The aim of the present study was to investigate the formation and development of networks of lifestyle coaches during the study period. Since their role is relatively new, to our knowledge the development of health care networks around lifestyle coaches and the coaches’ coordinating role in these networks have not previously been studied. Since the Coaching on Lifestyle (CooL) intervention is a new intervention, the networks had not yet been formed around the lifestyle coaches. Because it is assumed that lifestyle coaches may be the linchpin in obesity care networks, it was expected that the lifestyle coaches would evolve towards a more central position in their networks during the study pilot.
The CooL intervention was executed by lifestyle coaches in two regions for adults (Regions 1 and 2) and in two regions for children (Regions 3 and 4). In the network of Region 1, the organisations collaborated less with others and the network was modestly centralised and not dense. The lifestyle coaches achieved more collaborations and a more central position over time. They were increasingly positioned as liaison brokers. The sector of the lifestyle coaches occupied a relatively central position in the network only at T2. That the professionals collaborate less with each other over time can be explained by the fact that the CooL pilot started with a small number of referrers in this region. This was later expanded to more referrers from which to receive more referrals. The first group of referrers remained active collaborators in the network. Furthermore, professionals in this region wanted to implement the children’s programme, which led to incorporation of new sectors.
In the network of Region 2, the organisations collaborated less with others and the network was modestly centralised and not dense. One of the lifestyle coaches had a high number of collaborations and had a central position. The lifestyle coaches strongly increased their role as consultants and their role as gatekeeper and liaison decreased slightly. The sector of the lifestyle coaches acquired a crucial place within the network over time, but later they occupied a central position together with the local sports organisation.
In the network of Region 3, the organisations collaborated less with others and the network was highly centralised and not dense. One of the lifestyle coaches gained more and closer collaborations with other professionals over time. The lifestyle coaches strongly increased their role as consultants and their role as gatekeeper and liaison decreased. The sector of the lifestyle coaches also fulfilled a quite central role in the network. However, at the start, the PHS occupied this central position and at T2 a star figure had been formed with the PHS and YHC as central organisations. Due to its central network and the role of the lifestyle coaches, this region came closest to the expected development.
In the network of Region 4, the organisations collaborated less with others and the network was low centralised and not dense. The lifestyle coaches were not active and their number of collaborations decreased over time. They had very low involvement in the brokerage roles. The sector of the lifestyle coaches only had a relatively central position in the network at T0. At T1, the PHS together with the municipal government seemed to be more central and at T2 the municipal government was the only central sector. These results can be explained by the fact that the lifestyle coaches were not active and did not invest in their network.
The observations during the study period [5] and the results of this network analysis are in line with each other. The central lifestyle coaches with a brokering role performed more entrepreneurial activities, which indicates that these activities are key for playing a central role in the network. In addition, some lifestyle coaches were less present in the network due to their personal situation or work situation.
Lifestyle coaches are seen as linchpins (i.e. having a central and connecting role) in the prevention and health care networks [18]. Fulfilling their linchpin role demanded entrepreneurial activities, and networking and brokering skills. However, it was observed in this study that the lifestyle coaches took up and developed this central role to a lesser degree than expected. A previous study showed that the CooL lifestyle coaches evaluated entrepreneurship as their least strong competence, while they also rated it the least important competence to have as a lifestyle coach [5]. This may partly be due to the fact that the lifestyle coach is a relatively new profession in the Netherlands and that training programmes focussed on coaching skills and did not take into account these more entrepreneurial competences. Only a few lifestyle coaches in the CooL pilot had a natural aptitude for this competence. This was observed in a previous study [18], but it was also evident in this study. Today, most training programmes for lifestyle coaches have integrated entrepreneurship into their programmes. A new study should investigate whether lifestyle coaches currently have more entrepreneurial, networking and brokering skills.
Building up and maintaining a dense network requires entrepreneurial, network and brokering skills, which include taking risks, looking for new opportunities, starting and maintaining relationships, connecting professionals, and combining knowledge [19, 20]. Research has also demonstrated that brokering professionals can use a personal approach to create a shared interest and build trust [21, 22]. Trust among stakeholders has been shown to be essential for building sustainable relationships [21–24]. Where collaborations already exist, trust is more likely to be built up. Therefore, relationships are better and more trust is built up when a professional has a more central position in a dense network [20, 25, 26]. However, building trust takes time and takes place throughout the collaboration process [27].
Another interesting observation in this study is that the central position was shared with other sectors (i.e. local sports organisation, PHS, YHC and the municipal government). From observations in the regions, we assumed that the other sectors had their own connectors and that these connectors knew where to find each other. This can become an ideal situation, in which the professional with the most entrepreneurial competences in their sector is the connector and that these connectors form a strong connection with each other. In this way, intersectoral collaboration can be increased and led by enthusiastic connectors.
Strengths and limitations
This is the first network analysis of the development of health care networks around lifestyle coaches and the coaches’ coordinating role in these networks. The strengths of this study include its longitudinal design and the comparison between different regions. Furthermore, this study started at the beginning of the intervention’s implementation phase, resulting in a good overview of how the networks developed over time when disseminating an intervention.
Being the first to perform this kind of research is also a limitation due to a missing frame of reference. Another limitation was having a lot of missing values. On average, 37.4% of the professionals did not fill in the questionnaire per measurement per region. To reduce the number of missing values, we assumed that there was a mutual collaboration if either one of the two professionals indicated collaborating with the other. This method can be used for up to 40% missing data [28]. Furthermore, since the child regions started implementation at a later stage, the period between baseline and T1 measurement differed for the adult and child regions. This allowed lifestyle coaches in child regions less time to build up their network. This can also lead to biased results as the lifestyle coaches in the adult region had a longer period to build up their networks, but we took this into account when we interpreted the results. This situation is typical when implementing an intervention. Finally, we studied four single regions within a pilot, therefore we cannot generalize these findings to other networks or situations. Despite these limitations, the study reveals initial insights in how networks around lifestyle coaches in obesity care networks develop.