**Background:** Chronic diseases affect 6 in 10 US adults and are the leading causes of death, disability, and annual healthcare costs of $3.5 trillion. Physical disabilities increase the risk of developing chronic conditions, and vice versa—creating a bidirectional relationship. Self-management support is the most frequently used and effective intervention approach for chronic disease management, and health coaching is a common, cost-effective delivery mechanism. However, people with physical disabilities face unique barriers to self-management (e.g., inaccessible environments, lack of appropriate equipment, low health literacy), and few inclusive programs exist. The My Health, My Life, My Way study aims to fill this gap by developing and optimizing an inclusive web-based self-management program using the multiphase optimization strategy (MOST) framework.
**Methods:** This is a 4-arm, 2 × 2 factorial randomized controlled trial. A total of 200 participants will be enrolled nationally in the United States via the National Center on Health, Physical Activity and Disability (NCHPAD) website (~45,000 visits/month). Eligible participants are adults ≥18 years with a permanent physical disability (e.g., spinal cord injury, spina bifida, multiple sclerosis, stroke) and at least one self-reported chronic condition (heart disease, chronic lung disease, hypertension, or type 2 diabetes). Exclusion criteria include current enrollment in any structured intervention, severe cognitive impairment, major cardiac event in the past 12 months, resting tachycardia, renal failure, severe peripheral neuropathy, active cancer treatment in the past 12 months, and both visual and hearing impairments. Participants are randomized 1:1:1:1 to: (1) scheduled coaching calls + gamified rewards, (2) scheduled coaching calls + flat rewards, (3) no scheduled coaching calls + gamified rewards, or (4) no scheduled coaching calls + flat rewards. The intervention lasts 6 months (24 weeks). All participants receive a Fitbit activity tracker, access to a telehealth platform with inclusive multimedia educational content, and the ability to contact health coaches on demand. Those in scheduled coaching arms receive weekly calls (up to 60 minutes). Gamified rewards involve increasing redeemable points for sustained adherence; flat rewards provide fixed points for regular participation. The primary outcome is health-related quality of life (SF-36E) at 6 months. Secondary outcomes include physical activity, self-efficacy (PROMIS short forms for managing symptoms, daily activities, emotions, social interactions, medications, sleep), emotional distress, dietary intake (Short Healthy Eating Index), medication adherence (MARS, BMQ), and usability (SUS, Health-ITUES). Surveys are administered at baseline, 3 months, and 6 months. The sample size (n=200, expecting 160 completers after 20% attrition) provides 80% power to detect a minimally detectable effect size of Cohen's d=0.36 for main effects (α=0.05, two-sided). Statistical analyses will use linear mixed models with intent-to-treat principles, reporting exact p-values. Up to 30 participants will complete qualitative exit interviews.
**Key Results:** This is a protocol paper; no results are reported. Recruitment and enrollment are projected to begin in May 2023. Data analysis is expected to be completed within 6 months of ending data collection. The protocol was approved by the University of Alabama at Birmingham IRB (IRB-300009485) and registered at ClinicalTrials.gov (NCT05481593).
**Clinical Implications:** The findings will determine which combination of coaching calls (scheduled vs on-demand) and reward structures (gamified vs flat) optimizes engagement and outcomes in a self-management program for people with physical disabilities and chronic conditions. If scheduled coaching is not more effective than on-demand coaching, this could reduce resource demands (health coaches, costs, training). If gamified rewards outperform flat rewards, programs should invest in extrinsic motivation strategies; if flat rewards are equally or more effective, intrinsic motivation may be more important than escalating incentives. The program is designed to be fully web-based and inclusive, addressing barriers of accessibility and environment. This study will provide evidence to guide the development of scalable, sustainable self-management interventions for an underserved population.