Abstract
African Americans experience numerous stress-related health outcomes and encounter disproportionate barriers to utilizing health-related services that could reduce poor health. Culturally-responsive mindfulness mHealth approaches provide promising opportunities to increase access to health skills that can reduce stress and improve wellbeing among this population. We employed a within subjects pre-post design over a two-week intervention period to analyze if the use of a culturally-responsive mindfulness mHealth application (app) contributed to pre-post changes in a sample of 39 African Americans. Paired t-tests revealed that, following the intervention, participants used more mindfulness practices, had greater self-efficacy using mindfulness, had lower levels of emotion regulation difficulties, and reported lower levels of stress. Participants also expressed high levels of satisfaction with the app and gave it positive ratings for its usability. These findings support the feasibility of a culturally-responsive mindfulness mHealth app to reduce stress and improve emotion regulation skills among African Americans. Future research directions are proposed.
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References
Abrams, J, A., Hill, A., & Maxwell, M. (2018). Underneath the mask of the strong Black woman schema: Disentangling influences of strength and self-silencing on depressive symptoms among U.S. Black women. Sex Roles, 1–22. https://doi.org/10.1007/s11199-018-0956-y.
Adams, C. E., Chen, M., Guo, L., Lam, C. Y., Stewart, D. W., Correa-Fernández, V., Cano, M. A., Heppner, W. L., Vidrine, J. I., Li, Y., Ahluwalia, J. S., Cinciripini, P. M., & Wetter, D. W. (2014). Mindfulness predicts lower affective volatility among African Americans during smoking cessation. Psychology of Addictive Behaviors, 28(2), 580–585. https://doi.org/10.1037/a0036512.
Adams, Z. W., Sieverdes, J. C., Brunner-Jackson, B., Mueller, M., Chandler, J., Diaz, V., Patel, S., Sox, L. R., Wilder, S., & Treiber, F. A. (2018). Meditation smartphone application effects on prehypertensive adults’ blood pressure: Dose-response feasibility trial. Health Psychology, 37(9), 850–860. https://doi.org/10.1037/hea0000584.
Ajibade, A., Hook, J. N., Utsey, S. O., Davis, D. E., & Van Tongeren, D. R. (2015). Racial/ethnic identity, religious commitment, and well-being in African Americans. Journal of Black Psychology, 42(3), 244–258. https://doi.org/10.1177/0095798414568115.
Akinbami, L, J., Moorman, J, E., & Liu, X. (2011). Asthma prevalence, health care use, and mortality: United States, 2005-2009. National health statistics reports; no 32. Hyattsville, MD: National Center for Health Statistics. 2011.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004.
American Psychological Association. (2017). Stress in America: The State of Our Nation. Stress in AmericaTM Survey.
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using self-report assessment methods to explore facets of mindfulness. Assessment, 13(1), 27–45. https://doi.org/10.1177/1073191105283504.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57(1), 289–300. https://doi.org/10.1111/j.2517-6161.1995.tb02031.x
Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., et al. (2017). Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation, 135, e146–e603. https://doi.org/10.1161/CIR.0000000000000485.
Bruce, M. A., Jeffers, K. S., Robinson, J. K., & Norris, K. C. (2018). Contemplative practices: A strategy to improve health and reduce disparities. International Journal of Environmental Research and Public Health, 15, 2253. https://doi.org/10.3390/ijerph15102253.
Burnett-Zeigler, I. E., Satyshur, M. D., Hong, S., Yang, A., Moskowitz, J. T., & Wisner, K. L. (2016). Mindfulness based stress reduction adapted for depressed disadvantaged women in an urban federally qualified health center. Complementary Therapies in Clinical Practice, 25, 59–67. https://doi.org/10.1016/j.ctcp.2016.08.007.
Burnett-Zeigler, I. E., Waldron, E. M., Hong, S., Yang, A., Wisner, K. L., & Ciolino, J. D. (2018). Accessibility and feasibility of using technology to support mindfulness practice, reduce stress and promote long term mental health. Complementary Therapies in Clinical Practice, 33, 93–99. https://doi.org/10.1016/j.ctcp.2018.09.001.
Burnett-Zeigler, I., Satyshur, M. D., Hong, S., Wisner, K. L., & Moskowitz, J. T. (2019). Acceptability of a mindfulness intervention for depressive symptoms among African-American women in a community health center: A qualitative study. Complementary Therapies in Medicine, 45, 19–24. https://doi.org/10.1016/j.ctim.2019.05.012.
Burzler, M. A., Voracek, M., Hos, M., & Tran, U. S. (2019). Mechanisms of mindfulness in the general population. Mindfulness, 10, 469–480. https://doi.org/10.1007/s12671-018-0988-y.
Can, Y. S., Arnrich, B., & Ersoy, C. (2019). Stress detection in daily life scenarios using smart phones and wearable sensors: A survey. Journal of Biomedical Informatics, 92(August 2018), 103139. https://doi.org/10.1016/j.jbi.2019.103139.
Cebolla, A., Galiana, L., Campos, D., Oliver, A., Soler, J., Demarzo, M., Baños, R. M., Feliu-Soler, A., & García-Campayo, J. (2018). How does mindfulness work? Exploring a theoretical model using samples of meditators and non-meditators. Mindfulness, 9(3), 860–870. https://doi.org/10.1007/s12671-017-0826-7.
Chambers, R., Gullone, E., & Allen, N. B. (2009a). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005.
Chambers, R., Gullone, E., & Allen, N. B. (2009b). Mindful emotion regulation: An integrative review. Clinical Psychology Review, 29(6), 560–572. https://doi.org/10.1016/j.cpr.2009.06.005.
Clark, R., & Adams, J. H. (2004). Moderating effects of perceived racism on John Henryism and blood pressure reactivity in Black female college students. Annals of Behavioral Medicine, 28(2), 126–131. https://doi.org/10.1207/s15324796abm2802_8.
Clark, R., Anderson, N., Clark, V., & Williams, D. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54(10), 805–816. https://doi.org/10.1037/0003-066X.54.10.805.
Clark, R., Adams, J. H., & Clark, V. R. (2001). Effects of John Henryism and anger-coping on mean arterial pressure changes in African American women. International Journal of Behavioral Medicine, 8(4), 270–281. https://doi.org/10.1207/s15327558ijbm0804_2.
Cohen, S., & Williamson, G. (1988). Perceived stress in a probability sample in the United States. In I. S. Spacapam & S. Oskampp (Eds.), The social psychology of health (pp. 31–67). Newbury Park, California: Sage.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396. https://doi.org/10.2307/2136404.
Effoe, V. S., Correa, A., Chen, H., Lacy, M. E., & Bertoni, A. G. (2015). High-sensitivity c-reactive protein is associated with incident type 2 diabetes among African Americans: The Jackson heart study. Diabetes Care, 38(9), 1694–1700. https://doi.org/10.2337/dc15-0221.
Gall, M., Gall, J., & Borg, R. (2007). Educational research: An introduction (8th ed.). New York, NY: Pearson Education.
Goldstein, D. S., & Mcewen, B. (2002). Allostasis, homeostasis, and the nature of stress. Stress: The International Journal on the Biology of Stress, 5(1), 55–58. https://doi.org/10.1080/10253890290012345.
Graham, J. R., West, L. M., & Roemer, L. (2013). The experience of racism and anxiety symptoms in an African-American sample: Moderating effects of trait mindfulness. Mindfulness, 4(4), 332–341. https://doi.org/10.1007/s12671-012-0133-2.
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94.
Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291. https://doi.org/10.1017/S0048577201393198.
Gu, J., Strauss, C., Bond, R., & Cavanagh, K. (2015). How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clinical Psychology Review, 37, 1–12. https://doi.org/10.1016/j.cpr.2015.01.006.
Hall, G, C, N. (2019). Why don’t people of color use mental health services?: Increasing the personal relevance of interventions has the potential to reduce disparities. Retrieved April 7, 2019, from https://www.apa.org/science/about/psa/2019/03/people-color-mental-health
Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47, 993–1014. https://doi.org/10.1016/j.beth.2016.09.005.
Hammond, W. P. (2012). Taking it like a man: Masculine role norms as moderators of the racial discrimination-depressive symptoms association among African American men. American Journal of Public Health, 102(Suppl), S232–S241. https://doi.org/10.2105/AJPH.2011.300485.
Harrell, C. J. P., Burford, T. I., Cage, B. N., Nelson, T. M., Shearon, S., Thompson, A., & Green, S. (2011). Multipe pathways linking racism to health outcomes. Du Bois Review, 8(1), 143–157. https://doi.org/10.1017/S1742058X11000178.Multiple.
Haslam, A., Ward, T. S., & Robb, S. W. (2018). Survey to assess interest in a mindfulness intervention at a midwifery and women’s health clinic. Holistic Nursing Practice, 32(5), 261–267. https://doi.org/10.1097/HNP.0000000000000286.
Hayes, A. M., Feldman, G., & Gables, C. (2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Science, 11, 255–262. https://doi.org/10.1093/clipsy/bph080.
Hicken, M. T., Lee, H., & Hing, A. K. (2018). The weight of racism: Vigilance and racial inequalities in weight-related measures. Social Science and Medicine, 199, 157–166. https://doi.org/10.1016/j.socscimed.2017.03.058.
Howells, A., Ivtzan, I., & Eiroa-Orosa, F. J. (2016). Putting the ‘app’ in happiness: A randomised controlled trial of a smartphone-based mindfulness intervention to enhance wellbeing. Journal of Happiness Studies, 17(1), 163–185. https://doi.org/10.1007/s10902-014-9589-1.
James, S. A. (1994). John Henryism and the health of African Americans. Culture, Medicine and Psychiatry, 18, 163–182.
James, D, C, S., & Harville, C. (2016). eHealth literacy, online help-seeking behavior, and willingness to participate in mHealth chronic disease research among African Americans, Florida, 2014–2015. Preventing Chronic Disease: Public Health Research, Practice, and Policy, 13(160210). https://doi.org/10.5888/pcd13.160210.
Jha, A. P., Morrison, A. B., Parker, S. C., & Stanley, E. A. (2017). Practice is protective: Mindfulness training promotes cognitive resilience in high-stress cohorts. Mindfulness, 8(1), 46–58. https://doi.org/10.1007/s12671-015-0465-9.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present, and future. Clinical Psychology: Science and Practice, 10(2), 144–156. https://doi.org/10.1093/clipsy/bpg016.
Kohn, L. P., Oden, T., Munoz, R. F., Robinson, A., & Leavitt, D. (2002). Adapted cognitive behavioral group therapy for depressed low-income African American women. Community Mental Health Journal, 38(6), 497–504.
Kubo, A., Kurtovich, E., McGinnis, M., Aghaee, S., Altschuler, A., Quesenberry, C., et al. (2019). A randomized controlled trial of mHealth mindfulness intervention for cancer patients and informal cancer caregivers: A feasibility study within an integrated health care delivery system. Integrative Cancer Therapies, 18, 153473541985063. https://doi.org/10.1177/1534735419850634.
Lewis, T. T., Cogburn, C. D., & Williams, D. R. (2015). Self-reported experiences of discrimination and health: Scientific advances, ongoing controversies, and emerging issues. Annual Review of Clinical Psychology, 11, 407–440. https://doi.org/10.1146/annurev-clinpsy-032814-112728.
Littlefield, M. B., Edwards, L., & Akers, T. (2014). A campus–community partnership to disseminate health internet technology resources among African Americans. Journal of Social Work Education, 50(4), 648–659. https://doi.org/10.1080/10437797.2014.947899.
Luxton, D. D., McCann, R. A., Bush, N. E., Mishkind, M. C., & Reger, G. M. (2011). MHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42(6), 505–512. https://doi.org/10.1037/a0024485.
Malarkey, W. B., Jarjoura, D., & Klatt, M. (2013). Workplace based mindfulness practice and inflammation: A randomized trial. Brain, Behavior, and Immunity, 27(1), 145–154. https://doi.org/10.1016/j.bbi.2012.10.009.
Mattila, E., Lappalainen, R., Välkkynen, P., Sairanen, E., Lappalainen, P., Karhunen, L., Peuhkuri, K., Korpela, R., Kolehmainen, M., & Ermes, M. (2016). Usage and dose response of a mobile acceptance and commitment therapy app: Secondary analysis of the intervention arm of a randomized controlled trial. JMIR mHealth and uHealth, 4(3), e90. https://doi.org/10.2196/mhealth.5241.
Merritt, M. M., McCallum, T. J., & Fritsch, T. (2011). How much striving is too much? John Henryism active coping predicts worse daily cortisol responses for African American but not white female dementia family caregivers. American Journal of Geriatric Psychiatry, 19(5), 451–460. https://doi.org/10.1097/JGP.0b013e3181eaffa4.
Michalak, J., & Heidenreich, T. (2018). Dissemination before evidence? What are the driving forces behind the dissemination of mindfulness-based interventions? Clinical Psychology: Science and Practice, 25(3). https://doi.org/10.1111/cpsp.12254.
Mossberger, K., Tolbert, C. J., & Anderson, C. (2017). The mobile internet and digital citizenship in African-American and Latino communities. Information Communication and Society, 20(10), 1587–1606. https://doi.org/10.1080/1369118X.2016.1243142.
Nilsen, W., Kumar, S., Shar, A., Varoquiers, C., Wiley, T., Riley, W. T., Pavel, M., & Atienza, A. A. (2012). Advancing the science of mHealth. Journal of Health Communication, 17, 5–10. https://doi.org/10.1080/10810730.2012.677394.
Osborn, R., Squires, D., Moty, M, M., Sarnak, D, O., & Schneider, E, C. (2016). In new survey of 11 countries, U.S. adults still struggle with access to and affordability of health care. Health Affairs, 35(12). https://doi.org/10.1377/hlthaff.2016.1088.
Palta, P., Page, G., Piferi, R. L., Gill, J. M., Hayat, M. J., & Connolly, a B., & Szanton, S. L. (2012). Evaluation of a mindfulness-based intervention program to decrease blood pressure in low-income African-American older adults. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 89(2), 308–316. https://doi.org/10.1007/s11524-011-9654-6.
Paul, N. A., Stanton, S. J., Greeson, J. M., Smoski, M. J., & Wang, L. (2013). Psychological and neural mechanisms of trait mindfulness in reducing depression vulnerability. Social Cognitive and Affective Neuroscience, 8(1), 56–64. https://doi.org/10.1093/scan/nss070.
Phinney, J. S. (1992). The multigroup ethnic identity measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7(2), 156-176. https://doi.org/10.1177/074355489272003.
Proulx, J., Croff, R., Oken, B., Aldwin, C. M., Fleming, C., Bergen-Cico, D., Le, T., & Noorani, M. (2017). Considerations for research and development of culturally relevant mindfulness interventions in American minority communities. Mindfulness., 9, 361–370. https://doi.org/10.1007/s12671-017-0785-z.
Roos, C. R., Kirouac, M., Stein, E., Wilson, A. D., Bowen, S., & Witkiewitz, K. (2019). An open trial of rolling admission mindfulness-based relapse prevention (rolling MBRP): Feasibility, acceptability, dose-response relations, and mechanisms. Mindfulness, 10, 1062–1073. https://doi.org/10.1007/s12671-018-1054-5.
Shadish, W. R., Jr., Cook, T. D., & Leviton, L. C. (1991). Foundations of program evaluation: Theories of practice. Sage Publications, Inc.
Sharp, L. K., Kimmel, L. G., Kee, R., Saltoun, C., & Chang, C. H. (2007). Assessing the perceived stress scale for African American adults with asthma and low literacy. Journal of Asthma, 44(4), 311–316. https://doi.org/10.1080/02770900701344165.
Slavich, G. M. (2016). Life stress and health: A review of conceptual issues and recent findings. Teaching of Psychology, 43(4), 346–355. https://doi.org/10.1177/0098628316662768.
Smith, E. N., Santoro, E., Moraveji, N., Susi, M., & Crum, A. J. (2019). Integrating wearables in stress management interventions: Promising evidence from a randomized trial. International Journal of Stress Management., 27, 172–182. https://doi.org/10.1037/str0000137.
Spears, C. A., Abroms, L. C., Glass, C. R., Hedeker, D., Eriksen, M. P., Cottrell-Daniels, C., Tran, B. Q., & Wetter, D. W. (2018). Mindfulness-based smoking cessation enhanced with mobile technology (iQuit mindfully): Pilot randomized controlled trial. JMIR mHealth and uHealth, 7(6), 1–14. https://doi.org/10.2196/13059.
van Emmerik, A. A. P., Berings, F., & Lancee, J. (2018). Efficacy of a mindfulness-based mobile application: A randomized waiting-list controlled trial. Mindfulness, 9, 187–198. https://doi.org/10.1007/s12671-017-0761-7.
Watson, N. N., Black, A. R., & Hunter, C. D. (2016). African American women’s perceptions of mindfulness meditation training and gendered race-related stress. Mindfulness, 7(5), 1034–1043. https://doi.org/10.1007/s12671-016-0539-3.
Watson-Singleton, N. N., Walker, J. H., LoParo, D., Mack, S. A., & Kaslow, N. J. (2018). Psychometric evaluation of the five facet mindfulness questionnaire in a clinical sample of African Americans. Mindfulness, 9(1), 312–324. https://doi.org/10.1007/s12671-017-0776-0.
Watson-Singleton, N. N., Black, A. R., & Spivey, B. N. (2019a). Recommendations for a culturally-responsive mindfulness-based intervention for African Americans. Complementary Therapies in Clinical Practice, 34, 132–138. https://doi.org/10.1016/j.ctcp.2018.11.013.
Watson-Singleton, N. N., Hill, L. K., & Case, A. D. (2019b). Past discrimination, race-related vigilance, and depressive symptoms: The moderating role of mindfulness. Mindfulness, 10(9), 1768–1778. https://doi.org/10.1007/s12671-019-01143-5.
Weiss, N. H., Tull, M. T., Davis, L. T., Dehon, E. E., Fulton, J. J., & Gratz, K. L. (2012). Examining the association between emotion regulation difficulties and probable posttraumatic stress disorder within a sample of African Americans. Cognitive Behaviour Therapy, 41(1), 5–14. https://doi.org/10.1080/16506073.2011.621970.
West, R. (2017). Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychology and Health, 32(8), 1018–1036. https://doi.org/10.1080/08870446.2017.1325890.
Williams, D. R. (2018). Stress and the mental health of populations of color: Advancing our understanding of race-related stressors. Journal of Health and Social Behavior, 59(4), 466–485. https://doi.org/10.1177/0022146518814251.
Womack, V. Y., & Sloan, L. R. (2017). The association of mindfulness and racial socialization messages on approach-oriented coping strategies among African Americans. Journal of Black Studies, 48(4), 408–426. https://doi.org/10.1177/0021934717696789.
Woods-Giscombé, C. L. (2010). Superwoman schema: African American women’s views on stress, strength, and health. Qualitative Health Research, 20(5), 668–683. https://doi.org/10.1177/1049732310361892.
Woods-Giscombé, C. L., & Black, A. R. (2010). Mind-body interventions to reduce risk for health disparities related to stress and strength among African American women: The potential of mindfulness-based stress reduction, loving-kindness, and the NTU therapeutic framework. Complementary Health Practice Review, 15(3), 115–131. https://doi.org/10.1177/1533210110386776.
Woods-Giscombé, C, L., & Gaylord, S, A. (2014). The cultural relevance of mindfulness meditation as a health intervention for African Americans: Implications for reducing stress-related health disparities. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association. https://doi.org/10.1177/0898010113519010
Zapolski, T. C. B., Faidley, M. T., & Beutlich, M. R. (2018). The experience of racism on behavioral health outcomes: The moderating impact of mindfulness. Mindfulness, 2013, 168–178. https://doi.org/10.1007/s12671-018-0963-7.
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NNWS: Collaborated on study conceptualization and wrote the paper. JP: Helped with study design, assisted with the data analyses, wrote the Results, created tables and figures, and helped with editing the final manuscript. TT: Helped with study design, managed development of the mHealth app, led recruitment and data collection, collaborated on data analysis, and collaborated in editing the final manuscript.
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Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health under award number R43MD012284. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Watson-Singleton, N.N., Pennefather, J. & Trusty, T. Can a culturally-responsive Mobile health (mHealth) application reduce African Americans’ stress?: A pilot feasibility study. Curr Psychol 42, 1434–1443 (2023). https://doi.org/10.1007/s12144-021-01534-9
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DOI: https://doi.org/10.1007/s12144-021-01534-9