Characteristics and Usage Patterns Among 12,151 Paid Subscribers of the Calm Meditation App: Cross-Sectional Survey

Jennifer Huberty, Ana-Maria Vranceanu, Colleen Carney, Michael Breus, Michael Gordon, Megan Elizabeth Puzia, Jennifer Huberty, Ana-Maria Vranceanu, Colleen Carney, Michael Breus, Michael Gordon, Megan Elizabeth Puzia

Abstract

Background: Meditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking.

Objective: This study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep.

Methods: Participants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep.

Results: Respondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P<.001), physical health (χ22=102.8; P<.001), stress (χ22=128.1; P<.001), and sleep (χ22=141.4; P<.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P=.003), were more likely to use Sleep Stories (χ12=1590.2; P<.001), and were more likely to notice changes in their physical health (χ12=49.2; P<.001) and sleep (χ12=2391.1; P<.001).

Conclusions: Results highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers.

Keywords: consumer behavior; digital health; health; meditation; mhealth; mindfulness; mobile health; psychological stress; sleep.

Conflict of interest statement

Conflicts of Interest: JH is currently the Director of Science at Calm. JH has been conducting research with Calm as a partner almost 5 years before becoming the Director of Science and the Scientific Advisory Board (SAB). A-MV, CC, and MB are members of Calm’s SAB and are independent from Calm leadership. Their role is to ensure the quality of Calm’s science. There are no financial incentives from the growth of Calm to any author.

©Jennifer Huberty, Ana-Maria Vranceanu, Colleen Carney, Michael Breus, Michael Gordon, Megan Elizabeth Puzia. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 03.11.2019.

References

    1. Kabat-Zinn J, Hanh TN. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. United States: Bantam Books; 2009.
    1. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clin Psychol. 2003;10(2):144–56. doi: 10.1093/clipsy/bpg016.
    1. Burke A, Lam CN, Stussman B, Yang H. Prevalence and patterns of use of mantra, mindfulness and spiritual meditation among adults in the United States. BMC Complement Altern Med. 2017 Jun 15;17(1):316. doi: 10.1186/s12906-017-1827-8.
    1. Creswell JD. Mindfulness Interventions. Annu Rev Psychol. 2017 Jan 3;68:491–516. doi: 10.1146/annurev-psych-042716-051139.
    1. Flett JAM, Hayne H, Riordan BC, Thompson LM, Conner TS. Mobile mindfulness meditation: a randomised controlled trial of the effect of two popular apps on mental health. Mindfulness. 2019;10(5):863–76. doi: 10.1007/s12671-018-1050-9.
    1. Rusch HL, Rosario M, Levison LM, Olivera A, Livingston WS, Wu T, Gill JM. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019 Jun;1445(1):5–16. doi: 10.1111/nyas.13996.
    1. Wahbeh H, Svalina MN, Oken BS. Group, one-on-one, or internet? Preferences for mindfulness meditation delivery format and their predictors. Open Med J. 2014;1:66–74. doi: 10.2174/1874220301401010066.
    1. Kracen AC, Mastnak JM, Loaiza KA, Matthieu MM. Group therapy among OEF/OIF veterans: treatment barriers and preferences. Mil Med. 2013 Jan;178(1):e146–9. doi: 10.7205/MILMED-D-12-00213.
    1. Huberty J, Eckert R, Larkey L, Kurka J, de Jesús SA, Yoo W, Mesa R. Smartphone-based meditation for myeloproliferative neoplasm patients: feasibility study to inform future trials. JMIR Form Res. 2019 Apr 29;3(2):e12662. doi: 10.2196/12662.
    1. Lau DT, Kirby JB. The relationship between living arrangement and preventive care use among community-dwelling elderly persons. Am J Public Health. 2009 Jul;99(7):1315–21. doi: 10.2105/AJPH.2008.151142.
    1. Mohr DC, Burns MN, Schueller SM, Clarke G, Klinkman M. Behavioral intervention technologies: evidence review and recommendations for future research in mental health. Gen Hosp Psychiatry. 2013;35(4):332–8. doi: 10.1016/j.genhosppsych.2013.03.008.
    1. Silver L, Smith A, Johnson C, Taylor K, Jiang J, Anderson M, Rainie L. Pew Research Center. 2019. Mar 7, [2019-09-25]. Mobile Connectivity in Emerging Economies .
    1. Taylor K, Silver L. Pew Research Center. 2019. Feb 5, [2019-09-25]. Smartphone Ownership is Growing Rapidly Around the World, but Not Always Equally .
    1. Elavsky S, Smahel D, Machackova H. Who are mobile app users from healthy lifestyle websites? Analysis of patterns of app use and user characteristics. Transl Behav Med. 2017 Dec;7(4):891–901. doi: 10.1007/s13142-017-0525-x.
    1. Plaza I, Demarzo MM, Herrera-Mercadal P, García-Campayo J. Mindfulness-based mobile applications: literature review and analysis of current features. JMIR Mhealth Uhealth. 2013 Nov 1;1(2):e24. doi: 10.2196/mhealth.2733.
    1. Krebs P, Duncan DT. Health app use among us mobile phone owners: a national survey. JMIR Mhealth Uhealth. 2015 Nov 4;3(4):e101. doi: 10.2196/mhealth.4924.
    1. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015 Aug 19;3(3):e82. doi: 10.2196/mhealth.4328.
    1. Chan J. SensorTower. 2019. Jul 8, [2019-09-25]. Top Health & Fitness Apps in the US for June 2019 by Downloads .
    1. Capritto A. CNET: Product reviews, how-tos, deals and the latest tech news. 2019. Oct 10, [2019-09-25]. 11 Meditation Apps for Better Sleep and Less Stress
    1. Ko PT, Kientz JA, Choe EK, Kay M, Landis CA, Watson NF. Consumer sleep technologies: a review of the landscape. J Clin Sleep Med. 2015 Dec 15;11(12):1455–61. doi: 10.5664/jcsm.5288. doi: 10.5664/jcsm.5288.
    1. Upchurch DM, Johnson PJ. Gender differences in prevalence, patterns, purposes, and perceived benefits of meditation practices in the United States. J Womens Health (Larchmt) 2019 Feb;28(2):135–42. doi: 10.1089/jwh.2018.7178.
    1. Clarke TC, Black LI, Stussman BJ, Barnes PM, Nahin RL. Trends in the use of complementary health approaches among adults: United States, 2002-2012. Natl Health Stat Report. 2015 Feb 10;(79):1–16.
    1. Pengo MF, Won CH, Bourjeily G. Sleep in women across the life span. Chest. 2018 Jul;154(1):196–206. doi: 10.1016/j.chest.2018.04.005.
    1. Fitzgerald M, McClelland T. What makes a mobile app successful in supporting health behaviour change? Health Educ J. 2017;76(3):373–81. doi: 10.1177/0017896916681179.
    1. Orji R, Moffatt K. Persuasive technology for health and wellness: state-of-the-art and emerging trends. Health Informatics J. 2018 Mar;24(1):66–91. doi: 10.1177/1460458216650979.
    1. Martin SS, Feldman DI, Blumenthal RS, Jones SR, Post WS, McKibben RA, Michos ED, Ndumele CE, Ratchford EV, Coresh J, Blaha MJ. mActive: A randomized clinical trial of an automated mHealth intervention for physical activity promotion. J Am Heart Assoc. 2015 Nov 9;4(11) doi: 10.1161/JAHA.115.002239.
    1. Norman GJ, Zabinski MF, Adams MA, Rosenberg DE, Yaroch AL, Atienza AA. A review of eHealth interventions for physical activity and dietary behavior change. Am J Prev Med. 2007 Oct;33(4):336–45. doi: 10.1016/j.amepre.2007.05.007.
    1. Rabbi M, Pfammatter A, Zhang M, Spring B, Choudhury T. Automated personalized feedback for physical activity and dietary behavior change with mobile phones: a randomized controlled trial on adults. JMIR Mhealth Uhealth. 2015 May 14;3(2):e42. doi: 10.2196/mhealth.4160.
    1. Kelly S, Martin S, Kuhn I, Cowan A, Brayne C, Lafortune L. Barriers and facilitators to the uptake and maintenance of healthy behaviours by people at mid-life: a rapid systematic review. PLoS One. 2016;11(1):e0145074. doi: 10.1371/journal.pone.0145074.
    1. Naslund JA, Aschbrenner KA, McHugo GJ, Unützer J, Marsch LA, Bartels SJ. Exploring opportunities to support mental health care using social media: a survey of social media users with mental illness. Early Interv Psychiatry. 2019 Jun;13(3):405–13. doi: 10.1111/eip.12496.
    1. Ridout B, Campbell A. The use of social networking sites in mental health interventions for young people: systematic review. J Med Internet Res. 2018 Dec 18;20(12):e12244. doi: 10.2196/12244.
    1. Zhang X, Liu S, Chen X, Wang L, Gao B, Zhu Q. Health information privacy concerns, antecedents, and information disclosure intention in online health communities. Inform Manag. 2018 Jun;55(4):482–93. doi: 10.1016/j.im.2017.11.003.
    1. de Choudhury M, De S. Mental Health Discourse on Reddit: Self-Disclosure, Social Support, and Anonymity. Proceedings of the Eighth International AAAI Conference on Weblogs and Social Media; ICWSM'14; June 1-4, 2014; Ann Arbor, Michigan, USA. 2014. pp. 71–80.
    1. Kingod N, Cleal B, Wahlberg A, Husted GR. Online peer-to-peer communities in the daily lives of people with chronic illness: a qualitative systematic review. Qual Health Res. 2017 Jan;27(1):89–99. doi: 10.1177/1049732316680203.
    1. Grossman P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits. A meta-analysis. J Psychosom Res. 2004 Jul;57(1):35–43. doi: 10.1016/S0022-3999(03)00573-7.
    1. Victorson D, Kentor M, Maletich C, Lawton RC, Kaufman VH, Borrero M, Languido L, Lewett K, Pancoe H, Berkowitz C. Mindfulness meditation to promote wellness and manage chronic disease: a systematic review and meta-analysis of mindfulness-based randomized controlled trials relevant to lifestyle medicine. Am J Lifestyle Med. 2015;9(3):185–211. doi: 10.1177/1559827614537789.
    1. Zeng X, Chio FH, Oei TP, Leung FY, Liu X. A systematic review of associations between amount of meditation practice and outcomes in interventions using the four immeasurables meditations. Front Psychol. 2017;8:141. doi: 10.3389/fpsyg.2017.00141. doi: 10.3389/fpsyg.2017.00141.
    1. Schoormans D, Nyklíček I. Mindfulness and psychologic well-being: are they related to type of meditation technique practiced? J Altern Complement Med. 2011 Jul;17(7):629–34. doi: 10.1089/acm.2010.0332.
    1. Jekauc D. Enjoyment during exercise mediates the effects of an intervention on exercise adherence. Psychol. 2015;6(1):48–54. doi: 10.4236/psych.2015.61005.
    1. Lewis BA, Williams DM, Frayeh A, Marcus BH. Self-efficacy versus perceived enjoyment as predictors of physical activity behaviour. Psychol Health. 2016;31(4):456–69. doi: 10.1080/08870446.2015.1111372.
    1. Harris K, Spiegelhalder K, Espie CA, MacMahon KM, Woods HC, Kyle SD. Sleep-related attentional bias in insomnia: a state-of-the-science review. Clin Psychol Rev. 2015 Dec;42:16–27. doi: 10.1016/j.cpr.2015.08.001.
    1. Lee CW, Ree MJ, Wong MY. Effective insomnia treatments: investigation of processes in mindfulness and cognitive therapy. Behav Change. 2018;35(2):71–90. doi: 10.1017/bec.2018.10.
    1. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017 Apr;32:246–56. doi: 10.1016/j.sleep.2016.08.006.
    1. Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018 Jul;27(7):1885–91. doi: 10.1007/s11136-018-1842-3.
    1. Lallukka T, Sivertsen B, Kronholm E, Bin YS, Øverland S, Glozier N. Association of sleep duration and sleep quality with the physical, social, and emotional functioning among Australian adults. Sleep Health. 2018 Apr;4(2):194–200. doi: 10.1016/j.sleh.2017.11.006.

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