Multidomain Outcomes of a Digital Self-Management Program in Rural Adults With Chronic Conditions: Single-Arm Prospective Interventional Study

Chronic disease and comorbid mental health problems disproportionately affect rural and underserved populations. Digital self-management programs are potentially scalable, but evaluations often focus on narrow outcomes.

This study examined 12-month longitudinal changes in psychological and multidomain outcomes among Pictou County Patient Empowerment Program participants and explored co-occurring changes and psychological moderators.

This single-arm prospective interventional study enrolled 182 community-dwelling adults with ≥1 chronic condition in Pictou County, Nova Scotia, between October 2023 and August 2025 through community-based outreach. Median age was 60 (IQR 51-68) years, 155 of 182 (85.2%) participants were women, and the median number of chronic conditions was 3 (IQR 1-3). The initial 6-month digital intervention delivered brief daily modules targeting physical activity, nutrition, stress regulation, sleep, habit formation, and social connection, followed by a 6-month lower-intensity maintenance period during which monthly group videoconference sessions continued to be offered. Outcomes were assessed at baseline, 6 months, and 12 months. Primary outcomes were illness perceptions (Brief Illness Perception Questionnaire), perceived stress (10-item Perceived Stress Scale [PSS-10]), disease-related worry (10-item Questionnaire on Distress in Cancer Patients), life satisfaction (Satisfaction With Life Scale), and mental well-being (World Health Organization-Five Well-Being Index [WHO-5]). Secondary outcomes assessed the physical, behavioral, and psychosocial domains. Generalized estimating equations estimated population-averaged longitudinal changes, adjusted for age, sex, relationship status, comorbidity burden, and baseline depression or anxiety medication use. Exploratory models examined co-occurring changes and moderation. Tests were 2-sided with α=.05.

Across outcomes and follow-up assessments, completion ranged from 58.2% (95% CI 51.0%-65.2%; 106/182) to 65.4% (95% CI 58.2%-71.9%; 119/182). At 12 months, illness perceptions decreased (β=-7.3, 95% CI -9.7 to -4.9), perceived stress decreased (β=-2.4, 95% CI -3.5 to -1.3), disease-related worry decreased (β=-6.3, 95% CI -7.8 to -4.7), life satisfaction increased (β=2.5, 95% CI 1.4-3.5), and mental well-being increased (β=10.4, 95% CI 7.2-13.5; all P<.001). Secondary outcomes improved across fatigue, sleep, diet quality, sedentary behavior, spiritual well-being, mental health-related quality of life, weight, and BMI. Exploratory analyses showed that improvements in fatigue, sleep quality, and illness perceptions co-occurred with greater well-being and life satisfaction and lower perceived stress and disease-related worry at both follow-up assessment points. Clinically meaningful stress improvement (≥4-point PSS-10 reduction) was achieved by 36.4% (95% CI 27.3%-45.6%, 39/107) and 43.4% (95% CI 34.0%-52.8%, 46/106) participants at 6 and 12 months, respectively. At 12 months, 43.5% (95% CI 34.2%-52.9%, 47/108) participants reported clinically meaningful improvement in mental well-being (≥10-point WHO-5 increase).

Participation in this low-bandwidth, home-based digital self-management program was associated with sustained psychological, physical, and behavioral improvements among rural adults with chronic conditions. These multidomain findings support randomized controlled evaluation of scalable digital self-management approaches as adjuncts to rural chronic disease care.