Associations Between Rural or Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: Longitudinal Survey Study

Abstract

Background Rural and urban differences in health outcomes and behaviors have been well-documented, with significant rural health disparities frequently highlighted. Mobile health (mHealth) apps, such as meditation apps, are a novel method for improving health and behaviors. These apps may be a critical health promotion strategy during the COVID-19 pandemic and could potentially be used to address rural health disparities. However, limited research has assessed whether meditation app health outcomes are associated with rural and urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users. Objective We aimed to explore associations between rural or urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural or urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural versus urban app users over time. Methods This study was a secondary analysis of a national survey conducted among subscribers to the meditation app Calm. Eligible participants completed online baseline surveys from April to June 2020, and follow-up surveys from June to September 2020, assessing demographics, psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity. Results Participants (N=8392) were mostly female (7041/8392, 83.9%), non-Hispanic (7855/8392, 93.6%), and White (7704/8392, 91.8%); had high socioeconomic status (income ≥US $100,000: 4389/8392, 52.3%; bachelor’s degree or higher: 7251/8392, 86.4%); and resided in a metropolitan area core (rural-urban commuting area code 1: 7192/8392, 85.7%). Rural or urban status was not associated with baseline stress, depression, anxiety, pre–COVID-19 and current physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Repeated-measures models showed overall decreases in depression, anxiety, and perceived effects of COVID-19 on physical activity from baseline to follow-up, and no significant changes in stress or perceived effects of COVID-19 on stress and mental health over time. Models also showed no significant main effects of rural or urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence. Conclusions We did not find associations between rural or urban status and psychological outcomes (ie, stress, depression, and anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural or urban status does not appear to drive differences in outcomes among meditation app users, and the use of mHealth apps should continue to be explored as a health promotion strategy in both rural and urban populations. Furthermore, our results did not show negative cumulative effects of COVID-19 on psychological outcomes and physical activity among app users in our sample, the majority of whom were urban, White, female, and of high socioeconomic status. Further research is needed to investigate meditation app use as a health promotion strategy in rural and urban populations.

The global evolution of mental health problems during the COVID-19 pandemic: A systematic review and meta-analysis of longitudinal studies

“…There were 15 studies ( Bhuiyan et al, 2021 ; Chen et al, 2021 ; Cousijn et al, 2020 ; Dalkner et al, 2021 ; González-Sanguino et al, 2021 ; Gulliver et al, 2021 ; Han et al, 2021 ; Iovino et al, 2021 ; Johansson et al, 2021 ; López-Morales et al, 2021 ; Mergel and Schützwohl, 2021 ; Russell et al, 2021 ; Shuster et al, 2021 ; Somma et al, 2021 ; Stevenson and Wakefield, 2021 ) which reported the means of anxiety. Ten studies reported the anxiety means in two waves, two studies reported it in three waves, one study reported it in 10 waves, and one study reported it in four waves.…”

“…Fourteen studies reported the means of depression ( Bhuiyan et al, 2021 ; Chen et al, 2021 ; Cousijn et al, 2020 ; González-Sanguino et al, 2021 ; Gulliver et al, 2021 ; Han et al, 2021 ; Iovino et al, 2021 ; Johansson et al, 2021 ; Mergel and Schützwohl, 2021 ; Russell et al, 2021 ; Yocum et al, 2021 ). Ten studies reported the means in two waves, three in three waves, and one in 10 waves.…”

Impact of mental health, job insecurity, and COVID-19 symptoms on protective behavior changes among White, Black, and other minorities in the US

“…The difference between non-White and White people specifically in rates of infection, rather than severity of the illness once infected, might be associated with variations in protective behaviours practiced ( Breakwell et al, 2022 ). Statistics showed that non-White people were more likely than White people to report difficulty to follow public health policies enacted by the government ( Bhuiyan et al, 2021 ). The level of NPIs practice required not only protective equipment such as facemasks and disinfectant, but also the ability to stock food, water, gasoline, and medicine ( Lehberger et al, 2021 ).…”

Examining equity in access and utilization of a freely available meditation app

“…Huberty and colleagues 21 examined utilization patterns amongst 12,151 paying subscribers to the Calm app and found that the sample was predominantly female (79.94%) and NL White (81.41%). Comparably, Bhuiyan and colleagues 22 examined 8,392 Calm users and found that the sample was mostly female (83.9%), NL White (91.8%), and college-educated (86.4%). However, one important potential barrier to access and utilization of meditation apps such as Calm is their cost which may limit accessibility 23 .…”