Financial Coaching for Enhancing Household Finances and Health/Well-Being: A Systematic Review.

Abstract

Background: Financial stress is a widespread and significant problem in the U.S., affecting a variety of populations. The long-term health/well-being effects of financial stress are well-documented (Shippee et al., 2012). The health problems associated with inadequate income are one of the social determinants of health, which refers to a broad range of social and environmental conditions that affect health/well-being (Francis et al., 2018; U.S. Department of Health and Human Services, n.d). Financial stress is also a result of financial exploitation, and a growing public policy and public health concern. In response to financial stress and financial exploitation, the intervention of financial coaching is growing in popularity. However, the effectiveness of financial coaching on financial and health outcomes is unclear.

Objectives: The purpose of this review was to inform policy and practice relevant to financial coaching by analyzing and synthesizing empirical evidence related to its financial outcomes and secondarily, to its health outcomes. The primary objectives of this review were to answer the following research questions:1. What is the extent and quality of financial coaching intervention research?2. What are the effects on financial outcomes of financial coaching embedded within community settings?3. What are the effects on financial outcomes of financial coaching embedded within healthcare settings?4. What are the effects on health/well-being-related outcomes of financial coaching embedded within community settings?5. What are the effects on health/well-being-related outcomes of financial coaching embedded within healthcare settings?

Search methods: We conducted a comprehensive search for published and gray literature in September 2024. We searched for and retrieved published studies from Google, Google Scholar, and 10 Electronic databases. We also searched seven relevant websites and three trial registries for registered studies. We harvested from the reference lists of included studies and conducted forward citation searching using Google Scholar. Lastly, we contacted the first authors of the 11 included studies and requested information about unpublished studies, studies in progress, and published studies potentially missed in the other search activities.

Selection criteria: Studies eligible for this review met the following criteria. First, studies must have used a prospective randomized controlled trial (RCT) or quasi-experimental (QED) research design with parallel cohorts. Second, studies must have involved an intervention that provided financial coaching. Third, the study must explicitly discuss two of three criteria in their financial coaching intervention: a. client-led goal setting; b. action planning; and c. progress monitoring by the coach. Fourth, the studies must be focused on financial coaching for personal, rather than business, finances. Fifth, the studies must have measured a financial outcome. Health related outcomes were extracted and analyzed but were not required for eligibility. All settings and populations were eligible.

Data collection and analysis: Searches were saved in the reference management software EndNote, and duplicates were removed and uploaded to Rayyan. Another round of duplicates were removed in Rayyan. Three reviewers then completed title and abstract screening on 4,635 entries in Rayyan. Three reviewers independently reviewed the 23 articles that were moved forward for full-text screening. A fourth reviewer reviewed discrepancies and made the final decision to include or exclude. Eleven studies that satisfied the inclusion criteria were retained for data extraction using a standardized extraction form. Because the included studies did not measure and report sufficient data to calculate effects sizes for similar outcomes, quantitative synthesis was not possible. Effect sizes were calculated when possible, and author-reported study outcomes were described.

Main results: Of the 11 unique studies included in this review, eight were randomized control trials and three were quasi-experimental designs. Eight of the 11 studies were conducted in community settings, and all studies involved adults. All studies offered financial coaching, with seven also providing financial education/literacy training. In addition to coaching, six provided credit/debt counseling and five offered budgeting or money management assistance. Seven of the studies combined financial education with financial coaching. All 11 studies reported at least one financial outcome, and four studies reported at least one health-related outcome. The evidence on the financial impacts of financial coaching is limited, as many studies did not report enough data to calculate effect sizes and or measure the same outcomes at the same points in time after the intervention. Most financial effects were small, with a mix of statistically significant and non-significant results. Some studies reported moderate effects on financial stress and financial self-efficacy, as well as small to moderate effects on smoking cessation. There were also some author-reported positive, statistically significant findings on financial and health-related outcomes. However, the risk of bias assessment indicated important methodological weaknesses across the included studies, and overall, the effectiveness of financial coaching remains uncertain.

Authors’ conclusions: Although financial coaching interventions are becoming popular and have the potential to improve financial and health outcomes, there is an overall lack of evidence about whether financial goals can be achieved through financial coaching. Across studies that met inclusion criteria, outcomes, and measurement time periods varied so widely that we are unable to draw any conclusions regarding intervention effects on finances. In addition, the quality of the studies was only moderate. Given the nascent nature of the research, the high level of enthusiasm for financial coaching seems to be outpacing the evidence about its effectiveness on important outcomes. We advocate that financial coaching settings agree on outcome domains and measurement time periods post treatment, then invest first in rigorous research. Only after these steps are taken can a determination be made about further promoting financial coaching in practice and/or move ahead to integrate coaching into other types of services.