A randomized controlled trial of a smartphone-based well-being training in public school system employees during the COVID-19 pandemic.

Abstract

Whereas the extraordinary pressures of the COVID-19 pandemic on student mental health have received considerable attention, less attention has been placed on educator well-being. School system employees play a vital role in society, and teacher levels of well-being are associated with the educational outcomes of young people. We extend extant research on the prevalence and correlates of educator distress during the pandemic by reporting on a pragmatic randomized wait-list controlled trial (N = 662; 64% teachers) of an innovative mental health promotion strategy implemented during the pandemic; a free 4-week smartphone-based meditation app designed to train key constituents of well-being (Healthy Minds Program [HMP]). Following our preregistered analysis plan and consistent with hypotheses, assignment to the HMP predicted significantly larger reductions in psychological distress, our primary outcome, at post intervention (Cohen’s d = −.53, 95% CI [−.69, −.38], p < .001) and at the 3-month follow-up (d = −.33 [−.48, −.18], p < .001). Also consistent with hypotheses, we observed similar indications of immediate and sustained benefit following the HMP on all six preregistered secondary outcomes selected to tap skills targeted in the app (e.g., perseverative thinking, social connection, well-being; absolute ds = .19–.42, all ps < .031 corrected except mindful action at follow-up). We found no evidence for elevated adverse events, and the HMP was equally effective among participants with elevated baseline anxiety and depressive symptoms. These data suggest that the HMP may be an effective and scalable approach to supporting the mental health and well-being of teachers and other school system employees, with implications for employee retention and performance and student outcomes.

Personalized Prediction of Response to Smartphone-Delivered Meditation Training: Randomized Controlled Trial

“…Individuals with more negative PAI scores, reflecting relatively stronger meditation app (ie, HMP) recommendations, had better outcomes if randomly assigned to the meditation app relative to the control condition. As expected, given overall group (ie, HMP > control) differences in outcome [31], the models typically predicted greater benefits from HMP versus the control condition. However, the predicted benefits of HMP were not always large, and in some cases, the PAI model predicted either relatively small between-group differences in outcome ("yellow zone" in Figure 3) or even better outcomes in the control condition ("red zone").…”

“…Wisconsin school district employees were recruited via email and other electronic media between mid-June 2020 and late August 2020 (for a full description of study procedures, refer to the study by Hirshberg et al [ 31 ]). Eligible participants were adults (aged ≥18 years) currently employed by a Wisconsin school who owned a smartphone capable of downloading the HMP, were fluent in English, had limited exposure to meditation or the HMP app, and had depressive symptoms below the severe range ( t score<70 on Patient-Reported Outcomes Information System [PROMIS] Depression [ 35 ]).…”

“…The HMP app was used for a mean of 10.9 (SD 9) days during the 4-week trial. For additional trial and sample details, refer to the study by Hirshberg et al [ 31 ].…”

“…The t scores are population normed at 50, with an SD of 10. On completing the pretest measures, 666 participants were randomly assigned to use the 4-week HMP or an assessment-only control condition (4 participants were removed for failing multiple attention checks; refer to Figure S2 in Multimedia Appendix 1 [31,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] for the CONSORT [Consolidated Standards of Reporting Trials] flow diagram). Participants completed weekly questionnaires during the intervention period (ie, weeks 1, 2, and 3) along with a posttreatment assessment (week 4) and follow-up assessment (3 months after the end of the intervention period).…”

“…This study involved a secondary analysis of a large-scale randomized controlled trial (RCT) comparing a meditation-based smartphone app, the Healthy Minds Program (HMP), with an assessment-only control condition [ 31 ]. The RCT was conducted on a sample of school district employees (n=662) in the state of Wisconsin during the COVID-19 pandemic.…”