Effectiveness of Mobile-Based Mindfulness Interventions for Healthy and At-Risk Adults: A Systematic Review and Meta-Analysis

Abstract

Background: There are an increasing number of mindfulness interventions being delivered through mobile applications. However, few meta-analyses specifically investigate the effectiveness of mobile-based mindfulness interventions (MMI). Aims: This systematic review aims to synthesize the best evidence available for the effectiveness of MMI in improving mindfulness skills, psychological outcomes and Quality Of Life (QOL) among healthy and at-risk adults. Methods: A systematic search of CINAHL, Cochrane Library, Embase, IEEE Xplore, Ovid MEDLINE, ProQuest, PsycInfo, PubMed and Scopus for English-language Randomised Control Trials (RCTs), without any year limitation, was conducted. MMI include applications and smartphone interventions focusing on mindfulness principles or Acceptance & Commitment Therapy (ACT) and used as the primary intervention in the study. Comparators include active controls, placebo, Treatment As Usual (TAU) and wait list groups. The primary outcomes are Anxiety symptoms, Depressive symptoms, Mindfulness skills, QOL and Stress. Among the studies identified, 25 RCTs were selected, involving 6,212 participants, across 14 countries. A risk of bias table and GRADE was used to assess methodological quality and data was extracted based on Cochrane Handbook for Systematic Reviews of Intervention guidelines. Meta-analysis was performed with RevMan software, with heterogeneity assessed using chi-square and I2 tests. Random-effects meta-analysis was used to approximate the standardized mean difference between MMI and comparators. Results: Meta-analysis revealed statistically significant improvement to mindfulness skills, depressive symptoms and stress as compared to comparators. Also, improvements to anxiety symptoms and QOL were similar to comparators. Overall, MMI had small to large effect sizes on the outcomes. Conclusion: The review findings support the efficacy of MMI for improving the selected outcomes. This suggests that MMI are promising self-management tools that are a possible feasible alternative to existing treatments.