Formative evaluation on cultural tailoring breathing awareness meditation smartphone apps to reduce stress and blood pressure

Abstract

Background: Chronic stress is an independent risk factor for essential hypertension (EH), cardiovascular disease (CVD), and is sometimes confronted by mal-adaptive coping behaviors (e.g., stress eating, excessive alcohol consumption, etc.). Pre-essential hypertension (preEH) is the leading predictor of future EH status.Breathing awareness meditation (BAM) can result in clinically beneficial blood pressure (BP) reductions, though face-to-face sessions presents barriers to reach those in need. The purpose of this study was to identify if a culturally tailored approach is needed in the design and preferences between groups of preEH African American and White adults toward using a smartphone BAM app, the Tension Tamer (TT) app.Methods: TT includes audio delivered BAM instructions, real-time heart rate, feedback graphs and motivational reinforcement text messaging. Questionnaires and two focus groups each of African American and White adults, [n=34, mean age =43.1 years, (SD 13.8 years), 44.1% African American] were conducted to understand stress, EH knowledge, app usage along with feedback from a hands-on demonstration of TT.Grounded theory using NVivo 10 was used to develop themes and combined with the questionnaires in the analysis.Results: No racial differences were found in the analysis including app use scenarios, preferences, knowledge, technology use or the attitudes and acceptance toward mobile health (mHealth) programs.Reported stress was high for African Americans [PSS-4: mean 6.87 (SD 3.3) versus mean 4.56 (SD 2.6); P=0.03]. Four main themes were found: (I) stress was pervasive; (II) coping strategies were both positive and negative; (III) BAM training was easy to incorporated; and (IV) tracking stress responses was useful.Responses suggest that additional personalization of app interfaces may drive ownership and adherence to protocols. Measures and reports of heart rate monitoring while in session were favorably viewed with low issues with confidentiality or trust issues on collected session data. Conclusions:Results suggest that a culturally tailored approach may be unnecessary in the design of BAM apps.Further investigation is warranted for other racial groups, age ranges, and disease conditions.

Health Care Professionals� Attitudes Toward, and Experiences of Using, a Culture-Sensitive Smartphone App for Women with Gestational Diabetes Mellitus: Qualitative Study (Preprint)

“…Even though mHealth can offer tailored information for different groups of people [42], there is still limited evidence on the effectiveness of culture-sensitive mHealth interventions. For instance, an evaluation of cultural tailored meditation smartphone apps concluded that a culturally tailored approach might be unnecessary [43].…”

“…There is still limited evidence on the effectiveness of culturesensitive mHealth interventions. Contrarily to another study investigating the effectiveness of a culture-sensitive smartphone application [43], our study participants stated that the Pregnant+ app could be an appropriate tool in the care of immigrant women. In line with other studies [46], participants had problems to recruit women with different ethnic backgrounds who could not speak the local language.…”

Meditation and Cardiovascular Health: What is the Link?

“…A broad variety of hypothetical and potential effects of meditation on neurophysiology and neuroanatomy have been published so far. 7,8 Anatomical and structural changes, such as tissue augmentation of the cerebral cortex, subcortical grey and white matter, as well as the cerebellum and brain stem, were discussed, and an increasing number of studies suggest that different meditation practices show distinct patterns of brain activity. 1,7,9,10 Moreover, improvement in the subjectively experienced levels of general stress, depression and quality of sleep have been reported.…”

“…7,8 Anatomical and structural changes, such as tissue augmentation of the cerebral cortex, subcortical grey and white matter, as well as the cerebellum and brain stem, were discussed, and an increasing number of studies suggest that different meditation practices show distinct patterns of brain activity. 1,7,9,10 Moreover, improvement in the subjectively experienced levels of general stress, depression and quality of sleep have been reported. 8,[11][12][13][14][15][16][17][18][19][20][21][22] Additionally, alterations on a neurophysiological level have been suggested.…”

“…However, due to a lack of sufficient sample size and randomisation, suchlike series must be assessed carefully and interpreted with caution. 7,10,20,23,24 Complex data derived from neuroimaging, such as PET or functional MRI, are promising to produce deeper insight, but are yet to be fully understood. 10…”