Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study

Abstract

Background Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%). Conclusions Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health.

Participant Engagement in Microrandomized Trials of mHealth Interventions: Scoping Review

“…16 out of the 20 studies (80%) to measure engagement included at least one measure of this category. Generally, researchers measured usage in three domains: (1) usage of a mobile application [17,21,28,35,38], (2) participant retention [18,25,30,31],…”

“…Two studies measured usage as simply opening the intervention application [17,35]. Two studies measured usage as the access/viewing of intervention application content.…”

“…Engagement as practicethat is, performing a behavior/activity taught, prompted, and/or promoted by the interventionwas measured in six out of the 20 studies (30%) to measure engagement [25,[32][33][34][35][36]. All six studies measured this category of engagement via self-reports: Latham [25] evaluated a sleep intervention designed to improve the regularity of wake times in college students via prompts.…”

“…One measure of engagement in this study was participants' self-reported adherence to the sleep-related suggestions included in the prompt. In Militello et al [35], researchers assessed the feasibility and acceptability of intervention prompts to encourage engagement in mindfulness activities guided by a mindfulness mobile application. Here, engagement was operationalized as self-reported performance of a mindfulness activity/exercise in the 24 hours after receiving an intervention prompt.…”

Review of Headspace: Meditation and sleep.

“…Research into mobile health applications is developing and ongoing. A few studies point to the relative effectiveness of the Headspace app (e.g., Haliwa et al, 2021; Mani et al, 2015; Militello et al, 2022; Zollars et al, 2019), however, information such as effect size is frequently underreported and no standard exists by which to judge newly developed mobile health apps (Lau et al, 2020). More rigorous research on the impact of mobile health care apps is needed.…”