JMIR Publications

ABSTRACT

Background:

Rural-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/urban residence, and it is unclear whether disparities in health and behaviors between rural and urban populations would persist among meditation app users.

Objective:

We aimed to explore associations between rural-urban status, psychological outcomes, and physical activity among users of a mobile meditation app. We further aimed to explore associations between rural-urban status and perceived effects of COVID-19 on stress, mental health, and physical activity, and to explore changes in these outcomes in rural vs. urban app users over time.

Methods:

This study was a secondary analysis of a national survey conducted in subscribers to the meditation app, Calm. Eligible participants completed online baseline (April-June) and follow-up (June-September) surveys assessing demographics , psychological outcomes, physical activity, and perceived effects of COVID-19 on stress, mental health, and physical activity.

Results:

Participants (N=8392) were female (83.9%), non-Hispanic (93.6%), White (91.8%), had high socioeconomic status (52.3% ≥$100,000 income; 86.4% ≥bachelor’s degree) and resided in a metropolitan area core (85.7%; Rural-Urban Commuting Area 1). Rural-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-urban status, COVID-19 statewide prevalence at baseline, or change in COVID-19 statewide prevalence.

Conclusions:

We did not find associations between rural-urban status and psychological outcomes (i.e., stress, depression, anxiety), physical activity, or perceived effects of COVID-19 on stress, mental health, and physical activity. Rural-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, and research should further investigate mediation apps as a health promotion strategy during the pandemic.