JMIR Publications

ABSTRACT

Background:

The prevalence of stress in the U.S. is at an all-time high. Experiencing chronic (i.e., long-term) elevated stress is associated with a number of mental and physical health conditions that impose a large economic burden resulting from workplace absenteeism, reduced productivity, and medical costs. Mindfulness meditation apps are a promising tool for stress management that can overcome several barriers associated with in-person interventions, but to date, poor app-based intervention adherence has limited the efficacy of these mobile health (mHealth) tools. Anchoring, or pairing, a new behavior with an existing routine has been shown to effectively establish automatic habits that can maintain behaviors over time, but this strategy typically only works for those with high initial motivation and has yet to be tested for maintaining meditation with a mobile app.

Objective:

This study will test novel combinations of behavioral economics-based incentives with the anchoring strategy for establishing and maintaining adherence to an effective dose of meditation with a mobile app.

Methods:

This 16-week study will use a five-arm, parallel, partially blinded (participants only), randomized controlled design. We will implement a fractional factorial study design that varies the use of personalized behavioral and psychological feedback and financial incentives to support participants’ use of the anchoring strategy for maintaining adherence to a ≥10 minutes per day meditation prescription during an eight-week intervention period, followed by an eight-week post-intervention observation period.

Results:

Continuous meditation app usage data will be used to measure weekly meditation adherence over the 16-week study as a binary variable equal to one if participants complete ≥10 minutes of meditation on four or more days per week, and zero otherwise. We will measure weekly anchoring plan adherence as a binary variable equal to one if participants complete ≥10 minutes of meditation within one-hour of the timing of their chosen anchor on four or more days per week, and zero otherwise. In addition to these primary measures of meditation adherence, we will also assess secondary measures of stress, anxiety, PTSD, sleep disturbance, and meditation app habit strength at baseline, week eight, and week 16.

Conclusions:

This study will fill a gap in the mHealth literature by testing novel intervention approaches for establishing and maintaining adherence to app-based mindfulness meditation. If successful, this study will identify an accessible and scalable stress management intervention that can be widely disseminated to help combat the ongoing stress epidemic in the U.S. Clinical Trial: Clinicaltrials.gov registration number NCT05217602.