Development and initial evaluation of a mobile application to help with mindfulness training and practice

https://doi.org/10.1016/j.ijmedinf.2017.05.018Get rights and content

Highlights

  • An app to help with the training and practice of mindfulness is presented.

  • The prototype takes into account some lacks detected in previous literature reviews.

  • Users perceived the app as user-friendly and helpful to obtain health benefits.

  • Usage time showed no relevant dependence on demographic variables.

  • The use of this kind of apps is a promising line of work in health and wellbeing.

Abstract

Background and objective

Different review articles support the usefulness and effectiveness of mindfulness techniques in health and wellbeing. In this paper we present a first prototype of a mobile application to help with the training and practice of mindfulness, taking into account the lacks detected in a previous literature review. Our aim was to measure acceptance and perceived quality, as well as gather data about app usage. Their dependence on demographic variables and the change in mindful level was also measured.

Materials and methods

Two versions of a new application were developed, “Mindfulness” and “Mindfulness Sci”. The application has been tested in two pilot studies: in traditional face-to-face mindfulness groups and in individual and independent use.

Results

3977 users were involved in this study: 26 in the first trial during an 8-week usage period and 3951 in the second trial during 17 months. In the first study, participants assessed the app with high scores. They considered it as a helping tool for mindfulness practice, user-friendly and with high quality of use. The positive perception was maintained after 8-weeks meditation workshops, and participants considered that its use could contribute to obtain benefits for mental and physical health. In the second study, we found rather weak associations between usage time and age, nationality and educational level. The mindful level showed a weak positive correlation with the session accomplished but slightly above the boundary of statistical significance (p-value = 0.051). Videos and information stood out as the most accessed resources.

Conclusions

Up to our knowledge, this is the first app developed with the help of health professionals in Spanish that could be used with a general aim, in health and wellbeing. The results are promising with a positive evaluation in face-to-face and independent use situations. Therefore, the number of potential users is enormous in a global worldwide context.

Introduction

Mindfulness can be defined as the awareness that emerges through paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience moment by moment [1], [2].

Different review articles support the usefulness and effectiveness of mindfulness techniques in health and wellbeing for a broad range of issues and populations [3], [4], [5], [6]. Mindfulness practice has not only been effective in clinical applications with patients [7], [8], [9], [10], [11], but has also been conceptualized in review articles as beneficial for different groups of health professionals [12], [13], [14], [15], [16].

On the other hand, research interest in mobile health (mHealth) is growing [17]. Links between smartphone technology and positive health outcomes have already been recognized in many fields, with preventive health and clinical interventions leading the way [18]. Mobile health explosion has reached mindfulness. Thus, it is possible to find different mobile applications related with mindfulness training and practice.

Mobile applications for wellbeing or happiness show interesting results: Howells et al. used Headspace app to carry out an intervention to enhance wellbeing [18]. Laurie and Blandfor studied how users adopted and experienced a mobile-based mindfulness intervention with the same mobile app [19]. Headspace was also used to examine the effects of mindfulness meditation on empathic accuracy and prosociality [20]. Parks et al. studied how happiness activities are practiced in people’s daily lives, using an iPhone application called Live Happy [21]. In this line, Wellness Diary (WD) was developed for personal wellness management based on the Cognitive-Behavioural Therapy [22].

Other mobile applications focused on specific mindfulness practices or purposes: the impact on affective experience of walking and meditative breathing [23], smartphone assisted walking meditation [24] or thought distancing [25], [26]. Mobile applications related with mindfulness were also developed as a tool in psychotherapy and clinical interventions, like reducing stress [27] or improving smoking cessation rates [28]. Ly et al. pointed out that using smartphones to distribute psychological treatment might make it possible to reach a broader group of people without fear of judgement or stigma [29].

Plaza et al. developed a systematic review of Android apps [30]. The results showed several points: the need to clarify the mindfulness concept, the existence of many apps with interfaces that are difficult to use, the lack of apps for both user and professional profiles, and a limited set of functionalities without exploring the possibilities of mobile technology. Other remarkable aspect was the need to develop apps in languages other than English since there are thousands of languages in the world and less people should be excluded from using them. These authors concluded that the potential for mobile mindfulness apps remained largely unexplored.

Afterwards, Mani et al. reviewed and evaluated iPhone apps [31]. They concluded that though many apps claim to be mindfulness-related, most were guided meditation apps, timers or reminders. Very few had high ratings on the visual aesthetics, engagement, functionality or information quality items. Little evidence of the efficacy of the apps in developing mindfulness was available.

From the previous state of the art, several conclusions can be pointed out: Mindfulness techniques are becoming relevant in health and wellbeing. Thus, the possibilities that mobile technology offers to complete the previous mindfulness tools have to be explored. Health professionals together with mindfulness professionals should review materials, in which scientifically validated test would permit evidence-based assessments and studies. Both, practitioners and professionals should be considered as potential users. It would be very convenient to contemplate usability and user-friendliness concepts in the design process. Finally, languages other than English should be explored.

Therefore, this work was motivated by the development of a new mobile app that takes into account several of the points raised in the previous reviews. In this paper, we describe the application briefly and we present the first experience with its use. The specific research goals are described below.

Section snippets

Objectives

The mobile app has been tested in two different scenarios. In the first study the app was used as a support tool in traditional face-to-face mindfulness training and practice. The goal of the research was to know the acceptance and the perceived quality of the prototype. Dependence on demographic variables was also measured.

In the second study, people utilised the app in their everyday contexts without additional controlled support. The goal of this study was to gather data about app usage:

Materials

Two versions of a new application were developed, “Mindfulness” and “Mindfulness Sci”. The “Scientific” version automatically collects usage data with research aim in an anonymous way. Fig. 1 shows several screenshots of the application [32].

The app consists of three main sections: “What is Mindfulness?”, “My virtual coach” and “My practices”.

The first section provides a short definition of mindfulness. It tries to clarify it, so that the expectations of potential users can be suitably

Subjects

Subjects were recruited among the participants of four traditional face-to-face mindfulness workshops that lasted 8 weeks. Sixty-two people attended these workshops. Twenty-six of them (38%) agreed to participate in this study. All subjects received oral and written information about the study, and written information consent was obtained from them.

Methods

A questionnaire consisting of sixteen items was designed based on:

  • The System Usability Scale (SUS) [36]: Ten items filled after the first contact

Subjects

The subjects were those who downloaded the application from Google Play (“Sci version”), without any kind of previous launch campaign. This study comprises the data obtained during 17 months, where 3951 people downloaded the app. The user was informed about automatic and anonymous data collection for research purposes the first time the application was started. Accepting this agreement was compulsory in order to proceed and use the app.

Methods

When using “Mindfulness Sci” for the first time, users were

Discussion

In this paper, we have presented the first experiences with a mindfulness application developed in Spanish to help with mindfulness practice and training. It takes into account some lacks detected in previous literature and targets a wide population.

In the first trial, the resulting SUS score was 81.63 ± 16.08. According to Bangor et al., this means 4th quartile in Quartile Ranges, Acceptable, in Acceptability score and between Good and Excellent in Adjective Rating Scale [41]. In an overall view

Conclusions

In this paper we have presented a new app in Spanish to help with the practice and training of mindfulness. It has been developed with the assistance of health professionals. The app targets a wide population and includes a comprehensive coverage of mindfulness. The evaluation and usage data in two different scenarios have been presented: as a support in a face-to-face mindfulness training program and in uncontrolled and personal use after downloading it from the online store. The app has been

Conflicts of interest

None declared.

Authors’ contributions

Conception and design of the work (IP, CM), Development of materials (IP, IG-M, GA, JG-C), Data collection (IP, CM, AS), Data analysis and interpretation (IP, CM, AS), Drafting the article (IP, CM, AS), Final approval of the version to be published (IP, CM, AS, IG-M, GA, JG-C).

Summary table

What was already known?

  • Mindfulness techniques are becoming relevant in health and wellbeing for a broad range of issues and populations.

  • Research interest in mobile health (mHealth) is growing and has reached

Acknowledgments

Authors are grateful to Mr. Antonio Ortega and Dr. Marcelo Demarzo for their previous ideas and collaboration in this work. This work was supported by the “Fondo Social Europeo”, the “Gobierno de Aragón” and The Ministry of Economy and Competitiveness (Project reference TEC2013-50049-EXP).

References (67)

  • M.J. Handel

    mHealth (Mobile Healt) – using apps for health and wellness

    Explore

    (2011)
  • S.J. Miah et al.

    Healthcare support for underserved communities using a mobile social media platform

    Inf. Syst.

    (2017)
  • U. Varshney

    A model for improving quality of decisions in mobile health

    Decis. Support Syst.

    (2014)
  • W. Brown et al.

    Assessment of the health IT usability evaluation model (Health-ITUEM) for evaluating mobile health (mHealth) technology

    J. Biomed. Inform.

    (2013)
  • M.M.P. Demarzo et al.

    The implementation of mindfulness in healthcare systems: a theoretical analysis

    Gen. Hosp. Psychiatry

    (2015)
  • J. Kabat-Zinn

    Mindfulness-based interventions in context: past, present, and future

    Clin. Psychol.: Sci. Pract.

    (2003)
  • R.A. Baer

    Mindfulness training as clinical intervention: a conceptual and empirical review

    Clin. Psychol.: Sci. Pract.

    (2003)
  • P. Sedlmeier et al.

    The psychological effects of meditation: a meta-analysis

    Psychol. Bull.

    (2012)
  • M. Goyal

    Meditation programs for psychological stress and well-being: a systematic review and meta-analysis

    JAMA Internal Med.

    (2014)
  • C.C. Dean

    A Review of the Literature on Mindfulness-Based Treatments for Patients with Cancer Master's Thesis

    (2009)
  • S.G. Hofmann et al.

    The effect of mindfulness-based therapy on anxiety and depression: a meta-analytic review

    J. Consult. Clin. Psychol.

    (2010)
  • K.W. Chen et al.

    Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials

    Depress. Anxiety

    (2012)
  • M.D. Stauffer

    Mindfulness in Counseling and Psychotherapy: A Literature Review and Quantitative Investigation of Mindfulness Competencies PhD Dissertation

    (2017)
  • D.M. Davis et al.

    What are the benefits of mindfulness? a practice review of psychotherapy-related research

    Psychotherapy

    (2011)
  • J.K. Swift et al.

    A multi-site study of mindfulness training for therapists

    Psychother. Bull.

    (2015)
  • J.A. Irvinga et al.

    Cultivating mindfulness in health care professionals: a review of empirical studies of mindfulness-based stress reduction (MBSR)

    Complement. Ther. Clin. Pract.

    (2009)
  • K. Raab

    Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature

    J. Health Care Chaplain.

    (2014)
  • M. Fiordelli et al.

    Mapping mHealth research: a decade of evolution

    J. Med. Internet Res.

    (2013)
  • A. Howells et al.

    Putting the ‘app’ in happiness: a randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing

    J Happiness Stud.

    (2014)
  • D. Lim et al.

    Mindfulness and compassion: an examination of mechanism and scalability

    PLoS One

    (2015)
  • A. Parks et al.

    Pursuing happiness in everyday life: the characteristics and behaviors of online happiness seekers

    Emotion

    (2012)
  • E. Mattila et al.

    Mobile diary for wellness management – results on usage and usability in two user studies

    IEEE Trans. Inf. Technol. Biomed.

    (2008)
  • Y. Meng-Chieh

    Multimedia-assisted Breathwalk-aware system

    IEEE Trans. Biomed. Eng.

    (2012)
  • Cited by (24)

    • The efficacy of mindfulness meditation apps in enhancing users’ well-being and mental health related outcomes: a meta-analysis of randomized controlled trials

      2021, Journal of Affective Disorders
      Citation Excerpt :

      Moreover, individual RTCs have found comparable effects to face-to-face interventions (Compen et al., 2018) and demonstrated that an online mindfulness course significantly reduced stress and these gains remained stable at follow-up (Krusche et al., 2012). Mobile technology provides a further platform for delivering mindfulness interventions (Garcia et al., 2017), but evidence of effectiveness has been mixed. Two recent meta-analyses on app-supported smartphone interventions for mental health problems found that these outperformed the control conditions for outcomes of distress, quality of life, symptoms of depression and anxiety (Linardon et al., 2019).

    • Intermittent mindfulness practice can be beneficial, and daily practice can be harmful. An in depth, mixed methods study of the “Calm” app's (mostly positive) effects

      2020, Internet Interventions
      Citation Excerpt :

      Indeed, contradictory evidence suggests that daily practice is not necessary for positive outcomes. In 13 of the 24 mindfulness studies reviewed by Vettese et al. (2009), there was no association between practice and outcome, a finding Plaza García et al. (2017) replicated using a mindfulness app. The present study aims to determine whether the use of a particular mindfulness app is associated with positive outcomes, and whether daily practice is necessary for these outcomes to be realised.

    • ABS-MindBurnout: An agent-based simulator of the effects of mindfulness-based interventions on job burnout

      2019, Journal of Computational Science
      Citation Excerpt :

      For instance, Mani et al. [8] reviewed the iPhone apps that supported the practice of mindfulness, while Plaza et al. [9] had previously reviewed the mindfulness-based mobile applications for Android platform. In addition, the recent “in-the-large” evaluation analysis of Plaza García et al. [10] of a Spanish app for training mindfulness shows that users (n = 3977) perceived this app as good for the well-being and health. Nowadays, the design of mindfulness programs is usually done without any decision support system, to the best of the authors’ knowledge.

    • Facilitating Mindful Eating with a Voice Assistant

      2023, Proceedings of the 5th International Conference on Conversational User Interfaces, CUI 2023
    • Mobile Application: Inductions in a Retail Company

      2023, International Journal of Engineering Trends and Technology
    View all citing articles on Scopus
    View full text