Digital delivery of a 6-month home-based empowerment program improves mental health in rural adults with chronic conditions: A single-arm prospective interventional trial

Background: Mental health conditions commonly co-occur with chronic diseases, yet few evidence-based interventions are designed for rural populations or scalable within primary care. This study evaluated the mental health impact, clinical significance, and usability of a digitally delivered Personal Empowerment Program (PEP). Methods: This single-arm prospective interventional trial (October 2023-August 2025) enrolled 182 community-dwelling adults with ≥1 physician-diagnosed chronic condition in Pictou County, Nova Scotia. The six-month PEP program delivered daily digital modules via email and YouTube covering physical fitness, nutrition, mindfulness, sleep, and social connection, with weekly self-monitoring and monthly videoconferencing, optimized for low-bandwidth mobile access. The primary outcome was psychological distress (Kessler Psychological Distress Scale (K10); secondary outcomes included anxiety (GAD-7) and depression (CES-D). Generalized estimated equations assessed changes (baseline, 6, and 12 months). Results: < 0.001). GAD-7 scores declined by 1.36 points (95% CI:-2.28,-0.45) at 6 months and 2.11 points (95% CI:-3.03,-1.20) at 12 months, while CES-D scores declined by 2.43 points (95% CI:-4.65,-0.21) at 6 months and 4.31 points (95% CI:-6.84,-1.78) at 12 months. Clinically meaningful improvement at 12 months was observed in 23% (K10), 23% (GAD-7), and 38% (CES-D) of participants. Usability ratings were high. Conclusions: PEP demonstrates sustained mental health benefits and high usability within a scalable, low-bandwidth digital model, supporting equitable mental health care for rural adults with chronic conditions.