To our knowledge, this is the first published account of a systematic approach to identify and validate the competencies needed for coaches who are leading GHWC in a variety of settings. Using well-established industry processes, this competency set is strongly validated. This delineation of group coaching competencies allows us to create an accurate and valid certification examination that evaluates the process for GHWC. [19, 25]
Well-accepted criteria for task acceptance includes mean Importance ratings ranging from 2.0 (lenient) to 3.0 (rigorous). [19, 25] All but five of the 77 proposed competencies achieved a 3.0 or higher and merit inclusion in relevant certification exam specifications. All five that are not included in our finalized set of competencies were related to the degree to which the faciliator(s) promotes the sharing of contact information among group members, openly discusses communication preferences between sessions and promotes resources sharing among participants between sessions. While these competencies can be used in GHWC, results of the validation study demonstrate they are not necessary. Hence, these competencies will not be expected of all coaches facilitating HWC groups.
The validated competency set has 72 specific competencies, with 36% falling into the structure domain and 64% falling into the processes domain. Competencies that were most highly weighted (≥ 0.9) tended to relate to the creation of a safe space, respecting individual differences and cultivating an inclusive community, as well as encouraging authenticity and empathy.
The response rate to the validation survey of 12.7% falls within the recommended range of 10–20%. [23, 24] Of those who did not complete the survey (49% of those who responded) may not have met the eligibility criteria, as the first part of the survey determined eligibility. While we recognized the potential of lower response rates given the survey design, we determined it most important to include those with adequate and recent experience to provide validation to the current field. The validation sample was diverse in terms of sociodemographics, age and practice settings, lending generalizability to our findings in many respects. While the validation sample was highly educated, largely female, and 92% White, no solid sociodemographic data has been published for the field for comparison.
In our identification of the GWHC competencies, foundational assumptions were made. First and foremost was that these group coaching competencies are built upon the individual HWC competencies previously defined and validated by the NBHWC [13, 14], and ideally used by coaches who are board-eligible or National Board Certified Health and Wellness Coaches (e.g., NBC-HWCs). Therefore, these competencies articulate only those aspects of expertise that are unique to the group setting, assuming individual coaching competency first.
While differing settings, obejctives, and participants may influence the flavor of any particular group coaching offering, the core definition of individual health coaching must hold:
A patient-centered approach wherein patients at least partially determine their goals, use self-discovery or active learning processes together with content education to work toward their goals, and self-monitor behaviors to increase accountability, all within the context of an interpersonal relationship with a coach. The coach is a health care professional trained in behavior change theory, motivational strategies, and communication techniques, which are used to assist patients to develop intrinsic
motivation and obtain skills to create sustainable change for improved health and well-being. [26]
In GHWC sessions, participants often receive brief periods of individualized coaching from the facilitating coach. Such brief, one-on-one encounters provide rich opportunities for other group members through vicarious learning as they discover relatable benefits for their own well-being. In addition, the group members learn to “provide encouragement/affirmation, focus on positive progress, take a nonjudgmental stance throughout the exploration, build rapport, and listen reflectively.”[27] A distinguishing characteristic of GHWC is that group members learn how to effectively support each other using key HWC communication skills as modelled and shaped by the coach.. For example, an individual participant is likely to receive genuine affirmations of their efforts, charactersitics and skills from other group members rather than, or in addition to, receiving such from the coach facilitator. Similarly, brainstorming potential solutions or next steps for an individual participant in GHWC draws ideas from multiple group members (versus only client and coach) while the individual still makes the autonomous choice of what to try next. Group members may also learn, following the modelling of the coach, how to elicit deeper reflection on each others’ actions and choices through the appropriate use of powerful questioning. As a final example, accountability agreements are typically co-created between individual members and their group, building upon the trust and support from within the group. As group members apply their learning from the group in their lives, sharing their success and challenges with their peers is especially powerful. These points taken together, the group facilitator not only needs strong individual coaching skills, but needs equally effective group facilitation skills.
We propose that GHWC competencies include the ability to manage group dynamics, build group cohesiveness, facilitate group discussions, provide a psychologically safe environment for all participants, and leverage the power of the group to enhance behavioral change. Hence, we chose to define GHWC as consisting of a committed small group (≤ 12) that meets at least four times. This decision was made to ensure that the competencies could build upon the peer-reviewed literature in terms of what is known about group process. For example, the competencies are designed to parallel the well-established evolution of group dynamics (e.g., forming, storming, norming and performing,[28] with the later addition of adjourning [29]) which have been generalized to coaching .[30] In GHWC, participants become a member of a type of community, which the coach cultivates to enhance self-directed behavioral change.[31] It is well established that social belonging in and of itself has the power to catalyze meaningful behavior changes.[32] The coach’s skillful use of the group as community is a large part of what differentiates group coaching from other types of groups more typically observed in healthcare such as drop-in support groups and/or education-based programs. While these group types afford individuals the opportunity to form their own supportive connections, they do not intentionally cultivate the group processes that so powerfully impact self-directed health behavior change.
In presenting the competencies for GHWC, we would like to acknowledge the significant overlap in structure and approach with Motivational Interviewing (MI) in Groups. MI is one of the foundations of HWC [33] and hence MI in Groups is directly applicable. However, MI in Groups often focuses on treatment (i.e., of substance abuse) rather than coaching alone and is often led by clinicians. [34] Additional competencies are necessary for treatment groups.
Group facilitation skills play a seminal role in the GHWC competencies, as they do in other types of groups, including leadership development, team building, addiction recovery, disease management, mental health, peer support, and health education groups.[8] While the GHWC competency set includes the critical shared qualities of leading effective groups in general, it also highlights the knowledge and skills that differentiate it.. At the core, GHWC is about enhancing both the group process and coaching skills to assist individuals to maximize health and well-being through self-directed behavioral change. By comparison, in team coaching, the improved functioning of the team for a common purpose is the goal of the intervention.[31] In group leadership coaching, optimizing the ability of an individual to lead teams or organizations is the primary desired outcome and the focus of the coaching.[8] While participant education may play a part in GHWC group, education is not the primary intent. This is in juxtaposition to a group which may use some coaching principles, but which primarily targets the increased knowledge base of the participants. HWC groups can integrate an educational section with the topic chosen by the participants, as a way to meet needs and catalyze interest in the group. For individual HWC sessions, keeping the educational portion of each session at at 25% or less is an NBHWCguideline designed to keep the focus on actual behavioral change.
Strengths and Limitations
This delineation of group coaching has both strengths and limitations. First, the decision to build the group competency set on top of individual coaching skills previously defined by the NBHWC allowed for clear focus on how coaches enhance and utilize the group process. However, that decision also limits generalizability to those who have already demonstrated their competency as individual coaches per the national board certification exam. Second, because the demographic and practice data survey in the validation study was sent separately from the validation ratings survey, we can not be sure that the subset of individuals who provided their personal data are the same as those who rated the competencies. We do know that 43% of those who opened the actual surveys provided personal data and that 43% of the same pool provided validation ratings. Finally, the limited racial and gender diversity of the original SME panel also limits external validity. That said, this concern is somewhat mitigated by slightly better diversity in the larger validation group, but would best be repeated in a more heterogeneous sample. It is not clear however, what would be a representative sample from the overall field of HWC.