Social support is a key factor in driving behavior change. Incorporating family and friends into digital health interventions (DHIs) has been shown to positively influence outcomes. The aim of this study was to evaluate the feasibility and acceptability of including Buddy support in the LvL UP intervention.

LvL UP is a mHealth holistic lifestyle intervention app designed to prevent noncommunicable diseases (NCDs) and common mental disorders (CMDs). Data were obtained from the LvL UP pilot RCT conducted between March and July 2024. We focused on 81 participants who were randomized to receive the app. LvL UP participants were asked to invite a Buddy to support them during the 8-week intervention. Consenting Buddies were asked to provide encouragement for task completion, healthy tips, perform weekly dyad activities, and provide reminders to participants. They received instructions on how to perform the role from the study team via automated WhatsApp messages and emails. Buddies completed weekly progress reports and surveys at weeks 4 and 8 to assess dose and fidelity to the intervention. Multiple regression and thematic analysis were used to understand the relationship between LvL UP Buddy involvement and (1) app engagement and (2) mental well-being.

Most Buddies (95.1%, 77/81) were paired with their participant within 7 days of the baseline visit. On average, each Buddy received 30 messages (9 via email and 21 via WhatsApp) and completed 4.6 (SD = 2.5) weekly progress reports. 80.3% (61/76) and 76.3% (58/76) Buddies completed the 4- and 8-week assessments, respectively. Multiple regression analysis suggested that adding Buddies’ task completions (dose) as variables to the model did not significantly improve the prediction of engagement or mental well-being outcomes. However, 74.1% (43/58) of the Buddies felt that their support had a positive impact on the participant’s health, and 58.6% (34/58) felt that it had improved their own health. Thematic analysis suggested that the Buddy component added an extra element of accountability and motivation to engage in healthy lifestyle behaviors.

Preliminary results suggest that including social support in the form of family and friends may have a reciprocal behavioral effect on both parties. It is essential, however, to explore the mechanisms of action to further understand the impact of support provided by existing social networks on successful lifestyle change in adults at risk of developing NCDs and CMDs.