(PS7-B27) Motivational Predictors of Sustained Adherence to a Mindfulness App and Implications for Dissemination

Mental health apps (MHapps) are increasingly recognized as an effective means of delivering evidence-based interventions and thereby improving treatment access. However, adherence is a significant limitation to disseminating these potential benefits. In fact, research indicates that over 90% of those who download a MHapp discontinue its use within thirty days (Neura, 2020). Additionally, the mental health symptoms that users are aiming to address through MHapps may themselves serve as barriers to adherence. For example, depressive symptoms such as anhedonia, low motivation, and lethargy can interfere with users’ ability to engage with interventions, such as MHapps, in a sustained manner (Gonzalez et al., 2011). Thus, it is important to gain a better understanding of the ways in which motivation-based factors may enhance longitudinal MHapp engagement. 

The present study longitudinally examined motivational factors as predictors of adherence to a mindfulness MHapp (Headspace; www.headspace.com). Undergraduate students (N= 66, Mage= 19.1) reporting clinically elevated depressive symptoms were enrolled in a three-month trial exploring the effectiveness of Headspace. The trial included three treatment conditions (Headspace alone; Headspace with an orientation; Headspace with a peer support group) and a waitlist control. Participants completed assessments at pre-trial baseline, Month 1, Month 2, and Month 3, and Headspace provided access to user data. 

Hierarchical Linear Modeling showed that higher baseline levels of self-regulation and perceived/expected benefit predicted fewer overall modules completed across the trial (𝛽11 = -.084, p < .001; 𝛽14 = -.059, p < .001; respectively), but both predicted greater engagement with depression-specific content (𝛽11 = .334, p = .002; 𝛽14 = .885, p < .001). Meanwhile, greater variability in timing of use predicted fewer minutes and modules completed on the MHapp over time (𝛽15 = -.011, p = .046; 𝛽15 = -.025, p < .001; respectively). Finally, higher levels of behavioral intention predicted greater engagement with depression-related content (𝛽13 = .376, p < .001). These findings suggest that using motivational interviewing skills, such as goal-setting and exploring the benefits and risks of changing behavior, may help to bolster individual motivation and, in turn, the completion of relevant content. Additionally, making clear connections between the content offered in MHapps and users’ symptoms may also prompt users to engage in content that is more applicable to their symptoms and goals. Overall, this study highlights the need for proactive discussions about adherence and intentionally building readiness for change before individuals begin using MHapps. These findings have important implications for MHapp design and stepped-care models, which will be further discussed in the poster presentation.