Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study

Abstract

Background: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands.

Objective: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app.

Methods: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability.

Results: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50% of days), as opposed to days without prompts (33/103, 32% of days). This pattern was consistent for most participants in this study (7/8, 87%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65% of days) and without (65/103, 63% of days) prompts. Participants found the Headspace app helpful (10/10, 100%) and would recommend the program to others (9/10, 90%).

Conclusions: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health.

Keywords: Headspace; engagement; mHealth; mental health; mindfulness; mobile phone.

Figure 1

Trial design.

Figure 2

Research apps Beehive, HeadspaceTM, and App Logger.

Figure 3

CONSORT (Consolidated Standards of Reporting Trials) diagram.

Figure 4

Distribution of hour of day (from 0 to 24, after midnight) when a participant opened the Headspace app.

Figure 5

Total duration of participant engagement with app by week in study across all participants (n=8). Points represent the mean value, and error bars around each point represent a 95% CI around the mean.

Figure 6

Hours from midnight prompts were sent based on the parent-selected time frame. Each bar represents a single hour of the day, and the height of the bars represents the total number of push notifications sent at that specific hour across all participants in the study.

Figure 7

Self-reported engagement with a mindfulness activity by week in study (n=8). Points represent the average number of ecological momentary assessment (EMA) responses within a week across participants, and error bars represent a 95% CI around the mean value. Each trajectory represents a specific type of EMA response (eg, “Mindfulness without Headspace”) as indicated in the legend.