Date of Award


Document Type


Degree Name

Doctor of Philosophy (Ph.D.)

School Name

College of Health Professions


Health Professions

Major Advisor

Dr. Barbara Jackson


Poor health behaviors cost the United States billions of dollars and tens of thousands of lives every year. The Veterans Affairs primary care delivery model uses health coaching as a catalyst to improve health behaviors in veterans. Health coaching is a complex skill that requires specialized training, repetitive practice, and professional confidence. Albert Bandura believed most people acquire skills and develop the confidence to use those skills through social learning. He posited that professional confidence played a critical role in skill acquisition, and people with low professional confidence were less likely to attempt to perform a skill. Bandura’s Theory of Self-Efficacy presents four sources of professional confidence and served as the framework for this study. Primary care nurses in the Veterans Affairs are trained in health coaching using facilitator-led instruction and role play. Modern training methodologies, like virtual standardized patient trainers, incorporate training characteristics aligned with Bandura’s determinants of professional confidence and may be more efficient and effective methods for training primary care nurses in health coaching. This quasi-experimental study explored the training effectiveness of virtual standardized patient-integrated health coach training by comparing the pretraining, post-training, and three-month follow-up training professional confidence levels for their use of health coaching skills as self-reported by primary care nurses at fourteen Veterans Affairs medical centers. Self-assessment survey tools were used to capture the three datasets before and after completing a three-hour virtual-standardized-patient-health coach training program called Virtual Interview Skills Training System. The data from a convenience sample of thirty-one registered nurse participants were analyzed using a repeated-measures, non-parametric analysis of professional confidence gain with a Wilcoxon Signed-Rank matched-pair test to compare the three datasets and a Kruskal-Wallis H analysis of the differences between pretraining, post-training, and three-month follow-up scores were compared by demographic and experiential groups. The results showed a statistically significant gain in the professional confidence of the participants after completing the virtual standardized patient-integrated health coach training. This professional confidence gain was sustained in the three-month follow-up assessment. The demographic and experiential characteristics of the participants showed no association with the gain in professional confidence. This study was conducted to inform the health coach training program of the National Center of Health Promotion and Disease Prevention at the Veterans Affairs on the efficacy of virtual-standardized-patient-integrated health coaching training.

Available for download on Thursday, April 03, 2025