Digital Prompts to Increase Engagement with Stress Regulation among Parents: Feasibility and Acceptability Evaluation (Preprint)

BACKGROUND Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. Yet, uptake of preventive mental health is limited among parents due to competing family demands. OBJECTIVE We examined the feasibility and acceptability of a mobile-based intervention designed to engage parents with the Headspace app and stress regulation (ie, mindfulness) within the context of everyday life. METHODS A 30-day pilot micro-randomized trial (MRT) was conducted among a sample of parents who use Android phones. Each day during a parent-specified timeframe, 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 (EMA) and passively collected phone data were used to assess proximal engagement (yes/no) with: a) the app, and b) any mindfulness activity (with or without the app). This data was combined with baseline and exit surveys to determine feasibility and acceptability. RESULTS Over 4-months, we enrolled 16 parents. Response rate to EMA was 72.4% (165 responses/228 pushed). Most participants perceived the prompts as a general reminder (9/10, 90%) to engage in mindfulness, rather than helpful (2/10, 20%) or annoying (2/10, 20%). Only 60% (6/10) reported that the timing of prompts was helpful despite having control over the delivery window. Average time from prompt delivery to participant action (either launch the app or dismiss notification) was 185 minutes. Across participants (7/8, 87.5%), we observed higher app usage on days with prompts (31/62 days, 50%), as opposed to days without prompts (33/103 days, 32%). Time spent using the app on days with prompts (M=566 seconds, SD=378) was descriptively higher than on days without prompts (M=225 seconds, SD=276). App usage was highest during the first week and declined over each of the remaining three 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 days, 65%) and without (65/103 days, 63%) prompts. There was no observable change in emotional affect. All participants found the Headspace app helpful (10/10, 100%) and most would recommend the program to others (9/10, 90%). CONCLUSIONS Our findings indicate that a mobile-based intervention leveraging prompts and a commercial app to engage parents in stress regulation was feasible and acceptable. Results suggest that parents are more likely to engage with an app for a longer duration when prompted. Our findings can further inform the design of a just-in-time adaptive intervention (JITAI) for stress regulation of parents. CLINICALTRIAL N/A