Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 10, 2025
Date Accepted: Dec 10, 2025
The Impact of a Health Coaching App on the Subjective Wellbeing of Individuals with Multimorbidity: A Mixed Methods Study.
ABSTRACT
Background:
Multimorbidity, the coexistence of two or more chronic conditions, is associated with poor wellbeing. Digital wellbeing apps offer cost-effective and accessible support. However, there is a lack of evidence of the impact of digital health interventions (DHI) on individuals with multimorbidity.
Objective:
The study aimed to assess the impact and acceptability of a DHI (the Holly Health (HH) app) on the wellbeing of adults with multimorbidity.
Methods:
An explanatory-sequential mixed methods design, with quantitative secondary data analysis in the first phase, and qualitative interviews in the second phase. In the quantitative phase (n=565), pre-and post-wellbeing (ONS4) scores from existing app users with multimorbidity were analysed using Bayesian growth curve modelling to assess the impact of HH. In the qualitative phase (n=22), data was collected via semi-structured interviews and analysed using reflexive thematic analysis. Mechanisms of action that supported wellbeing were categorised using the Multi-level Leisure Mechanisms Framework.
Results:
There was a significant increase in life satisfaction (Coef.=0.71, 95% HDI=0.52-0.89), worthwhileness (Coef.=0.62, 95% HDI=0.43-0.81), and happiness (Coef.=0.74, 95% HDI=0.54-0.92) and a decrease in anxiety (Coef.=-0.50, 95% HDI=-0.74-(-0.25)) before and after using the HH app. Eight acceptable app features activated five mechanisms of action, including behavioural, psychological, and social mechanisms. Three additional factors influenced the acceptability of the DHI: type of chronic condition, availability of time, and the use of other support tools.
Conclusions:
The study demonstrates that DHIs could be effective and acceptable support tools for individuals with multimorbidity. This study contributes to understanding why DHIs support wellbeing and could be used to inform the development of future DHIs in multimorbidity.
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