Parks Acacia C, Williams Allison L, Kackloudis Gina M, Stafford Julia L, Boucher Eliane M, Honomichl Ryan D
Happify, New York, NY, United States.
Case Western Reserve University, Cleveland, OH, United States.
J Med Internet Res. 2020 Jan 10;22(1):e16211. doi: 10.2196/16211.
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.
This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition.
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.
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.
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.
慢性病占医疗保健成本的75%，且慢性病的影响预计会随着时间推移而增加。尽管主观幸福感预示着更好的健康结果，但患有慢性病的人往往报告幸福感较低。改善幸福感可能会降低与慢性病相关的成本；然而，现有的干预措施可能难以获得，且往往基于单一理论方法。Happify是一个从多种理论传统中汲取灵感以提升幸福感的数字幸福干预项目，已被确立为改善困境和非困境用户幸福感的有效手段。
本研究旨在比较使用Happify前后，患有和未患有慢性病的用户幸福感随时间的变化。
数据来自Happify用户，这是一个可通过网站或手机应用程序访问的公开数字幸福项目。用户参与解决特定问题（如克服消极想法）的课程，这些课程由基于积极心理学、认知行为疗法和正念原则的游戏和活动组成。样本包括821名至少接受6周Happify干预（42至179天）且符合其他纳入标准的用户。作为基线问卷的一部分，受访者报告了人口统计学信息（年龄和性别）以及是否患有任何预先指定的慢性病：关节炎、糖尿病、失眠、多发性硬化症、慢性疼痛、牛皮癣、湿疹或其他疾病（450人报告患有慢性病，371人未患慢性病）。主观幸福感通过Happify量表进行评估，该量表是一个包含9个项目的积极情绪和生活满意度测量工具。为了评估幸福感随时间的变化，我们拟合了一个混合效应线性回归模型来分析主观幸福感，并控制了人口统计学和平台使用情况。
在基线时，患有慢性病的用户主观幸福感（均值38.34，标准差17.40）显著低于未患慢性病的用户（均值43.65，标准差19.13）。然而，患有或未患有慢性病的用户的变化轨迹没有显著差异；两组在幸福感方面都有同等程度的改善。我们还发现了基线时间（b = 0.071；标准误 = 0.010；P <.01）和完成活动数量（b = 0.03；标准误 = 0.009；P <.01）的影响，以及完成活动数量与基线时间之间的双向交互作用（b = 0.0002；标准误 = 0.00006；P <.01），即完成更多活动并在更长时间内进行这些活动会提高幸福感得分。
本研究数据支持以下结论：患有慢性病的用户随着时间推移有显著改善。尽管总体主观幸福感较低，但他们使用Happify时的变化轨迹与未患慢性病的用户相当。与过去的研究一致，但完成更多活动且时间更长的用户改善最为明显。简而言之，患有慢性病并不妨碍用户在使用Happify时幸福感得到提升。
