Department of Behavioral and Social Sciences, Brown University, Providence, RI, United States.
J Med Internet Res. 2022 Aug 15;24(8):e33696. doi: 10.2196/33696.
App-based interventions provide a promising avenue for mitigating the burden on mental health services by complimenting therapist-led treatments for anxiety. However, it remains unclear how specific systems' use of app features may be associated with changes in mental health outcomes (eg, anxiety and worry).
This study was a secondary analysis of engagement data from a stage 1 randomized controlled trial testing the impact of the Unwinding Anxiety mobile app among adults with generalized anxiety disorder. The aims of this study were 2-fold: to investigate whether higher microengagement with the primary intervention feature (ie, educational modules) is associated with positive changes in mental health outcomes at 2 months (ie, anxiety, worry, interoceptive awareness, and emotional reactivity) and to investigate whether the use of adjunctive app features is also associated with changes in mental health outcomes.
We analyzed the intervention group during the stage 1 trial of the Unwinding Anxiety mobile app. The total use of specific mobile app features and the use specific to each feature were calculated. We used multivariate linear models with a priori significance of α=.05 to investigate the impact of cumulative app use on anxiety, worry, interoceptive awareness, and emotional regulation at 2 months, controlling for baseline scores, age, and education level in all models. Significant relationships between system use metrics and baseline participant characteristics were assessed for differences in use groupings using between-group testing (ie, 2-tailed t tests for continuous data and chi-square analyses for categorical data).
The sample was primarily female (25/27, 93%), and the average age was 42.9 (SD 15.6) years. Educational module completion, the central intervention component, averaged 20.2 (SD 11.4) modules out of 32 for the total sample. Multivariate models revealed that completing >75% of the program was associated with an average 22.6-point increase in interoceptive awareness (b=22.6; SE 8.32; P=.01; 95% CI 5.3-39.8) and an 11.6-point decrease in worry (b=-11.6; SE 4.12; P=.01; 95% CI -20.2 to -3.1). In addition, a single log unit change in the total number of meditations was associated with a 0.62-point reduction in the Generalized Anxiety Disorder-7 scale scores (b=0.62; SE 0.27; P=.005; 95% CI -1.2 to -0.6), whereas a single log unit use of the stress meter was associated with an average of a 0.5-point increase in emotional regulation scores (Five Facet Mindfulness Questionnaire; b=0.5; SE 0.21; P=.03; 95% CI 0.1-0.9).
This study offers a clearer understanding of the impact of engagement with app features on broader engagement with the health outcomes of interest. This study highlights the importance of comprehensive investigations of engagement during the development of evidence-based mobile apps.
基于应用程序的干预措施为减轻心理健康服务的负担提供了一个有希望的途径，通过补充治疗师主导的治疗方法来治疗焦虑症。然而，目前尚不清楚特定系统对应用程序功能的使用方式如何与心理健康结果的变化（例如，焦虑和担忧）相关联。
本研究是对 Unwinding Anxiety 移动应用程序的 1 期随机对照试验中参与度数据的二次分析，该试验旨在测试广泛性焦虑症成年人使用 Unwinding Anxiety 移动应用程序的影响。本研究的目的有两个：一是调查初级干预功能（即教育模块）的高微观参与度是否与 2 个月时的心理健康结果（即焦虑、担忧、内感受意识和情绪反应）的积极变化相关联；二是调查辅助应用程序功能的使用是否也与心理健康结果的变化相关联。
我们分析了 Unwinding Anxiety 移动应用程序 1 期试验中的干预组。计算了特定移动应用程序功能的总使用量和每个功能的特定使用量。我们使用具有事先设定的显著性水平为α=.05的多变量线性模型，在控制所有模型中的基线评分、年龄和教育水平的情况下，调查 2 个月时累积应用程序使用量对焦虑、担忧、内感受意识和情绪调节的影响。使用组间测试（即连续数据的双尾 t 检验和分类数据的卡方分析）评估系统使用指标与基线参与者特征之间的显著关系，以评估使用分组的差异。
该样本主要为女性（25/27，93%），平均年龄为 42.9（SD 15.6）岁。教育模块完成情况是中心干预组成部分，总样本中有 20.2（SD 11.4）个模块完成。多变量模型显示，完成>75%的方案与内感受意识平均增加 22.6 点相关（b=22.6；SE 8.32；P=.01；95%CI 5.3-39.8），与担忧减少 11.6 点相关（b=-11.6；SE 4.12；P=.01；95%CI -20.2 至-3.1）。此外，冥想总次数的单个对数单位变化与 7 项广泛性焦虑症量表评分降低 0.62 分相关（b=0.62；SE 0.27；P=.005；95%CI -1.2 至-0.6），而应激计的单个对数单位使用与情绪调节评分平均增加 0.5 分相关（五因素正念问卷；b=0.5；SE 0.21；P=.03；95%CI 0.1-0.9）。
本研究更清楚地了解了与应用程序功能参与度相关的应用程序功能参与度对更广泛的健康结果的影响。本研究强调了在开发基于证据的移动应用程序时全面调查参与度的重要性。
