Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel

Abstract

Background Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

Mental health apps and U.S. military veterans: Perceived importance and utilization of the National Center for Posttraumatic Stress Disorder app portfolio.

“…The finding that VA users were more likely to have used NCPTSD-developed apps is consistent with that of Hogan et al (2022), who similarly observed that being connected with VA care may help raise awareness of VHA health-related apps, including the mental health apps created by the NCPTSD. These findings also align with previous research among U.S. veterans focused the use of a single app within the portfolio (COVID Coach), where veterans with higher levels of education, greater smartphone utilization, two or more deployments, and a greater number of adverse childhood experiences were more likely to have tried the COVID Coach app (Jaworski et al, 2022).…”

“…Accumulating evidence suggests that U.S. veterans are open to using apps to support health, and mental health apps developed by the VA and the Defense (DoD) have been found to be both feasible and acceptable (Gould et al, 2019;Hogan et al, 2022). With respect to the suite of apps developed by the VA's National Center for PTSD to address the self-management of mental health and wellbeing, there is a growing evidence base to suggest they can be of use for PTSD (Hallenbeck et al, 2022;Kuhn et al, 2014Kuhn et al, , 2017Miner et al, 2016;Owen et al, 2015;Possemato et al, 2016), COVIDrelated stress (Jaworski et al, 2021(Jaworski et al, , 2022, sleep problems (Koffel et al, 2018;Kuhn et al, 2022;Reilly et al, 2019), and the practice of mindfulness (Kozlov et al, 2020(Kozlov et al, , 2022. Although the evidence base to support these apps is growing, the research on these apps has been centered on two distinct types of studies-randomized controlled trials limited to participants who meet very specific study eligibility criteria, or "in the wild" evaluations of anonymous app analytics data, where no demographic, health, or any other identifying information about the app users is known.…”

Factors Associated with Veteran Self-Reported Use of Digital Health Devices

“…33 As of 2021, 85% of Americans reported owning a smartphone, 33 a number similar in magnitude to our sample (90%) and to other broader Veteran populations (81.5%). 34 Programs that support technology access may also support DHD adoption. For example, VHA’s Offices of Connected Care and Rural Health successfully supported tablet use by distributing tablets to Veterans experiencing barriers to in-person access, with the intention of supporting clinical video visits.…”