Personal Health Behaviors and Lifestyles
A college student says they do not exercise because their neighborhood does not have sidewalks or safe outdoor spaces. What type of barrier to health behavior change is this?
Environmental barrier — the physical surroundings and built environment make healthy behavior harder; this is not an individual level barrier but a structural one that exists outside the person
A client says: "I've been going to the gym three times a week for the past two months and I feel so much better — I just need to figure out how to keep it going when things get busy." What stage is this client in?
Action
A client says they want to eat healthier. The coach responds: "Great — I've put together a meal plan for you that should help you hit your nutrition goals." Is this person-centered or expert-centered?
Expert-centered — the coach immediately prescribes a solution without asking the client anything about their life, preferences, or what healthy eating means to them personally
A client who relapses after six months of behavior change is back to square one in the precontemplation stage.
False — relapse does not automatically send a client back to precontemplation; many relapsing clients remain in contemplation or preparation and the experience of relapse often provides important information about barriers and triggers
A client in precontemplation says: "I don't think my weight is really a problem." The coach responds: "Actually, your BMI indicates you are in the obese range and that puts you at serious risk for diabetes and heart disease." Is this an appropriate coach response?
No — this is the righting reflex in action; the coach is arguing for change and presenting unsolicited health information which will likely increase the client's defensiveness and resistance; a more appropriate response would acknowledge the client's perspective with curiosity and build rapport without pushing
What are the eight dimensions of wellness covered in the Wellness Wheel?
Physical, emotional, social, intellectual, occupational, spiritual, environmental, and financial
A client says: "My doctor keeps telling me I need to exercise more but honestly I feel fine. I don't really see why it's such a big deal." What stage is this client in?
Precontemplation
A client comes in unsure of what to focus on today. The coach responds: "We have some time together — what feels most important to you to talk about today?" Is this person-centered or expert-centered?
Person-centered — the coach invites the client to set the agenda collaboratively rather than assuming what the session should focus on
The action stage is the most important stage because it is when real behavior change is happening.
False — all stages are equally important; without successfully moving through precontemplation, contemplation, and preparation, action is rarely sustained; and without maintenance, action stage gains are often lost
A client in contemplation says: "I've been thinking about quitting smoking but I'm not sure I'm ready." The coach responds: "It sounds like part of you is considering this even if another part is not quite there yet — what makes you say you've been thinking about it?" Is this an appropriate coach response?
Yes — the coach reflects the client's ambivalence without taking sides and uses an open-ended elaborating question to invite the client to share more; this is a person-centered response that honors where the client is without pushing
What is the intention-behavior gap and why does it matter for health coaching?
The intention-behavior gap is the space between wanting to change a behavior and actually changing it; it matters for health coaching because it explains why knowledge and motivation alone are not enough to produce lasting behavior change
A client says: "I know I should quit smoking — I really do. But I also love it and I'm not sure I'm ready to give it up. Some days I think I will and other days I think I won't." What stage is this client in?
Contemplation
A client in the action stage misses their exercise goal for an entire week due to a family emergency. They come in feeling guilty and discouraged. What is the MOST person-centered coach response?
Normalize the setback, affirm that one difficult week does not erase two months of consistent effort, explore what happened with curiosity rather than disappointment, revise the plan collaboratively, and develop a specific if-then plan for managing future high-risk situations
A client can be in different stages of change for different health behaviors at the same time.
True — a client might be in action for physical activity, contemplation for diet changes, and precontemplation for reducing alcohol use all at the same time; stage of change is behavior-specific, not a general characteristic of the person
A client in preparation says: "I've decided I want to start eating better and I've already cleared out my pantry." The coach responds: "That's great — now let's also work on your exercise habits, your sleep, and your stress levels while we're at it." Is this an appropriate coach response?
No — while the coach's enthusiasm is understandable, trying to address multiple behavior changes at once is overwhelming and reduces the likelihood of success on any of them; the coach should affirm the steps already taken and focus on one realistic goal at a time
According to research, intentions only explain approximately what percentage of actual behavior change, and what does this tell us about the role of a health coach?
Approximately 18 to 23% — this tells us that the vast majority of what determines whether someone actually changes their behavior has nothing to do with how much they intend to; a health coach's role is to address the other factors that influence behavior including confidence, environment, social support, and barriers
A client says: "I've already cut back on soda this week and I signed up for a yoga class that starts next Monday. I feel like I'm finally ready to really commit to this." What stage is this client in and what specific language tells you that?
Preparation — the client has already taken concrete steps (cut back on soda, signed up for yoga) and has a specific plan for the near future; language like "already," "signed up," and "finally ready to commit" all signal preparation rather than contemplation
A client with diabetes says they have not been taking their medication consistently. The coach responds: "That is really important for me to understand — what gets in the way of taking it?" Is this person-centered or expert-centered and what makes this response effective?
Person-centered — rather than warning the client about the consequences of non-adherence or prescribing a reminder system, the coach responds with a simple open-ended question that invites the client to identify the barrier themselves; the phrasing assumes there is a reason rather than a character flaw
If a client is in the preparation stage, the most effective coaching approach is to immediately develop a detailed action plan covering all of their health behavior goals at once.
False — even in preparation, the coach should focus on one realistic goal at a time; trying to address all health behaviors simultaneously overwhelms the client and reduces the likelihood of success on any of them
A client in the action stage says: "I've been exercising three times a week for two months but I missed all my workouts last week because work was crazy." The coach responds: "Missing a full week is a real setback — let's make sure that doesn't happen again by adding more accountability to your plan." Is this an appropriate coach response?
No — the coach is treating the setback as a crisis and placing blame rather than normalizing and exploring with curiosity; a more appropriate response would affirm the two months of consistent effort, normalize the difficult week, explore what happened with genuine curiosity, and collaboratively develop a plan for managing high-stress weeks in the future
A client tells their health coach: "I know I should eat better but healthy food is too expensive, my family always eats together and I don't want to be different, and honestly I just don't have the energy after work to cook." Identify which type of factor each barrier belongs to.
"Healthy food is too expensive" is an environmental and systemic barrier — cost and food access are structural constraints.
"My family always eats together and I don't want to be different" is an interpersonal barrier — family norms and social dynamics influence behavior.
"I don't have the energy after work to cook" is an intrapersonal barrier — fatigue and competing demands affect self-regulation.
A client says: "I quit drinking fourteen months ago after trying for years. I still think about it sometimes when I'm stressed but I have a plan for those moments and it works. Last month I went to a work event where everyone was drinking and I got through it." What stage is this client in and what would you NOT do as their coach in the next session?
Maintenance — the client has sustained the change for fourteen months, well past the six month threshold, and has developed effective coping strategies. The coach should NOT withdraw support or assume the work is done; maintenance stage clients still need ongoing support focused on relapse prevention and managing high-risk situations
A client says: "I know I should exercise more but I just can't seem to make it happen." Coach A responds: "You really need to get at least 150 minutes of cardio per week — I'd suggest starting with walking 30 minutes every day." Coach B responds: "It sounds like part of you really wants this even though something keeps getting in the way — tell me more about what that has been like." Which coach is using a person-centered approach, which is using an expert approach, and what is the specific impact of each response likely to be on the client?
Coach A is using the expert model — they jump immediately to prescribing a solution without understanding the client's situation, which is likely to produce defensiveness or shallow compliance. Coach B is using a person-centered approach — they reflect the client's ambivalence and invite them to share more, which is likely to produce openness, more honest sharing, and naturally elicit the client's own reasons for change
The Transtheoretical Model suggests that the best predictor of whether a client will successfully change a behavior is how motivated they feel at the start of coaching.
False — the TTM suggests that stage of change, not motivation alone, is the best predictor of behavior change success; a highly motivated client in precontemplation is less likely to change than a moderately motivated client in preparation; matching the coaching approach to the client's stage is more important than the client's level of motivation
A client in the maintenance stage says: "I've been smoke-free for eight months and I feel amazing — I think I've got this under control now." The coach responds: "That is incredible and you should be so proud. Since things are going so well I think we can wrap up our sessions — you clearly don't need coaching anymore." Is this an appropriate coach response?
No — while the affirmation is appropriate, withdrawing support entirely because a client is doing well in maintenance is premature and risky; maintenance stage clients still benefit from ongoing support focused on relapse prevention, managing high-risk situations, and sustaining long-term change; the coach should celebrate the progress while continuing to provide support