Effectiveness of a Multimodal Online Well-Being Intervention

Abstract

BACKGROUND: Well-being encompasses physical, psychological, and social aspects of health and predicts healthcare utilization and expenditures. Despite their potential clinical impact, interventions that leverage social network effects to target well-being are uncommon. PURPOSE: Using a pragmatic design, to evaluate the effectiveness of an online well-being intervention as part of ongoing program development. DESIGN: Randomized, placebo-controlled, parallel-group trial with longitudinal outcome measurements at baseline, 30 days, and 90 days. PARTICIPANTS/SETTING: A total of 1503 U.S.-based adults were enrolled. Recruitment, eligibility verification, and baseline data collection were conducted entirely online; follow-up took place online or by phone. The study was conducted in 2012. INTERVENTION: A multimodal e-mail-, web-, and mobile-based intervention (Daily Challenge), in which participants receive daily suggestions of small health actions that they complete in a social environment. A traditional weekly health newsletter served as control. MAIN OUTCOME MEASURE: Overall well-being as measured by the Individual-level Well-Being Assessment and Scoring Method (scale: 0 to 100). RESULTS: Follow-up rates reached 68.7% (n=1032) at 30 days and 62.6% (n=940) at 90 days. Overall, 84.6% of treatment group participants visited the website, and 76.5% opened program e-mails (vs 51.1% in the control group). Daily Challenge improved well-being significantly more than control at 30 days (2.27 points, p=0.004) and at 90 days (2.35 points, p=0.004). A dose response for intensity of use was observed at 30 days (p=0.001) and 90 days (p=0.003). Well-being improvement was greater in participants with than without social ties in the program (at 30 days: p=0.02; at 90 days: p=0.003). CONCLUSIONS: A multimodal online intervention leveraging social network effects significantly improved well-being over control. Higher levels of participation as well as increasing levels of social integration were associated with greater improvement in well-being. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT01586949).