Health Coaching: A Model for Enhancing Quality of Life

Coaching, designed as a support process aimed at achieving personal and professional goals, is gaining increasing relevance in the context of health and well-being. By integrating motivational and behavioral techniques, coaching can have a significant impact on various aspects such as physical activity, stress management, and self-esteem building, all of which play a central role in promoting a healthy and fulfilling lifestyle. When coaching is specifically applied to health management, it is referred to as Health Coaching. 

Health coaching is based on the assumption that individuals possess internal resources to address health-related challenges, and its primary role is to support individuals in achieving their health goals through non-judgmental, solution-focused, and person-centered conversations [1]. This approach helps individuals develop greater self-efficacy and intrinsic motivation, essential tools for managing daily challenges and reaching their goals, thereby contributing to improved psychological well-being and quality of life.

The integration of health coaching with the improvement of psychological well-being, self-esteem, and quality of life has been the subject of numerous studies, highlighting the effectiveness of this approach in fostering positive changes in health-related behaviors and enhancing individuals' psychological conditions.

Studies such as those by Scully et al. [2] and Rebar et al. [3] confirm that regular physical activity plays a crucial role in improving self-esteem, managing stress, and preventing depression. In fact, physical exercise has been associated with increased self-esteem levels, a reduction in symptoms of anxiety and depression, and an overall improvement in quality of life. Specifically, Rebar et al. [3] emphasize that physical activity is positively correlated with self-efficacy, enhancing not only physical health but also mental and psychological well-being.

The relationship between stress and physical activity is equally significant. Physical activity is considered one of the most effective strategies for stress management, as it helps reduce perceived stress levels and improves mood [4]. In this context, health coaching proves to be particularly valuable, as it can facilitate the adoption and maintenance of a regular exercise regimen by overcoming the psychological and physical barriers that often hinder engagement in physical activity.

Moreover, health coaching not only promotes physical activity but can also integrate practices such as mindfulness and other relaxation techniques to enhance stress management [5]. These techniques are increasingly incorporated into coaching programs to improve emotional awareness and psychological regulation, fostering overall well-being. The combination of mindfulness and coaching has been shown to lead to a significant reduction in stress and an overall improvement in quality of life, as demonstrated by Chiesa and Serretti [5].

The literature also explores the connection between health coaching and chronic diseases management. Studies such as that by Anderson & Carter [6] suggest that coaching can be particularly effective in improving adherence to treatment programs for chronic illnesses, thereby enhancing patient satisfaction and psychological well-being. Moreover, the adoption of healthy behaviors, such as regular physical activity, can contribute to the improvement of both physical and psychological conditions, increasing self-efficacy and overall quality of life.

In summary, the integration of health coaching with physical activity, stress management, and self-esteem enhancement, represents a powerful and holistic approach to improve quality of life. The effectiveness of this approach is rooted in the personalization of interventions tailored to individual needs, as well as in the use of motivational techniques that encourage sustainable behavioral changes. Findings suggest that health coaching not only promotes better physical health but also supports a psychological transformation that leads to a healthier, more fulfilling, and resilient life.

Based on the defined premises, an observational study was conducted with the aim of measuring the effectiveness of the Mastercap program in terms of psycho-physical-emotional well-being of enrolled students. The objective is to enable them to perceive the tangible benefits gained in terms of well-being improvement and stress reduction, as well as to assess all the outcomes achieved at the end of the program. 

The Mastercap program is a true transformational journey, structured around theoretical and practical lessons covering a range of disciplines, from coaching and NLP to neuroscience, epigenetics, and PNEI  (Psychoneuroendocrinoimmunology), as well as topics related to a healthy lifestyle. Participants in the program are supported by a dedicated Health Coach who guides them through the transformation process, along with experts in nutrition, physical activity, and medical professionals.

The objective of the study is to assess the effectiveness of Health Coaching (HC) in a group of individuals who have participated in a dedicated HC program lasting 10 months.

A prospective pre-post observational study was conducted to evaluate the effectiveness of the HC program, assessing the following indicators:

1. Self-Esteem
2. Perceived Stress
3. Psychological Well-Being
4. Quality of Life
5. Sleep Quality
6. Wheel of "Second-Level Needs": This tool measures the perception of second-level needs, including security and control, self-love and being loved, creativity and productivity, freedom and variety, experiencing pleasure, and self-affirmation and recognition.
7. Wheel of the "5 A’s": Love, Attitude, Training, Nutrition, and Allies/Environment.
8. Wheels of Life Domains.

These variables were measured using validated tools or specifically developed instruments by researchers to ensure a comprehensive assessment. 

The tools used are: 

Self-Esteem: To assess self-esteem perception, the Italian version of the Rosenberg Self-Esteem Scale [7] was used. This scale consists of 10 items rated on a 4-point Likert scale (0 = Strongly Disagree – 3 = Strongly Agree). In our study, the scale demonstrated good reliability (Cronbach’s α = .865).

Perceived Stress: To evaluate stress levels, the Perceived Stress Scale (8) was administered in its Italian translation (edited by A. Fossati, Università Vita-Salute San Raffaele, Milan). It consists of 10 items rated on a 5-point Likert scale (0 = Never – 4 = Very Often). In our study, the scale demonstrated good reliability (Cronbach’s α = .875). 

Psychological Well-Being: To assess overall psychological well-being, the Italian version of The Psychological General Well-Being Index (PGWBI) (9) was used. This scale comprises 22 items rated on a 6-point Likert scale (0 = Never – 5 = Always). In our study, the scale demonstrated good reliability (Cronbach’s α = .861). 

Quality of Life: To assess quality of life, the WHOQOL-BREF (10) was used. This instrument consists of 24 items divided into four main domains, each focusing on a specific aspect of quality of life: 

• Physical Domain (7 items): Evaluates the perception of physical health and bodily well-being, including the ability to perform daily activities, presence of pain, rest and sleep quality, energy levels, etc.
• Psychological Domain (6 items): Assesses mental and emotional well-being as well as overall psychological health, focusing on aspects such as life satisfaction, self-esteem, mood, and stress levels.
• Social Domain (3 items): Examines the quality of interpersonal and social relationships, interactions with family, friends, and the community, and the perception of social support.
• Environmental Domain (8 items): Analyzes the external context in which a person lives, including environmental conditions, safety, access to financial resources, healthcare services, and opportunities for leisure and cultural activities.Respondents rated their experiences on 5-point Likert scales (e.g., 1 = Not at all – 5 = Very much, or 1 = Very dissatisfied – 5 = Very satisfied). In our study, the total index was used, demonstrating good reliability (Cronbach’s α = .821). 

Sleep Quality Measured using the Pittsburgh Sleep Quality Index (PSQI) (11). This scale consists of 19 items assessing subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of hypnotic medications, and daytime dysfunction. The PSQI evaluates sleep patterns over the past month. In our study, the scale demonstrated good reliability (Cronbach’s α = .821). 

Needs, Secondary Needs, and the 5 A’s: To assess the perception of these factors, researchers developed custom-designed wheels. The wheel is a tool commonly used in coaching that allows one to reach the core aspects of an individual's life within minutes. It is a pie chart representing the student’s life, divided into segments based on the most significant domains. 

To evaluate the reliability of the scales, exploratory factor analyses were conducted using principal component analysis, considering only factors with eigenvalues greater than 1. Preliminary tests were performed for all the wheels, including the Kaiser-Meyer-Olkin (KMO) test and Bartlett’s test of sphericity. The KMO values were .788, .850, and .921 for the 5 A’s Wheel, the Wheel of Life, and the Needs Wheel, respectively, indicating the adequacy of the correlation matrices. Bartlett’s test of sphericity yielded values of <.05 for all three wheels, confirming the suitability of the factor analysis.

For the Wheel of Life (10 items), the explained variance was 60% with a single factor, and Cronbach’s alpha was .882.
For the Needs Wheel (7 items), the explained variance was 66% with a single factor, and Cronbach’s alpha was .914.
For the 5 A’s Wheel (5 items), the explained variance was 63% with a single factor, and Cronbach’s alpha was .855.

The convenience sample consists of first- and second-year participants of the Mastercap program who voluntarily agreed to participate in data collection.

Both descriptive analyses and statistical tests were conducted to assess the significance of differences between pre- and post-values of the measured variables.

To evaluate the reliability of the validated scales, Cronbach’s alpha was calculated, while exploratory factor analyses were performed for the wheel-based scales.

The Kolmogorov-Smirnov test was used to assess whether the samples followed a normal distribution. The test yielded significant values (<.05) for the variables WHOQOL, Stress, Self-Esteem, and Sleep Quality, as well as for the Wheels of Life, Needs, and the 5 A’s, indicating a non-normal distribution. Conversely, the test returned a non-significant value (p = .200) for the variable Well-Being, which was therefore considered normally distributed.

Therefore, two types of tests were used to determine whether the mean differences of the variables were statistically significant:

• A non-parametric test for related samples (Wilcoxon test)for variables without a normal distribution;
• A parametric test for related samples (t-test)for variables with a normal distribution.

Additionally, correlation analyses were conducted among certain continuous variables using Spearman’s R model. Only significant correlations with a coefficient above 30 were considered [7].

The sample consisted of 149 individuals who participated in the HC project.

Females represented 65.8% (n = 98) of the sample. Regarding age, the sample had a mean of 41.95 years (SD = 14.508). Concerning educational level, 43% (n = 64) reported holding a high school diploma, while a similar percentage (43.6%, n = 65) held a university degree. Additionally, 12.8% (n = 19) reported having a lower secondary school diploma, and only one participant (0.7%) reported holding an elementary school certificate [Tables 1-3].

The following tables present the pre- and post-intervention values recorded for each investigated variable.

Table 1: Values of the Variables. 

The tables below present the data for the variables, considering the differences between post- and pre-measurements, along with the corresponding statistical significance values.

Table 2: Differences in Pre-Post Variable Values and Corresponding Statistical Data (Variables with Non-Normal Distribution).

1. Wilcoxon Signed-Rank Test
2. Based on negative ranks
3. Based on positive ranks

Table 3: Difference in Pre-Post Variable Values and Corresponding Statistical Data (Variables with Normal Distribution).

The findings of our study provide a significant contribution to understanding the effectiveness of health coaching in enhancing participants' psychophysical well-being. The observed increase in self-esteem aligns with existing literature, which highlights that the adoption of healthy behaviors and participation in coaching programs can foster an improved self-perception and sense of personal efficacy [8].

Furthermore, the significant reduction in perceived stress confirms that the coping strategies acquired during the HC program can be effective in managing daily challenges. Stress management through physical activity, mindfulness, and coaching not only lowers anxiety levels but also promotes an overall improvement in mood and quality of life, suggesting a positive interaction between physical activity and psychological well-being [9,10].

The improvement in sleep quality observed among participants represents an additional positive indicator. The relationship between psychological well-being and sleep quality is complex; however, the findings suggest that the development of awareness and the relaxation techniques learned through health coaching may play a crucial role in promoting restorative and regenerative sleep [11].

Regarding the analyzed sample, the predominance of female participants and the age distribution suggest that our intervention echoed particularly with a specific group, highlighting the need to tailor future interventions to diverse demographic categories to maximize the effectiveness of health coaching. Additionally, the significant variations observed in the "Wheels of Life," "Needs," and "5 A’s" underscore the importance of adopting a systemic approach to health coaching—one that considers not only individual well-being but also interpersonal relationships and the broader environment.

Finally, the positive findings highlight the importance of further longitudinal studies to examine the long-term effects of health coaching. The limitations of our study include its observational nature and the absence of a control group, which may affect the generalizability of the results.

In conclusion, the data-driven findings suggest that the Mastercap program may act as an effective strategy not only for improving physical health but also for fostering psychological transformation toward a healthier, more fulfilling, and resilient life. The personalization of the intervention and the person-centered approach may prove to be essential tools for addressing personal well-being challenges, highlighting the potential of health coaching as an innovative therapeutic intervention. The data indicate an improvement in all assessed variables, with statistically significant differences across all measures.

We would like to thank all the Health Coaches who contributed to the realization of the project, the organizational secretariat of the health coaching Academy (Lucia Pieroni and Pamela Corbara) and all the students who took part in the study contributing to the scientific research.

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