Background:

Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behaviour changes. Digital health coaching has proved to be effective to this aim, with the rising use of text-based interventions. In order to guarantee coaching fidelity and effectivity, there is a need for research in the field of linguistics as a core element of these interventions. State-of-the-art research has considered wording but lacks grammar analysis and the meanings originated from the speaker’s linguistic choices. When investigated, these choices can disclose the speaker’s experiences of the world, their relationship with the receiver and the interpretation of their wording as a text message. Furthermore, empathy is associated with these meanings, and becomes pivotal during coaching for a successful coach-user relationship and positive patient outcomes.

Objective:

We aim to analyse user cues in a digital health intervention and contribute to future research on coach communication.

Methods:

We tested a combination of empathy and a linguistic approach to code 148 text messages sent by 29 women recruited in a randomized trial on tele-coaching for the prevention of gestational diabetes and postnatal weight loss.

Results:

We identified 143 empathic opportunities present in 42.37% of the word count in the corpus. These were mainly negative (82.2%) and implicit (60%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (86.2%) with a declarative structure (86.3%). Processes represented a 22.4% of the corpus, with half being material (10.7%) and related to food and diet (26.9%), physical activity (26.9%), and lifestyle goals (11.2%).

Conclusions:

The combination of empathy and linguistic analysis showed promising results. Our findings reveal preliminary insights on the coach-user relationship. The absence of explicit empathic opportunities and direct questions could be attributed to a low trust or information on the coach's abilities. We will be conducting further research to explore additional linguistic features and code coach messages. Clinical Trial: Trial registered on the Australian New Zealand Clinical Trials Registry (ANZCTR) with registration number ACTRN12620001240932.