The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study

Abstract

Background Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. Objective This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. Methods Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. Results At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. Conclusions Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify.

Assessment of Adaptive Engagement and Support Model for People With Chronic Health Conditions in Online Health Communities: Combined Content Analysis

“…Online health communities (OHCs) are internet-based platforms that allow people to connect over shared experiences and communicate about health [ 20 - 22 ]. OHCs are disrupting traditional hierarchies in the health care industry by offering what traditional health care cannot offer—conversations about the lived experiences of people with particular health conditions.…”

Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial

“…Previous research demonstrated that 8 weeks of Happify Health use improved subjective well-being among people with chronic physical conditions, including type 2 diabetes, at the same rate as people without these conditions [ 61 ]. However, the previous study examined the effects of Happify Health use on users with at least one self-reported chronic condition but was unable to examine the impact on users with specific chronic conditions.…”

“…Thus, our intervention may have weaker effects, particularly on diabetes-specific outcomes, than CBT modified for diabetes. However, there is preliminary evidence that completing regular activities (ie, not disease specific) on Happify Health is associated with improved subjective well-being among people with chronic physical conditions [ 61 ] and that mindfulness and PP interventions without behavioral strategies for managing diabetes can improve participants’ health outcomes [ 30 ]. If we are able to demonstrate that Happify Health use can have physical as well as psychological benefits for people with poorly managed type 2 diabetes and elevated depressive symptoms, without incorporating specific behavioral strategies for managing diabetes, the effects are also likely to have broader applicability.…”

“…Similarly, we also plan to examine the effects of baseline depressive symptoms as a moderator of the effects of the intervention. Finally, given that the effects of Happify Health use are typically moderated by usage [ 57 - 61 ], we plan to examine the effects of frequency of usage as another moderator of changes in the primary and secondary outcomes.…”

“…Similar effects were obtained from RCTs focused specifically on people with higher levels of emotional or workplace distress [ 60 ]. More recent research also suggests that Happify Health use improves subjective well-being among people living with chronic physical conditions, including, but not limited to, diabetes, at the same rate as those without chronic conditions [ 61 ]. Consequently, there is preliminary evidence to suggest that Happify Health could effectively improve subjective and psychological well-being among individuals diagnosed with type 2 diabetes.…”