Making time for mindfulness
Graphical abstract
Introduction
The penetration of ubiquitous technologies into every corner of our lives provides excellent opportunities for new forms of health and wellbeing interventions. [1] Among these technologies, mobile applications offer cost-effective methods of healthcare delivery. Mobile devices are carried with the user throughout the day, can connect to the internet and can deliver interventions using features such as push notifications, text based information and rich media content. These features make mobile devices particularly suitable for the delivery of mental wellbeing interventions [2]. Consequently, there is a growing market for consumer healthcare applications that deliver interventions such as stress reduction and anxiety management programs. If such technologies are to be effective vehicles for health behaviour change, then it is necessary to understand both how they are used in practice, what are the key features of experience, and what are the barriers and enablers of use. A deeper understanding of these issues will contribute to theoretical discussions about the design of e-health technologies and persuasive design (see, for example, [3], [4]). The study reported here investigated how people adopted one mental wellbeing app (Headspace, www.headspace.com), how they fitted use into their lives, and how they experienced use over time.
Section snippets
Background
Mindfulness is a growing area in the field of e-mental health, within and outside clinical practice. Mindfulness is “a state of psychological freedom that occurs when attention remains quiet and limber, without attachment to any particular point of view”. [5] Many claims have been made for the efficacy of mindfulness for mental wellbeing. Advocates argue that increased mindfulness is correlated with greater self-control [6], objectivity [7], concentration [8], capacity to deal with stress [9]
Objectives
In order to develop effective mental wellbeing technologies and improve current interventions for behaviour change, it is essential to understand the relationship between users and the technology. This involves understanding complex psychological phenomena and behaviours occurring over time, to deliver design recommendations for future development of such technologies. As noted above, although studies have demonstrated the effectiveness of mindfulness and meditation delivered through
Preparatory study: autoethnography
Autoethnography is a research method where the researcher becomes a participant in order to enter into an empathic relationship with users. For instance, O’Kane et al. [36] present an autoethnography of using a wrist blood pressure monitor over a three month period to better understand the experience of using a device to help manage a long-term health condition. Krizek [37] argues that researchers must recognise that autoethnography provides a limited, subjective insight into the user
Semi-structured interview study methods
A semi-structured interview study was carried out to explore the user experience of Headspace. Three-month download codes were donated by Headspace to give participants full access to the content. Participants downloaded the application onto their smartphones and signed up for their free three-month period of use. They were asked to use the application in a self-directed way. Semi-structured interviews were conducted prior to the trial period to explore expectations and intentions. An exit
Results
Most participants began the study with the intention to use the app on a regular basis. However, four participants came to the conclusion within three uses that they did not want to use the app. This was explored in their exit interviews and their reasons are presented below.
In presenting the findings, we begin by summarising the reported patterns of use. In subsequent sections, we present the core theme of fitting use of the app into everyday life, followed by other factors that shaped the
Discussion
In this section, we re-visit the findings, relating them to the Reasoned Action Approach (RAA) to behaviour change. The study illuminates ways in which conditions affect users of the application, and how the design of the technology facilitates and prohibits mindfulness meditation practices; we therefore also discuss implications for design, and also limitations of our study.
Conclusion
In this study, the Reasoned Action Approach was found to be a valuable theoretical framework for analysing and understanding behaviour and experience.
To be truly effective, behaviour change technologies need to work with people’s lifestyles, values and expectations. This research revealed that the primary concern of users of a mobile mindfulness application was fitting use of the application into their lives. User responses to this concern were influenced by a number of interrelated factors.
Conflict of interest
No conflicts of interest to declare.
Contributions
This paper reports on a study completed by the first author as part of his Masters research. The second author is the corresponding author.
The contributions of the authors are as follows:
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James Laurie: conducted the study, including all data collection and primary data analysis; drafted first version of this paper.
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Prof Ann Blandford: primary supervisor for Laurie’s MSc; oversaw the design of the study; gave guidance on data collection and analysis; edited the paper (through several iterative
Acknowledgments
We are grateful to Dr David Cox and Headspace for their generosity in providing access to Headspace for participants, and to all participants for their time, energy and thoughtful input.
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