Holly Health is a digital health coaching tool already supporting over 25,000 people across the UK. We have already demonstrated significant physical and mental health outcomes after engaging with the service for only 8 weeks. For example, users who start with low to medium levels of exercise experience on average an 18% increase in exercise levels and those who start with low to medium levels of personal wellbeing as measured by the ONS-4 scale, see an average of 20% improvements across items (including life satisfaction, happiness and anxiety). So the next question we wanted to ask was, what happens with those users who engage with the service for longer?
Methods
To answer that question we sent a survey to all Holly users who are still using the Holly Health service after 5+ months. We asked them about any perceived changes to their physical and mental health, primary care service utilisation since using Holly, and general feedback.
We got a response from over 120 users. Most respondents have been using the service for 6-12 months (71%), 17% signed up between 5-6 months ago and 13% have been with Holly Health for longer than 12 months.
Mirroring the trend across all Holly Health users, the most prevalent long-term conditions across survey respondents were depression/anxiety (32%) and cardiovascular-related conditions, primarily hypertension (27%).
Results
Perception of physical and mental health changes
Since using Holly Health, almost 2/3rds of respondents (63%) consider that their physical health has improved, and over half (55%) think that their mental health has improved.
When we asked users about the perceived benefit of using Holly Health on specific health areas, 90% of users reported experiencing benefits from using the service, with the most reported benefits being lower stress and anxiety, better general health, being more active and improved mood.
In addition to the quantitative data, we also provided the option for free-text responses to each question so we can better understand the impact of Holly Health on each individual’s life. When analysing the qualitative responses, four key themes came up as perceived factors/benefits in physical and mental health changes:
- Consistency of healthy habits
- Symptom improvement
- More awareness/positive mindset
- Motivation support
Consistency of healthy habits across physical and mental health
Users identified that one of the ways in which Holly Health has helped them improve their physical and mental health is through supporting them to create healthy habits that with time have become embedded in their daily routines. The most common health-promoting behaviours that users called out were doing more exercise, drinking more water, eating better, journaling, and meditating. Here are some quotes:
“I'm able to use Holly Health as positive aims for the day which have become rituals built in my daily routine”
“It has helped me improve my fitness by inspiring me to take more exercise. Since starting Holly health , I have been going regularly for long walks 3-4 hours. Also I have been doing more anaerobic exercise”
“The Holly app has helped me to regularly journal , be aware of my intrusive thoughts and be able to let them go. The app has also allowed me to develop and continue to adhere to healthy habits”
“Holly Health has kept me on track and I have followed daily meditations. I have enjoyed reading suggested plans with Holly Health and the regular reminders help.”
Symptom improvement across physical and mental health
Users also listed some improvements to their physical and mental health symptoms since using Holly. Here are a few:
“I managed to get my blood pressure down from high enough to be prescribed medication to normal, without meds.”
“HbA1c lower, blood pressure lower, cholesterol lower, mood better, more mobile (with walker). “
“Feel happier and have a stronger feeling of wellbeing”
“Not as worried, more confident, better self esteem than before.”
“i turn to the app if I am struggling and is useful to set goals and I find my anxiety is better controlled now.”
More awareness and a positive mindset since using Holly Health
One of the key phrases that we keep hearing from users is that Holly Health has helped them to be more aware of their health and their actions, and this survey was no exception:
“It's heightened my awareness of making good habits, focusing on particular needs at a time.”
“More aware of the small steps to take on a daily basis to work towards better health.”
Kindness and compassion also remain at the centre of Holly Health’s approach and we can see it’s having a positive effect on our users:
“It has made me more mindful, and by making conscious choices to take better care of myself, with compassion and at times take more control of my inner critic”
“Although I am now peri-menopausal, I understand my mental health more than before, and am learning to be kinder to myself.”
The effect of Holly Health on ongoing motivation
Holly Health’s small habits approach, adaptive coaching and motivational messages are helping people to acknowledge and celebrate even the small everyday wins, which has a big impact on long-term behaviour change:
“The everyday quotes are very motivating and help me get ready for the day ahead. They also remind of the little things I should do, take some time for myself, eat two hours before bed. I feel so much happier with these in my life.”
“Holly’s daily encouragement has helped me mentally and physically.”
“The app has definitely supported my mental health to feel better. Even when I dip in how I feel the reminders from the app support me and encourage me to remember what I have achieved”
“It helps me to remember my goals while I’m struggling mentally. I can choose as small changes to improve my wellbeing as I want to and still feel I’m able to achieve them.”
GP support and condition management since using Holly Health
Previous data from Holly Health users show that 33% of people feel they need less support from their GP after using Holly Health for 8 weeks. In this survey, 37% of users report needing less GP support after 5+ months of using Holly. These results hint at the fact that longer Holly Health use, leads to better self-management skills, which may translate into less reliance on primary care services.
Reasons for needing less GP support:
When looking at the qualitative data for perceived changes in GP support and on a follow-up question asking users about the effect of Holly Health on their existing medical conditions, three themes emerged:
- Better mental health
- Improved-self management skills
- More consistency (habits, medication)
Better mental health after using Holly Health
We know from previous surveys that a key factor for Holly users to better manage their physical health is that they are in a better place mentally. Here, one major reason for people reporting needing less GP support was because of an improvement in their mental health. Holly users reported feeling more equipped to manage their symptoms and, in some cases, it even reduced their need for medication.
“I don’t feel the need for antidepressants, I can manage in my own.”
“Lower anxiety as a result of Holly being there.”
“Don't feel depressed and feel generally healthier”
“I’ve not had to talk to the dr about mental well-being”
“Feel I can cope better. “
“Less anxiety and less desire to medicate for it.”
“My anxiety levels have changed to 100% better thanks to information and help from Holly.”
“I suffer with chronic pain all the time. Whereas before Holly came along, I would do a routine of gentle stretching to relieve some of the pain. Often it was a case of " It hurts too much so why bother". Now my head is in a better place. I know it helps, and because my mental health has improved I feel strong enough to say " Come on! You can do this!"
Improved self-management skills
Relatedly, users consistently mentioned that through Holly Health, they have enough support and resources to make changes on their own and without having to rely on their GP:
“I probably should have contacted my surgery as my anxiety was bad last year but I was reluctant to bother a GP when the surgery was under a lot of pressure. The Holly app has made it possible for me to help myself.”
“Less stress means less illness so don’t need to see GP as often. Also need less frequent tests as within normal ranges. Also have new resources so don’t need to bother GP /nurse for info and referrals“
“It has enabled me to be more self sufficient. Honestly I am not sure how much time my very busy GPs practice would have to spend on helping me to focus and develop better habits. Thank you so much, I feel much more 'in control' of my physical and mental wellbeing now”
“It may sound silly, but because the app was suggested / given by my GP it feels like I have a connection with the practice, as though it is an extension of their care. So whether I use the app daily or not, the check ins and notifications are positive and motivating. I'm more able to stay above the baseline.”
“Dr in an app!”
“I have more resilience I think. I didn’t go to the gp that much before anyway but I think I am more encouraged to manage by myself and find my own solutions than before.”
“On using this app I believe I am more mindful of the importance to be proactive in my attempts to stay as healthy as possible for as long as possible. To be proactive in maintaining good health, blood pressure etc and the prevention of developing health conditions which require attendance with my GP and of course medical treatment .”
“I'm able to use Holly Health as my "Go-To" and see what I could do to help benefit my wellbeing which could be meditation, walking, being in nature”
“I can use the app as a first action rather than thinking about GP contact”
“I’ve had telephone call appointments booked in but have felt I’m coping so have cancelled them”
“Singing has improved my asthma control and I have reduced both my ventolin use and a LABA (spireva). Also my weight has stayed steady and slowly reducing rather than yo yo ing. (I suffer from obesity). It’s not affected my auto immune condition in a physical way, however it has improved my ability to manage my stress”
“I am managing my back pain better”
More consistency (habits, medication)
As with the perceived benefits on physical and mental health, consistency of healthy habits was identified by users as one of the factors that contributed to them feeling less need to contact their GP, and to manage their conditions better:
“Because spending a bit more time actually thinking about what exercise I take when and what I eat and taking medication regularly at the same time that I am probably better health wise for it.”
“Eating better”
“Developed an consistent exercise routine now”
“I think it's the moving about, I have more energy”
“I have managed to take my medication more regularly”
“I take my medication at the right times.”
“I have learnt more about pacing myself and only doing what is essential in order to stay well. I was previously pre-diabetic. By eating more healthily and taking regular exercise I am no longer pre- diabetic”
“My depression has been managed by remembering to take evening medication. I now have periods of exercise each morning and relaxation early evenings.”
“Still have arthritis of course but help keep me mobile with having regular tasks to do. Helped after my recent knee replacement. “
General user feedback
We always love getting as much user feedback as possible, it helps us understand what feels helpful and what we can improve to make the service even better. In this survey, the main feedback themes that popped up were:
- Reminders/prompts
- Usefulness/support
- Noticeable changes
- Endorsement for other people
Reminders/prompts
Holly Health’s gentle nudges and habit reminders seem to be one of the favourite features among users:
“I love the little quotes or motivating words of advice each day. They set me up for the day, remind me to take time for myself and eat well!!!!”
“It is helpful to have reminders to make sure that you look after yourself”
“Helpful tips to start the day are always appreciated and helpful.”
Usefulness/support
Users have expressed finding the Holly Health app useful to keep up with their motivation and everyday actions:
“It's actually easier to get your sense of wellbeing doing this everyday”
“Have appreciated the support of offering Holly Health through my GP”
“It's been fun! I should have mentioned the emphasis on being kind to yourself, so reassuring. It's been a surprise to realise how much I needed this. Thank you so much.”
“I have noticed that some of my habits I want to sabotage when I feel low. However, I continue and it improves again. I think the app helps me to pick myself up again and carry on with habits even if I sometimes do them less or have a couple of bad days”
“Thank you for sharing this with me, keeps me motivated 👍”
“I just would like to thank the team for helping me to make changes”
Noticeable changes
It’s great to see that after 5+months of using Holly Health, users are noticing big changes to their health and overall wellbeing:
“Thank you for helping me change my life.”
“Thank you for all the help you have given me I really appreciate it and feel so much better for it. If anyone I know needs help I recommend you now and explain what you have done for me. Thank you xxx”
“Only that it is a brilliant app and changes ones mindset from a negative to a positive one, with choice and mindful goals each day to move towards a healthy body and mind. It assists the journey using small manageable steps on a daily basis to achieve better physical and mental health, both of which I believe are linked and influence each other considerably.”
“It’s a great app that has made a massive change to my life . It is not too intrusive which is great too. I am still working towards doing more anaerobic exercise . I am grateful that Holly health is helping me with that too.”
“I'm not the same person who started this 7 months ago”
Endorsement for other people
And last but not least, Holly users said they would recommend Holly Health to other people and some expressed their thoughts about more people having access to the service:
“I highly recommend Holly Health app”
“I think this is an excellent app and I’m sure it must be helping very many people”
“Fantastic app! Everyone should be offered it!”
“Would recommend people to use Holly health.”
“I feel sure a lot of people will benefit so much from the Holly Health app. It is fun and easy to use and the regular prompts and reminders are a fail safe way to success. Thank you!”
We are working on other exciting projects to better understand the long-term impact of Holly Health, and to dive deeper into specific markers of physical and mental health. Watch this space for more updates 👀
