Abstract
BackgroundChronic 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.ObjectiveThis study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition.MethodsData 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.ResultsAt 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.ConclusionsData 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.
Highlights
The United States spends significantly more on health care than any other nation
More than 75% of our health care spending is on people with chronic conditions.[3]
Heart disease death rates are higher among African Americans than whites,[4] and diabetes rates are substantially higher among
Summary
The United States spends significantly more on health care than any other nation. In 2006, our health care expenditure was over $7,000 per person, more than twice the average of 29 other developed countries.[2]. More than 75% of our health care spending is on people with chronic conditions.[3] These persistent conditions—the nation’s leading causes of death and disability—leave in their wake deaths that could have been prevented, lifelong disability, compromised quality of life, and burgeoning health care costs. Cancer continues to claim more than half a million lives each year and remains the nation’s second leading cause of death.[4]. Obesity Obesity has emerged as a priority in chronic disease prevention and has been linked to increased risk for heart disease, high blood pressure, type 2 diabetes, arthritis-related disability, and some cancers. Almost 60% of children—or 22 million children aged 3 to 11 years old—are exposed to secondhand smoke, which slows lung growth and increases risk for acute respiratory diseases and for more severe asthma.[25]
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