The Health Promotion and Wellness course faculty instructed first-semester accelerated Bachelor of Science in Nursing students to create an 8-week health education program for employees of a local career rehabilitation organization. The learning objectives for the students were to (a) create an evidence-based nutritional program consistent with health promotion theory and (b) utilize motivational interviewing techniques to engage participants of the program in health promotion activities.
Based on the components of the Health Belief, Ecological, and Transtheoretical Health Promotion Models, as well as the United States Department of Agriculture website ( https://www.choosemyplate.gov/), the students created a program called the “Wellness Challenge.” Over 8 weeks, a total of 66 accelerated Bachelor of Science in Nursing students in groups of eight to 10 provided health coaching and program monitoring for the participants in the Wellness Challenge Program. The same clinical instructor supervised the experience; however, each week, a different group of students rotated through the site.
The Wellness Challenge was promoted by the organization's production supervisor, and 30 employees voluntarily signed up to participate. The participants ranged in age from 24 to 57 years. The distribution of men and women was nearly equal. During one-to-one interviews, students used motivational interviewing strategies to assess participants' readiness for change (transtheoretical model), interest in the program, and individual obstacles that might have an impact on participation in the program (Health Belief and Health Promotion Model; Simpson, 2015). Each participant received a welcome kit with a pedometer, a lanyard, and a pack of stickers. During weekly check-in sessions, the students and the participants discussed a different nutritional topic. The topics, including choosing healthy snacks, drinking water, identifying appropriate portion sizes, and decreasing salt intake were derived from the United States Department of Agriculture website ( https://www.choosemyplate.gov/). Each week, students coached the participants through three suggestions for making a nutritious choice. The participants kept track of each time they implemented one of the suggestions. For each healthy decision, the participant earned a one-point sticker. As an incentive, the participants also earned extra stickers for each 5-minute period of exercise completed during the week. At the end of 8 weeks, the three participants who collected the most stickers earned a prize.
The Wellness Challenge
The weekly strategies were:
- Week 1 (snacks): Choose a healthy snack. Choose a piece of fruit over a sugary dessert. Try a new vegetable. Keep snacks to one serving size.
- Week 2 (making healthy choices during the day and drinking water): Buy a healthy snack rather than a nonhealthy snack. Drink water with a meal. Drink eight glasses of water in 1 day.
- Week 3 (whole grains/brown rice): Choose a whole-grain versus enriched-grain rice, a whole-grain cereal, or a whole-grain bread instead of enriched bread. Try a new healthy food.
- Week 4 (reading a food label, meal planning, and snacking): Measure out one serving of a food based on the label guidelines. Make a grocery list before going to the store and stick to the list. Opt out of a snack because it contains too much sugar, salt, calories, or carbohydrates.
- Week 5 (cooking and baking with healthy fats and less salt): Use olive or coconut oil when cooking. Try spices other than salt. Choose baked chicken over fried. Avoid all fried food.
- Week 6 (lean meats): Select beef that is at least 95% lean. Choose turkey or chicken instead of red meat. Substitute turkey bacon instead of pork bacon. Eat at least one serving of fish.
- Week 7 (building a healthy plate): Check that your serving of meat is no larger than the size of your palm and carbohydrate servings are no more than one quarter of the plate. Measure all portions to ensure correct serving sizes.
- Week 8 (Recipes): Try a new healthy recipe. Share a healthy recipe with a friend or coworker. Bring your lunch to work.
The Wellness Challenge program supplies included plastic lanyards to hold the challenge cards, stickers, a spreadsheet with the list of participants and weekly challenge totals, and three prizes for the winners. Students reported being excited to have the opportunity to practice motivational interviewing skills and expressed hope that the Wellness Challenge program would have a lasting impact on participants. Likewise, participants also reported enjoying the program, and several said they planned to continue using the nutritional strategies they learned. Faculty felt that this project could be easily adapted for different health-promotion topics and different patient populations.
The faculty and students agreed that (a) incentivizing participants with a leader board may have inspired greater effort, (b) distributing more points for exercising or exercising for longer periods of time might encourage more physical activity, and (c) greater marketing of the challenge and playing music at the weekly check-ins might increase participants' excitement in the program and encourage more participants to enroll.
PhD, CNM, CNE
Lauren Heaslip, BS
Duke University School of Nursing