The Impact of a Health Coaching App on the Subjective Well-Being of Individuals With Multimorbidity: Mixed Methods Study.

Abstract

Multimorbidity, the coexistence of 2 or more chronic conditions, is associated with poor well-being. Health coaching apps offer cost-effective and accessible support. However, there is a lack of evidence of the impact of health coaching apps on individuals with multimorbidity. This study aimed to assess the impact and acceptability of a health coaching app (the Holly Health [HH] app) on the subjective well-being (SWB) of adults with multimorbidity. This study used 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-SWB (Office for National Statistics' 4 personal well-being questions [ONS4]) scores from existing app users with multimorbidity were analyzed using Bayesian growth curve modeling to assess the impact of HH. In the qualitative phase (n=22), data were collected via semistructured interviews and analyzed using reflexive thematic analysis. Mechanisms of action that supported SWB were categorized using the Multi-Level Leisure Mechanisms Framework. There was a significant increase in life satisfaction (Coef.=0.71, 95% highest density interval [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 to -0.25) before and after using the HH app. Overall, 8 acceptable app features activated 5 mechanisms of action, including behavioral, psychological, and social mechanisms. Three additional factors influenced the acceptability of the health coaching app: type of chronic condition, availability of time, and the use of other support tools. The study demonstrates that health coaching apps could be effective and acceptable support tools for individuals with multimorbidity. This study contributes to understanding why health coaching apps support SWB and could be used to inform the development of future digital health interventions in multimorbidity.