PhD candidate Elena Agachi studied the potential of online preventive health programs. Her project was a cooperation between the University of Groningen and health insurance company Menzis. Elena’s research was centred around the lifestyle program SamenGezond, analyzing real world data on activities in the program, as well as healthcare costs. The project’s findings demonstrate the potential of online preventive programs to improve individual health, supporting the transition from reactive healthcare to proactive well-being.

The project allowed Elena to combine her passion for data and statistics with her interest in healthcare. “I firmly believe that our goal as a society should be the healthiest population, instead of the most efficient healthcare system. Contributing to a project that advances the evidence base for prevention aligns with this vision, as prevention is the key to safeguarding healthy life years and protecting against the onset of diseases.”

The SamenGezond program (translates to English as: Healthy Together) is an online, open-access, preventive health program, with the goal of improving the wellness and lifestyle behaviours of its participants. It promotes physical activity, healthy eating habits, social activity, mental health, good sleep habits, and stress minimization. Through the program’s website and mobile app, participants can record physical activities, read articles, set goals, include friends in challenges, answer questions related to their health, and receive assistance from a web-based coach. On the basis of individual activities in the program, participants gain points, which can be used to acquire specific products, vouchers for various services, or make charity contributions. Elena analyzed real-world data on activities in the program, which resulted in some interesting findings.

Socioeconomic disparities in the usage of prevention programs

One of the findings from this project relates to the adoption of the health program: it appears that the mobile app of the health program is more likely to be adopted by the group of the population with lower socio-economic conditions than the website, and that the app has a higher probability of being adopted by the group with lower socio-economic conditions than by the group with higher socio-economic conditions. This is an important finding, as the lower socio-economic population group would benefit most from preventive programs, since they have the highest burden of disease, while showing the lowest usage rates. “One particularity of online preventive health programs in general is that they are more often used by participants who belong to population groups with higher socioeconomic conditions, likely due to greater access to digital resources, higher health literacy, more interest in a healthy lifestyle, and more available time to engage with such programs. As a result, socioeconomic disparities often arise in the usage of these programs, with lower involvement from population groups with lower socioeconomic conditions”, Elena explains.

A surprising finding from her PhD project is that, beyond initial adoption, there were no statistically significant socioeconomic differences either in the intensity of program usage, or in the reduction of healthcare costs. “This indicates that promoting such programs across all population groups is crucial: once participants are motivated to sign up, it is possible that they all benefit similarly, regardless of their socioeconomic background.”

Lower healthcare costs

Another important outcome in Elena’s research is the demonstrated effectiveness of the analyzed preventive health program in improving individual health. “My analysis reveals that participants using the mobile app of the program incur significantly lower healthcare costs compared to non-participants, starting from the second year of program usage. On average, this amounts to about 150 euros saved per participant per year.’’ Additionally, the study shows that greater reductions in healthcare costs are associated with higher activity levels within the program. Specifically, the frequency of activity (measured by the total number of active weeks per year) proves to be more important than the intensity of activity (measured by total points gained in a year). “This finding aligns with habit formation theory, which suggests that consistent, small efforts are more effective in adopting new behaviors than highly intensive but sporadic activities.”

From reactive healthcare to proactive well-being

Elena’s findings highlight the potential of online preventive health programs to reach diverse population segments, having the ability to improve individual health outcomes and ultimately contribute to the sustainability of future healthcare systems. “Increasing healthcare costs have become a pressing issue, with much of these costs being associated with the treatment of non-communicable diseases. These diseases are driven by risk factors that are preventable in nature (such as physical inactivity, unhealthy diets, tobacco and alcohol abuse), which can be addressed with such interventions as health programs”, Elena states.

Investing in prevention programs is often cost-effective and yields significant long-term benefits. By addressing the root causes of diseases like heart disease, diabetes, and certain cancers, their incidence and severity can be reduced, alleviating the financial burden on healthcare systems and allowing resources to be used more efficiently. “Prevention programs also enhance quality of life by promoting healthier lifestyles and supportive environments. Healthier populations mean reduced absenteeism, increased productivity, and less strain on social services. Prioritizing prevention builds a foundation for a more sustainable and healthier society, shifting focus from reactive healthcare to proactive well-being and disease prevention”, Elena adds.

Towards population-wide prevention

While Elena’s project clearly demonstrates the potential of online preventive programs to improve individual health, questions remain regarding their large-scale, population-level implementation. “Key issues include how to integrate these programs into a comprehensive, population-wide prevention policy with well-defined structure, ownership, and financial support. These are some of the topics I am currently exploring as I shift my focus from analysing individual preventive health programs to examining prevention policy on a national level.”

PhD defence and symposium E-healthy lifestyle

On the 8^th of July 2024, Elena Agachi will defend her PhD. In the afternoon, after her defence, she will present her research at a symposium centred on E-health and lifestyle. The symposium is organized by the Faculty of Economics and Business's Centre for Public Health in Economics and Business. Apart from Elena, psychologist and epidemiologist Esther Metting (UG, UMCG) and Sipko van Dam from digital health start-up Ancora will give a presentation. The program will be concluded with a panel discussion led by Professor of Public Health Economics Jochen Mierau (FEB). You can find more information about the symposium on the website of the Centre for Public Health in Economics and Business.