Bhuiyan Nishat, Puzia Megan, Stecher Chad, Huberty Jennifer
College of Health Solutions, Arizona State University, Phoenix, AZ, United States.
Behavioral Research and Analytics, LLC, Salt Lake City, UT, United States.
JMIR Mhealth Uhealth. 2021 May 26;9(5):e26037. doi: 10.2196/26037.
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.
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.
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.
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.
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.
健康结果和行为方面的城乡差异已有充分记录，农村地区显著的健康差距经常受到关注。移动健康（mHealth）应用程序，如冥想应用程序，是改善健康和行为的一种新方法。在新冠疫情期间，这些应用程序可能是一项关键的健康促进策略，并且有可能用于解决农村地区的健康差距问题。然而，仅有有限的研究评估了冥想应用程序的健康结果是否与城乡居住情况相关，以及城乡人群在健康和行为方面的差距在冥想应用程序用户中是否会持续存在。
我们旨在探讨移动冥想应用程序用户的城乡状况、心理结果和身体活动之间的关联。我们还旨在探讨城乡状况与新冠疫情对压力、心理健康和身体活动的感知影响之间的关联，并探讨随着时间推移，农村和城市应用程序用户在这些结果方面的变化。
本研究是对冥想应用程序Calm的订阅者进行的一项全国性调查的二次分析。符合条件的参与者在2020年4月至6月完成了在线基线调查，并在2020年6月至9月完成了随访调查，评估了人口统计学特征、心理结果、身体活动，以及新冠疫情对压力、心理健康和身体活动的感知影响。
参与者（N = 8392）大多为女性（7041/8392，83.9%）、非西班牙裔（7855/8392，93.6%）和白人（7704/8392，91.8%）；社会经济地位较高（收入≥10万美元：4389/8392，52.3%；学士学位或更高：7251/8'392，86.4%）；居住在大都市区核心地带（城乡通勤区号1：7192/8392，85.7%）。城乡状况与基线压力、抑郁、焦虑、新冠疫情前及当前的身体活动，或新冠疫情对压力、心理健康和身体活动的感知影响均无关联。重复测量模型显示，从基线到随访，抑郁、焦虑以及新冠疫情对身体活动 的感知影响总体上有所下降，而压力或新冠疫情对压力和心理健康的感知影响随时间没有显著变化。模型还显示，城乡状况、基线时新冠疫情在全州的患病率或新冠疫情在全州患病率的变化均无显著的主效应。
我们没有发现城乡状况与心理结果（即压力、抑郁和焦虑）、身体活动，或新冠疫情对压力、心理健康和身体活动的感知影响之间存在关联。城乡状况似乎并不会导致冥想应用程序用户在结果上产生差异，应继续探索将移动健康应用程序作为城乡人群健康促进策略的应用。此外，我们的结果并未显示新冠疫情对我们样本中应用程序用户的心理结果和身体活动有负面累积影响，样本中的大多数用户为城市居民、白人、女性且社会经济地位较高。需要进一步研究，以调查冥想应用程序作为城乡人群健康促进策略的应用情况。
