Introduction

Technologically-mediated spiritual practices are becoming increasingly more common. The COVID-19 pandemic offered a glimpse into new ways by which individuals are engaging in religious and spiritual practices. Prior research has documented the associations between religious and spiritual practices with physical and mental health (Koenig, 2012; Paul Victor & Treschuk, 2020; Peteet, 2022). However, little is known about how practices that rely on technological media are similar to or differ from traditional religious and spiritual practices. The purpose of the current research was to begin to examine the perceptions of users of digitally mediated religious and spiritual practices.

Religion may be a boon for health. For example, religious individuals have a lower risk of mortality than non-religious individuals (Powell et al., 2003), and religion appears to lower risk for a wide range of physical health problems (Ellison & Levin, 1998). There also appears to be several benefits of religion for mental health; religious individuals often report higher levels of well-being and lower levels of mental health symptoms such as depression and anxiety (Peteet, 2022). Various mechanisms have been proposed for the religion-health link (Ellison & Levin, 1998), such as the regulation of individual lifestyles and behaviors (McCullough & Willoughby, 2009), social integration and support (Ellison & George, 1994), meaning in life (Steger & Frazier, 2005), and religious/spiritual coping (Pargament et al., 1998).

Approximately three out of four Americans report they identify with a specific religious faith, with Christians (69%) representing the largest percentage and approximately one in four Americans being Christians of color (26%) (Jones et al., 2021). The majority of Black Americans (79%) report they are affiliated with a religion and rely on prayer to help make major life decisions (Besheer et al., 2021). In 2020, almost 50% of adults belonged to a church, synagogue, or mosque (Jones, 2021). However, more recently, there has been a gradual and steady decline of individuals who identify as religious, especially as younger, less religious cohorts replace older and more religious populations (Packard & Ferguson, 2019). A Pew survey (2018) revealed that many individuals are now practicing their faith in “other ways”; seeking spiritual connections outside traditional religious structures (Center, 2018). For example, in 2020, the COVID-19 pandemic forced religious institutions to shut their doors to the public, which directly impacted the 36% of adults who attended religious institutions weekly (Pillay, 2020). As such, some in-person religious practices have shifted to digital formats, allowing individuals to continue their religious practice and sense of religious community online (Baker et al., 2020). Digital accessibility to religious practices may help mitigate daily obstacles, such as occupational and family demands, time, transportation, and overall cost of attending in-person religious services, allowing individuals to adapt to the demands of their lives while maintaining their religious/spiritual practices.

Although technology-mediated religious experiences may be increasing, research in this domain is lacking. Since 2020, religious and prayer-based applications (i.e., apps) have been burgeoning in the consumer market, increasing threefold since 2019 (Taylor, 2021). More people are turning towards digital media to facilitate their spiritual experiences, such as participating in chat groups with pastors, viewing online sermons, listening to religious podcasts, and engaging with religious content on social media (Melore, 2022). Modern technology is making organized religion much more appealing and accessible for millennials and younger generations (Melore, 2022). According to market research from PitchBook Data, venture capital funding for religious (primarily Christian-based) apps increased from $48.5 million in 2020 to $176.3 million in 2021 (Taylor, 2021), suggesting there is an increasing demand for app-based religious practices. Despite the growth in use of and investment in technology-mediated religious experiences, no studies have explored how users are engaging in these technologies and how they may be impacting health.

To examine our research question, we focused on one of the largest religious and prayer-based apps on the market. Pray.com is the world’s No. 1 app for daily prayer, with more than 12 million downloads. Content of the Pray.com app includes daily devotionals, Bible stories with original content, and Bedtime Bible stories narrated by inspirational speakers, faith leaders, or celebrities to help users sleep.

Given the increase of digitally-mediated spiritual practices and the lack of extant research in this area, the purpose of this study was to explore the usage patterns of United States (US) subscribers of an online religious/spiritual app (i.e., Pray.com) and the associations of app usage with physical health (i.e., overall physical health and sleep), mental health (i.e., overall mental health, stress, anxiety, depression, burnout), spiritual health (spiritual well-being, relationship with God, prayer life), and well-being (e.g., meaning and purpose in life) outcomes. Such findings will inform future interventions to test the effects of digital-based approaches for delivering religious/spiritual practices on mental health outcomes.

Methods

Ethics Approval

This study was approved by an Institutional Review Board at Biola University (STUDY F22-012). All participants provided electronic consent prior to participating in the survey. The deidentified datasets generated or analyzed during the study are available from the corresponding author upon request.

Study Design/Recruitment

This study was cross-sectional. Participants were paying US subscribers to the mobile application, Pray.com, who were at least 18 years of age. Subscribers were recruited from October 2022 to November 2022.

Participants and Procedure

Subscribers received an invitation to answer a series of quantitative questions related to their use of Pray.com and were informed that their answers would help improve their experience with the app and that results of this study may be used in reports, presentations, or publications. Potential participants were invited via push notifications, in-app messages, text messages, and emails. At the end of the survey, participants had the option of providing an email address to be entered into a drawing to win one of two $99 Amazon gift cards. No other identifying information was collected, and responses were not linked to the email provided or in-app usage data.

Survey

The survey was developed by doctoral-level researchers in the field of psychology, behavior change, and religious/spiritual practices. The survey was administered online using Qualtrics and took most participants between 5 and 10 min to complete. All responses were kept separate from email addresses provided. Participants were asked to complete approximately 25 multiple-choice quantitative questions (not including demographics) about their engagement with the Pray.com app (e.g., frequency of use, reasons for using the app, content used, app features that support usage frequency) and whether they noticed improvements in health outcomes (e.g., physical health, mental health, stress, sleep, anxiety, depression, burnout, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life) after using Pray.com. Questions varied slightly based on answers to the frequency of use. At the end of the survey, participants completed six questions about demographic characteristics.

Statistical Analysis

Data were analyzed using IBM SPSS 27.0. For questions about demographic characteristics, reasons for starting to use Pray.com, the content of Pray.com used, app features that support usage frequency, and noticing health outcome improvements, participants were able to endorse multiple items from a list of options; selected items were treated as endorsements and unselected options were treated as non-endorsements. Chronic condition(s) were recoded as dichotomous (e.g., yes/no) and additionally recoded to reflect a chronic mental health condition (e.g., yes/no) and a chronic physical health condition (e.g., yes/no). Because respondents were able to endorse multiple chronic conditions, individual chronic condition(s) were recoded as dichotomous (e.g., yes/no). Because not all participants answered every question (i.e., survey was free response), sample sizes differed across analyses.

We report the data from all available completed data. Usage frequency was categorized as ordinal, reflecting use of the app or content of the app as (1) non-endorsed, (2) up to two times per week, (3) three to five times per week, or (4) five or more times per week. Variables for noticing improvements in health outcomes (i.e., physical health, mental health, stress, sleep, anxiety, depression, burnout, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life) were ordinal reflecting: (1) no improvement, (2) A little improvement, (3) Some improvement, (4) Moderate improvement, (5) Significant improvement, and (6) Extreme improvement. Improvements in health outcomes were also recoded as dichotomous (i.e., significant to extreme improvement / non-endorsed to some improvement). Chi-square tests examined differences in self-reported dichotomous improvements in health outcomes based on frequency of app use and demographic characteristics (i.e., race, age, gender). In all cases, significant chi-square tests were followed up with z-tests of column proportions. P values were adjusted for multiple comparisons using Bonferroni correction. Because respondents were able to endorse multiple reasons for starting Pray.com and multiple types of content used and given the large number of answer choices for each of those questions, the relationships between reasons for starting and content used were described and detailed, but not statistically compared.

Results

Demographic Characteristics

A total of 1031 subscribers participated in the survey (see Table 1 for participation rates by invitation medium). The average age of respondents was 57 (SD = 12.42), with Gen X (i.e., 42–57 years of age; 35.31%, 64/1031) and Boomers (i.e., 58–67 years of age; 30.16%, 311/1031) being the most-represented age groups. Approximately two-thirds of respondents were female (68.87%, 710/1031). Most respondents identified as White (55.77%, 575/1031) and 26.29% identified as Black or African American (271/1031). Most respondents reported at least one chronic health diagnosis (62.85%, 648/1031) with physical health conditions more prevalent than mental health conditions (54.03%, 557/1031 vs. 35.21%, 363/1031). Sample demographics are presented in Table 2.

Table 1 Participation rates by invitation medium
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Table 2 Sample demographics (N = 1031)
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General App Usage Patterns

Length and Frequency of Use for Pray.com

Most respondents reported having used Pray.com for at least one year (59.94%, 618/1031; see Table 3). More than half of respondents were high-frequency users (i.e., more than five times per week; 58.78%, 606/1031) or moderate-frequency users (i.e., three to five times per week; 24.35%, 251/1031).

Table 3 App usage (N = 1031)
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Reasons for Starting to Use Pray.com

The most common reason for starting to use Pray.com was to grow spiritually (87.78%, 905/1031; see Table 3). A substantial proportion of the sample also started using Pray.com because of the desire for improvements in mental and physical health as reasons for starting.

Content and Feature Use

The most widely used content on the app were Daily Prayer and bible reading. For example, Daily Prayer was the most popular content used (87.20%, 899/1031; see Table 4). Other popular content used by participants included Bible in a Year (46.75%, 482/1031), Bible Stories (42.39%, 437/1031), Bedtime Bible Stories (33.75%, 348/1031), and Meditative Prayers (32.88%, 339/1031).

Table 4 Self-reported app content and feature use
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Regarding features of the app that helped participants use the app more regularly, approximately 50% of respondents used Daily Prayer reminders to encourage them to use the app. Other features were used less often. Less than 20% of respondents used other in-app features that support usage frequency (e.g., Share Streaks, app tracking, Prayer Journal, Pray.com community). Approximately one-third of respondents had friends or family that used Pray.com, but utilization of the in-app community feature was low (6.79%; see Table 4). Of those with friends that used Pray.com, over 70% discussed the app among themselves.

Improvements in Health Outcomes

Most respondents reported improvements in spiritual well-being outcomes [relationship with God (66.54%, 685/1031), prayer life (58.20%, 600/1031), and spiritual well-being (57.13%, 589/1031; see Table 4)]. Between 30 and 40% respondents reported improvements in overall mental health and stress, and well-being (i.e., meaning and purpose in life) while approximately 30% reported improvements in sleep and anxiety. Less than 20% of respondents reported improvements in physical health, depression, and burnout. Of those who reported improvements in their spiritual health, approximately 70% (see Table 5) considered their improvements in these areas to be “Significant”, or “Extreme”. Of those who reported improvements in mental health (overall mental health, stress, anxiety, depression, burnout), the majority considered their improvement to be “Significant”, or “Extreme”. Approximately 6% of respondents reported no improvements in any of the outcomes.

Table 5 Self-reported improvements in health outcomes
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Differences Between Frequency of Use and Noticing Moderate to Extreme Improvements

There were several differences in self-reported improvement based on app usage frequency (see Table 6 for percent reporting improvement by group and omnibus comparisons).

Table 6 Frequency of use and noticing improvements in health outcomes
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Physical Health Outcomes

High-frequency users were significantly more likely than moderate-frequency users to report significant to extreme improvements in overall physical health (χ22= = 9.88, p = .007), but low-frequency users were not significant compared to high- or moderate-frequency users regarding noticing significant to extreme improvements in physical health.

Mental Health Outcomes

High-frequency users were more likely than low- and moderate-frequency users to report significant to extreme improvements in overall mental health (χ22= = 14.53, p < .001) and stress (χ22= = 15.19, p < .001); however, low- and moderate-frequency users did not significantly differ from each other. High-frequency users were more likely than low-frequency users to report significant to extreme improvements in anxiety (χ22= = 15.61, p < .001), but moderate-frequency users did not significantly differ from either group. Frequency of use was not related to the likelihood of reporting significant to extreme improvements in depression and burnout.

Spiritual-Well-Being

High-frequency users were more likely than low-frequency users to report significant to extreme improvements in spiritual well-being (χ22= = 38.04, p < .001), but moderate-frequency users were not significant compared to high- or low-frequency users regarding noticing significant to extreme improvements in spiritual well-being. High-frequency users were more likely than moderate- and low-frequency users to report significant to extreme improvements in their relationship with God (χ22= = 29.95, p < .001), and prayer life (χ22= = 33.03, p < .001).

Well-Being

High-frequency users were more likely than moderate-frequency users to report significant to extreme improvements in meaning and purpose in life (χ22= = 6.25, p = .044); but low-frequency users were not significant compared to high- or moderate-frequency users.

Differences Between Reasons for Starting Pray and Noticing Significant to Extreme Improvements

Regarding the most popular reasons for starting to use Pray.com, meaning and purpose was associated with improvements in overall physical and mental health, stress, spiritual well-being, relationship with God, and prayer life (see Table 7 for percent reporting improvement by group and omnibus comparisons). Using Pray to reduce stress was significantly associated with improvements in sleep, relationship with God, and prayer life (see Table 7 for percent reporting improvement by group and omnibus comparisons). To grow spiritually was not significantly associated with improvements in any health outcomes measured.

Table 7 Reasons for starting and noticing improvements in health outcomes
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Differences Between Content Use and Noticing Significant to Extreme Improvements

Regarding the most popular content used, Daily Prayer was associated with the increased likelihood of reporting significant or extreme improvements in overall physical health, overall mental health, stress, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life. The use of Bible in a Year was associated with the increased likelihood of reporting significant or extreme improvements in overall mental health, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life. The use of Bible Stories was associated with the increased likelihood of reporting significant or extreme improvements in stress, sleep, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life (see Table 8 for percent reporting improvement by group and omnibus comparisons).

Table 8 Content used and noticing improvements in health outcomes
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Differences Across Demographic Groups

Race

Because the two largest racial groups in our sample were White and Black participants, we tested for differences between these two groups. There were significant differences in the likelihood of reporting improvements in health outcomes, reasons for starting to use Pray.com, content used, and length of use across racial groups (see Table 9 for percent reporting improvement by group and omnibus comparisons). Black or African American respondents were more likely than White respondents to report moderate to extreme improvements in overall physical health (χ21= = 12.00, p < .001), overall mental health (χ21= = 11.59, p < .001), stress (χ21= = 10.21, p < .001), anxiety (χ21= = 5.94, p = .015), depression (χ21= = 7.45, p = .006), spiritual well-being (χ21= = 6.96, p = .008), prayer life (χ21= = 14.74, p < .001), and meaning and purpose in life (χ21= = 6.60, p = .010). Black or African American respondents were more likely than White respondents to report starting to use the app for help coping with a crisis (χ21= = 4.35, p = .037) and if a friend recommended the app (χ21= = 16.13, p < .001), and Black or African American respondents were more likely than White respondents to report using Meditative Prayer (χ21= = 5.70, p = .017) and Reading the Bible (χ21= = 8.23, p = .004). Black and African American respondents were more likely than White respondents to report having used the app for two or more years (χ21= = 18.35, p < .001), whereas White respondents were more likely than Black or African American respondents to have used the app for one to two years (χ21= = 9.98, p = .002). There were no significant differences across race with regard to frequency of use.

Table 9 Self-reported improvements by race
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Age Group

There were significant differences in the likelihood of reporting significant to extreme improvements in health outcomes across age groups (see Table 10 for percent reporting improvement by group and omnibus comparison). Gen X respondents (i.e., ages 42–57) were more likely than older respondents (i.e., 68–84 years of age) to report significant to extreme improvements in prayer life (χ24= = 19.76, p < .001). Other significant findings reported in Table 7 may be invalid due to small cell sizes (n < 5). There were no significant differences across age group with regard to frequency of use.

Table 10 Self-reported health improvements by age group
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Gender

There were no significant differences in self-reported improvement or frequency of use across genders.

Discussion

The purpose of this study was to explore technologically-mediated religious and spiritual practices. Namely, we examined the usage patterns of subscribers of a popular religious-based app (i.e., Pray.com), a mobile app designed to facilitate religious/spiritual practices, as well as the associations of usage with physical health, mental health, spiritual well-being, and well-being outcomes. This is one of the first investigations to explore usage patterns and associations with health outcomes among religious/spiritual mobile app users.

Most of the respondents had been using the app between one and two years, and more than half were high-frequency users (i.e., more than five times per week). Although almost all the app subscribers reported that they used the app to grow spiritually, many participants also reported that they started to use the app because of mental and physical health concerns. For example, almost half used the app to reduce stress and one-third used the app to reduce anxiety. Regarding the content most used by participants, daily prayer was the most popular component of the app.

The majority of respondents reported improvements in their relationship with God, over one-third reported improvements in their overall mental health and stress, and almost one-third reported improvements in their sleep and anxiety. Reporting improvements in overall mental health and stress was more likely in high- and moderate-frequency users as compared to low-frequency users. There were differences in self-reported improvements in health outcomes based on frequency of app use and race and age.

Most respondents reported being long-term (i.e., using the app for more than one year) and moderate to high-frequency users (i.e., using the app at least three times per week). The most common reason for starting to use the app was to grow spiritually and many participants also started to use the app for mental and physical health benefits. Consistent with this purpose of using the app, many participants noticed improvements in overall physical and mental health. Given the prior research on the salutary effects of religion on health (Ellison & Levin, 1998; Koenig, 2012; Powell et al., 2003), it is unsurprising that individuals would turn toward mobile apps designed to facilitate religious involvement as a way to maintain their religious practice when and where it was convenient (Bellar, 2017) and also to enhance their physical and mental health. Because prior work on technology-mediated religious activities and health-related outcomes is largely nascent, this work contributes to this growing area.

Daily Prayer was the most popular app content used and approximately half of respondents used the in-app feature, Daily Prayer reminders, to support usage frequency. Many respondents had friends who also used Pray.com, but usage of the in-app community feature was low. Our findings suggest the majority of users engage in prayer privately as a way to enhance their health and well-being, despite the conflicting (if not limited) scientific evidence that doing so has health benefits (Breslin & Lewis, 2008; Masters & Spielmans, 2007). Interestingly, although social support is one of the key mechanisms that has explained the link between religious involvement and health benefits (George et al., 2009), it appears that engagement in the mobile app (at least in our sample) is primarily a private activity. Future research is warranted to explore ways to engage practitioners with in-app communities and the impact that this might have on using the app and the health benefits associated.

Almost half of the respondents used the app to reduce stress and one-third to reduce anxiety. Over one-third reported improvements in their overall mental health and stress, whereas almost one-third noticed improvements in their sleep and anxiety. In general, respondents reported noticing improvements in the domain that brought them to the Pray.com app. For example, almost half of those who used the app for stress reported improvements in stress. It is not surprising that users are turning to a religious app to help them with their stress and anxiety, as belief systems play a beneficial role in coping with stressful experiences, especially those that are difficult to explain (Koenig, 2018; Pargament et al., 2000). It is also not surprising that of those who used the app to reduce stress, almost half reported improvements in overall mental health and stress. A study by McCullough et al. suggests those who are affiliated with a religion and have high levels of religious involvement are at reduced risk for depressive symptoms and disorders (McCullough & Larson, 1999). These findings support that technology-mediated religious experiences, such as Pray.com, are associated with increased self-reported mental health improvements and symptom-specific improvements. More research is needed to explore the effects that engagement with religiously-based mobile apps has on mental health.

When examining self-reported improvements, we found that greater improvements in overall mental health and stress were reported among high and moderate-frequency users compared to low-frequency users. High-frequency users were more likely to report improvements in several domains as compared to lower-frequency users. This suggests a possible dosage effect in self-reported improvement, such that greater use of religious technology is related to increased self-reported improvement. These findings warrant the need to better understand the behavior of low-frequency users and explore ways to increase engagement. Future research could test in-app education on the “ideal” usage for potential improvement in health outcomes or explore various motivations in high-frequency vs. low-frequency users.

We also explored the relationship between demographic characteristics (i.e., gender, age, race) and frequency of using the app but found no significant associations between age, gender, or race and frequency of use. Although there were no significant demographic differences in app usage, there were some significant demographic differences regarding health improvements from using the app. With regard to race, Black or African American respondents were more likely than White respondents to report improvements in overall physical health, overall mental health, stress, anxiety, depression, spiritual well-being, prayer life, and meaning and purpose in life. This is consistent with previous research that has found that African Americans have a more elaborate prayer life, including higher rates of praying for guidance for one’s health (Krause & Chatters, 2005). In addition, Chatters et al. (2008) found African Americans were more likely to endorse the importance of prayer when dealing with stress and more likely to look to God for strength, support, and guidance compared to non-Hispanic Whites. Prior research has also suggested higher levels of religious participation among African Americans (Taylor et al., 1996), as well as the strong influences of religion/spirituality in African American culture (Johnson et al., 2005). Previous literature posits that Black individuals may be more likely to reap the health-related benefits of religion because they are more involved in it (Krause, 2002). For example, Black respondents who attended church more frequently reported a greater decline in somatic depressive symptoms, whereas church attendance was not associated with somatic depressive symptoms among White respondents (Krause, 2003). Further research is needed to understand why Black or African American respondents were more likely than White respondents to report improvements in overall physical and mental health, stress, anxiety, depression, spiritual well-being, prayer life, and meaning and purpose in life after participating in digital religious practices regardless of frequency of use.

With regard to age, there was a significant association between generational age groups and self-reported health outcomes. Gen X respondents (i.e., ages 42–57) were more likely than older respondents (i.e., 68–84 years of age) to report significant to extreme improvements in prayer life (χ24= = 19.76, p < .001). This may be due to Gen X having more experience/comfort using mobile apps. Gen X didn’t use the app more, but their experience/comfort may have contributed to improvements in prayer life as their comfort with technology is more comparable to that of millennials than older generations (Calvo-Porral & Pesqueira-Sanchez, 2020).

Finally, we explored the relationship between reasons for using the app and self-reported improvements in health outcomes, as well as the relationship between content use and health outcomes. Previous research has demonstrated that religion is a primary pathway for meaning in life. Specifically, prior studies have found that meaning is the conduit through which religion enhances well-being (Chamberlain & Zika, 1992; Ivtzan et al., 2013; Steger & Frazier, 2005). Consistent with this, participants reporting using the app to increase meaning and purpose was associated with improvements in overall physical and mental health, stress, spiritual well-being, relationship with God, and prayer life. This suggests that motivations to enhance meaning as associated with flourishing and spiritual engagement. When participants reported using the app to reduce stress, it was significantly associated with improvements in sleep, relationship with God, and prayer life. Indeed, such associations are consistent with prior research demonstrating the role of religion in mitigating stress (Pargament & Park, 2019; Park, 2005) and its associations with health (Graham et al., 2001; Siegel et al., 2007). Interestingly, indicating the use of the app to grow spiritually was not significantly associated with improvements in any health outcomes measured. Given previous research documenting associations between spirituality and mental health (Hall, 2004), we encourage future research to explore this relationship further.

Of the top three most popular content used, the use of Daily Prayer was significantly associated with improvements in overall physical health, overall mental health, stress, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life. Although the cross-sectional nature of this study precludes causal statements, it is possible that regular engagement in a daily activity is associated with greater self-reported flourishing and well-being. Certainly, greater religious involvement (Ellison, 1991) and religious rituals or habits (Sohi et al., 2018) have been linked with well-being. Similarly, the use of Bible in a Year was significantly associated with improvements in overall mental health, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life, and the use of Bible Stories was associated with significant improvements in stress, sleep, anxiety, spiritual well-being, relationship with God, prayer life, and meaning and purpose in life. Although there are myriad reasons why individuals may seek out particular content, and cross-sectional designs are limited in their explanatory power, these associations should be further explored in longitudinal designs; moreover, respondents were able to endorse multiple reasons for starting to use Pray.com and content used, so future feasibility studies should also be conducted.

Limitations

This was a descriptive, survey-based study and there are a number of important limitations to consider. First, the sample was a convenience sample of Pray.com users who used the app quite frequently, had been using the app for quite some time, and most respondents were female and identified as White. Additionally, the survey did not include those who used the app less than up to two times per week, decreasing participation rates of infrequent users. Future research should explore perceptions in more diverse samples in terms of gender, race/ethnicity, and pattern of usage. Second, the survey was designed specifically for this study by investigators. Because of space constraints, the survey was brief and consisted of mostly single-item measures. Future studies could extend the findings of this paper by using validated measures and questionnaires to assess mental health. Third, with regard to Pray.com content use, many respondents used Daily Prayer, Bible in a Year, and Bible Stories, and it is difficult to parse out the unique effects of these components. Future research could randomize participants to use one specific religious content to assess the benefits of specific content on mental health. This information could be presented alongside qualitative data to inform future experimental studies. Fourth, the retrospective ratings of self-improvement are subject to bias. For example, people may overreport improvement in areas where there may have objectively been little change (Jayawickreme et al., 2021). Future research should employ longitudinal designs to assess these dimensions over time, rather than relying on retrospective self-reports. Fifth, the investigators did not ask follow-up questions for respondents that did not see improvements. Although the percentage of people who did not report an improvement in the outcomes measured was low, future research should ask follow-up questions to better understand if no improvement was observed or if symptoms or perceptions of the outcome may have worsened. Sixth, the investigators did not ask questions regarding if respondents attend in-person religious practice or are involved in a religious community outside of the Pray.com app. Participation in a religious community outside Pray.com participation may have impacted the findings and future work should explore this possibility. Lastly, a cross-sectional, nonexperimental study design yields no evidence for causation or direction. We cannot infer causality regarding the impact of Pray.com as the analyses relied on subscribers’ self-reported recollection of app usage, perceptions of improvement in various health outcomes, and their beliefs about how Pray.com has impacted them. Future studies should explore these relationships prospectively, and randomized clinical trials are needed to determine the extent to which improvements in health outcomes can be attributed to Pray.com usage.

Conclusion

Individuals are becoming increasingly exposed to technology-mediated religious activities. However, previous research has not explored this new frontier of religion and spirituality. This is the first study to explore the usage patterns of a sample of paid subscribers of a religious/spiritual mobile app (i.e., Pray.com) and the associations of usage with self-reported health outcomes as well as the associations of self-reported health outcomes with regard to user demographics. Although many individuals engaged with the app to experience spiritual growth, many also reported retrospective improvement in mental and physical health. Despite some methodological limitations, this research serves as an initial examination of how religious-based apps may be associated with self-reported improvements in physical, mental, and spiritual health outcomes. This study lays the foundation for future clinical trials and longitudinal studies aimed at determining the efficacy of religious-based apps in improving health outcomes.