapport with their coach. They discussed how this facilitated awareness, learning and growth and helped them to feel motivated and accountable. This reinforces previous findings that participants who worked with human coaches, through digital communication reported feeling that their coaches really cared about them and held them accountable, which motivated and encouraged them (Asri et al., 2020). These findings highlight that it is possible to establish a strong rapport with clients via an online platform.

There were some contrasting findings identified. Some participants found it easy to communicate using the online messages, felt a strong personal connection with their coach and were able to communicate openly. However, others found that the technical aspect of the online text-based communication limited their connection with the coach and made it challenging for them to communicate openly. These participants felt that they would have been able to communicate better with the coach if they had the option to talk to them via a telephone call. The variation seen in participants experiences correspond to the suggestion made by Rehder et al. (2021), that, given the broad number of variables that contribute to burnout among HWs, no single intervention will work to prevent burnout. The coaching intervention described in this study allows for this multifaceted approach and also ensures that the interventions offered, are tailored to the individual needs and goals. Wannheden et al. (2021) found individual differences in participants’ experience of using digital health technologies. They suggested that digital health platforms need to be flexible in order to accommodate for a variety of needs and experiences.

Text-based coaching created motivation and accountability for participants who subsequently started to make changes in their lives, beyond their initial goal. This included changes in attitude and perspective. A similar finding is reflected in participants’ experience of Forward Momentum in the Pillars of Lifestyle Medicine. Anticipated future interaction could have played a role in developing relationships between the coach and participant that supported motivation and accountability. Anticipated future interactions are inherent in face-to-face (FTF) communication as people know they can recognise one another when they meet again (Walther, 1994). When individuals anticipate future interaction, they experience more affection for, similarity to and trust in the person they are communicating with (Walther, 1994). Additionally, they interpret messages more positively, provide more self-disclosures and are more honest, when future interaction is anticipated (Pang et al., 2018). When communicating via text, it is important to make future interaction obvious. Creating an explicit expectation of future interaction is also required to build long-lasting relationships. In this study, this expectation of future interaction was achieved through scheduling regular review sessions and the coach’s ongoing availability to communicate with participants, when needed.

Participants also experienced increased self-awareness and self-compassion, which impacted their experience of overall wellbeing. This is similar to previous studies, which have found that mindfulness and self-reflection practices increases predicted, integrated self-knowledge and self-compassion (Galla, 2016; Viskovich & De George-Walker, 2019). Significantly, a recent study has found that self-compassion can reduce the emotional exhaustion component of burnout (Prudenzi et al., 2022). Similarly, self-compassion training, administered to mental health workers and educators, significantly increased levels of emotional awareness, positive affect, joviality, self-assurance, attentiveness and serenity (Milicevic et al., 2016). It has been suggested that heightened self-awareness during CMC is created by the lower cognitive load demands in CMC, compared to FTF interactions, which involve visual processing and more behavioural emotional management (Sassenberg et al., 2005). Within CMC there are more cognitive resources available for participants to direct towards processing their own thoughts and desires. This cultivates more self-awareness within the conversation (Okdie et al., 2011).

Participants had a sense of autonomy over the goals they set and felt that the coach was supporting them rather than telling them what to do. Autonomy is one of the three basic psychological needs that explain intrinsic motivation and plays an important role in human–computer interaction and digital health technologies (Ryan & Deci, 2000). Previous studies have highlighted that autonomy can be cultivated on online platforms by offering options for tailored support (Przybylski et al., 2010), providing personalised feedback, directing messages to individuals’ needs and allowing individuals to set their own goals (Schwarz et al., 2020). These characteristics were incorporated into the goal setting process and likely cultivated a sense of autonomy and ownership by participants as they journey through the coaching process.

Findings highlight that the process used to set goals with participants was impactful and effective. Participants found the process clear, easy to follow and beneficial in helping them to start making changes to their lifestyle. This is in line with research by Grant (2020) which suggests that a goal-focused coaching style facilitates goal attainment and allows the coach to work more efficiently with their clients, helping them to achieve insight and behavioural change to enhance their personal wellbeing and sense of self. Our findings contrast with claims that goal-focused coaching can constrict the coaching conversation (Clutterbuck, 2010). In fact, participants reported a sense of ownership over their goals and had the flexibility to alter and change their focus, according to their needs at different stages of the process. Participants also highlighted that the goal-setting process produced positive changes to other aspects of their lives, outside of the specific goals they set.

Strengths and limitations

The findings of this research are strengthened by the use of double coding from a total of three researchers. The goal of using multiple researchers was not to provide a more valid, singular truth but instead to facilitate the identification and exploration of different facets of the data and the research questions that help map out why the themes are important. This approach to double coding is known as ‘crystallisation’ (Tracy, 2010). The goal of crystallisation is not to provide a more valid, singular truth but to identify, explore and understand the different facets and complexities of research questions and participants experiences (Tracy, 2010). It was used throughout the analysis process to challenge the researcher’s perceptions and ideas about the data and to develop a more complex and in-depth understanding of participants’ experiences.

A small number of hospital workers based in Ireland took part in this study and this limits the generalisability of our findings. While a diverse sample of professions (participant role) were recruited, all participants were female. This reflects the gender balance within the Coach Connect project, which only had two male participants in total. This may reflect a broader issue of poor engagement from males in digital health interventions and a need to encourage male healthcare professionals to take part in wellbeing interventions such as Coach Connect. To address these issues related to generalisability, we provide a detailed description of the findings in order to allow readers to determine whether they are generalisable and applicable to other settings and populations (Tracy, 2010).

Implications and future research

Findings highlight the benefits of offering participants a tailored approach to working with their coach online. They reported that the goal-setting process was easily adaptable to their individual needs, which made them feel more in control of their goals. This tailored approach could be extended in future research to examine the feasibility of using a hybrid approach that would offer participants the option to communicate with a coach about their goal via telephone call, as well as text messages. This would offer an alternative approach to participants who felt uncomfortable using text messages and ensure that the coaching being delivered is tailored to the needs of all participants. This also represents an opportunity to examine any changes in participants experiences and outcomes (such as wellbeing and burnout measures) when engaging with the coach via telephone call.

Conclusion

This qualitative study has explored the experiences of HWs while working with a pilot human coach via a digital support platform, targeted at improving wellbeing and mitigating burnout. Findings highlight that coaching via an on online platform can produce positive changes for HWs. These benefits extend beyond achieving individual goals related to improving lifestyle. Positive changes also occurred in participants’ attitudes to self, including increased self-awareness and self-compassion, which added to their perception of enhanced overall wellbeing.

Ethical approval (IRB 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. JD, LMC and RK conducted data collection. JD and LMC contributed to data analysis. CL was involved in study design and delivery. DK, GO and AS were involved in study design and content development. GO supported recruitment at Beaumont Hospital Dublin. 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); 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).

Disclosure statement

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.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author [ROD]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Additional information

Funding

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