JMIR Publications

ABSTRACT

Background:

Chronic conditions account for 75% or more of health care costs, and the impact of chronic illness is expected to further grow over time. The burden of chronic illness can be amplified by depression, which is problematic because in the context of chronic illness, depression is substantially more common than in the general population. Existing interventions can target depression in chronic conditions already, but they can be difficult to access and rarely contain multiple existing, evidence-based intervention approaches. Happify, a digital well-being intervention program, which draws from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and non-distressed users.

Objective:

To compare change in well-being over time after using a digital well-being program for users with a chronic condition and users reporting no chronic condition.

Methods:

Data were drawn from a sample of 821 users of the digital well-being program Happify, who had received a minimum of 6 weeks exposure to Happify (ranging from 42 to 179 days) and met other inclusion criteria. As part of a baseline questionnaire, respondents were asked for demographic information (age, gender) and if they had any of the pre-specified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (N = 450 reported a chronic condition, N = 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 scores on subjective well-being (M = 38.34, SD = 17.40) than users without (M = 43.65, SD = 19.13). However, there was no significant difference between change trajectories for users with or without a chronic condition; both groups experienced equivalent improvements in well-being. Additionally, there was 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), as well as a two-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 time periods interacted to produce improved well-being scores.

Conclusions:

The current data support the conclusion that users with a chronic condition experienced significant improvement over time, and that despite reporting lower subjective well-being on the whole, their change trajectory while using Happify does not differ from those without a chronic condition. Users who completed more activities over a longer time period showed the greatest amount of improvement, consistent with past research. In short, the presence of a chronic condition did not prevent users from showing improved well-being when they use Happify.