Associations Between Rural-Urban Status, Health Outcomes and Behaviors, and COVID-19 Perceptions Among Meditation App Users: A Longitudinal Survey (Preprint)

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 in our sample (majority urban, White, female and of high socioeconomic status) Further research is needed to investigate meditation apps as a health promotion strategy in rural and urban populations. CLINICALTRIAL