Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data

Abstract

Background The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement.

The growing field of digital psychiatry: current evidence and the future of apps, social media, chatbots, and virtual reality

“…Actual data on app engagement from over 100,000 participants in different studies across various health conditions showed that the median participant retention was just 5.5 days 203 . As mentioned before, this dropoff in use was also found in a 2021 report of the stress app COVID Coach, which reported that only 1.56% of users remained engaged for at least 14 days 115 . Research data also do not confirm commonly held assumptions that older adults will engage less than younger people 203 , although other reviews suggest the opposite 197 .…”

“…While commercial app companies do not publish engagement data, it is clear that downloads do not automatically translate into active use. For example, the popular (and free) COVID Coach app designed to address stress during the pandemic re ported over 140,000 downloads, but only 1.56% of individuals who have downloaded the app recorded at least two weeks of use 115 .…”

Effectiveness and Acceptance of a Smartphone-Based Virtual Agent Screening for Alcohol and Tobacco Problems and Associated Risk Factors During COVID-19 Pandemic in the General Population

“…For alcohol, 30.35% of our sample were identified with risky use of alcohol, which is higher than what was found (8.6% to 23.6%) in a general population study aged 18-75 years (34). Thus, it is possible that the application was more appealing for at-risk individuals (22). Current tobacco users were more frequently identified as being at risk of an SUD diagnosis (around 70% with CDS-5) than alcohol users (around 33% with CAGE), and they were more likely to report a problem of use since the context of the epidemic.…”

“…Also, the use diary was helpful for almost half of the users but used by a minority only. Low ongoing use has been found in other populations using a mental health application during COVID (22). In general, the use of mental health applications is waning over time, and a small proportion of users actually use popular applications regularly (41).…”

“…Protocols may be oriented toward the development of virtual and/or distant resources and the reduction of face-to-face visits (6). During the first lockdown in 2020, numerous research projects have emerged to assess the experiences of individuals and the evaluation of various mental disorders in the most ecological way possible (22). It is in this context that KANOPEE was developed.…”