Real-World Meditation App Engagement: Longitudinal Study of the Medito Meditation App.

Background: Meditation apps are increasingly popular but face significant engagement challenges. Most research does not meaningfully capture real-world engagement or associated user characteristics. Engagement patterns and reasons for engaging or disengaging remain relatively unexplored. Objective: This study aimed to examine Medito app user engagement over the first 30 days after download and how intended use, demographics, user traits, and mental health factors predict engagement. Methods: A prospective online survey was conducted among 668 Medito app users from 30 countries. Factors assessed included demographic factors (eg, age, sex, education, employment, and country of residence); user factors (eg, number of apps tried, hours of experience, meditation-related adverse events, expectations, readiness to change, and personality); and mental health factors (eg, quality of life, perceived stress, psychological distress, well-being, and satisfaction with life). Detailed engagement data included days of use, meditations completed, app opens, and minutes of use obtained via a data-sharing agreement with Medito. Minutes of use in the first 30 days after download served as the main outcome variable. Results: App use was relatively low, with 50% (328/655) of users engaging for a total of 16 minutes or less in the first month after download (median 16.11, IQR 0-74.51 min). Fewer than 20% (124/655, 18.86%) of users continued using the app after 14 days. Intended use (mean 418.56, SD 472.5) significantly exceeded actual use (mean 70.02, SD 176.81; d=0.710; P<.001). In terms of user factors, expectation match (ie, extent to which outcomes from the app matched initial expectations; ρ=0.214; P=.002), expectations for anxiety (ρ=0.102; P=.01), expectations for attention or focus (ρ=0.091; P=.02), and conscientiousness (ρ=0.124; P=.003) were associated with higher engagement. Neuroticism was negatively associated with engagement (ρ=-0.103; P=.010). For mental health factors, satisfaction with life (ρ=0.123; P=.002) and well-being (ρ=0.135, P<.001) were associated with higher engagement, while perceived stress (ρ=-0.107; P=.007), psychological distress (ρ=-0.138, P<.001), and quality of life (ρ=-0.100; P=.011) were associated with lower engagement. Only readiness to change showed unique associations with higher engagement (semipartial r=0.156; P<.001). Regression analysis showed that only perceived stress predicted higher engagement (β=.020; P=.04). However, when mental health was included as a single component, expectations for anxiety (β=.015; P=.049) and readiness to change (β=.011; P=.048) predicted greater engagement, and mental ill health predicted lower engagement (β=-0.008; P=.049). Conclusions: Overall, app engagement is generally quite low. Acute stress motivated meditation app use, while chronic stress disrupted it. Engagement is optimal when experiences match expectations and users are prepared to make a change. More transparency is necessary in the promotion of meditation apps so that users have a realistic understanding of the time and effort required to achieve benefits.