Characteristics and Usage Patterns Among 12,151 Paid Subscribers of the Calm Meditation App: Cross-Sectional Survey
Authors: Huberty Jennifer , Vranceanu Ana-Maria , Carney Colleen , Breus Michael , Gordon Michael , Puzia Megan Elizabeth 
Published: September 2019

Background
Meditation has become increasingly popular due to its health benefits; however, barriers to delivering meditation programs in traditional group-based formats limit the accessibility of these benefits. Smartphone-based meditation may increase the availability of these programs to larger, more diverse audiences; however, research on subscriber characteristics and usage patterns in meditation mobile apps is lacking.

Objective
This study aimed to describe the demographics, clinical characteristics, and usage patterns of a convenience sample of Calm subscribers and explore the relationship between self-reported app usage and changes in health, stress, and sleep.

Methods
Participants were 12,151 paying Calm subscribers (response rate=12.08%, 12,151/100,594) who completed an anonymous Web-based survey with 11 quantitative questions related to user engagement, reasons for starting Calm, and changes after using the app. Demographic characteristics, chronic health diagnoses, and sleep difficulties were also assessed. Chi-square tests were used to examine differences in app usage. Logistic regression models were used to examine demographic and health characteristics that may predict changes in health, stress, and sleep.

Results
Respondents were 18-96 years old (mean 48.57 [SD 13.79]), primarily female (79.94%, 8778/10,981), white (81.41%, 8959/11,005), and most reported a chronic health diagnosis (56.86%, 6289/11,061). Mental health diagnoses (41.13%, 4549/11,061) were more common than physical health diagnoses (32.19%, 3560/11,061). Most respondents (76.31%, 8684/11,360) reported difficulties falling or staying asleep. On average, respondents had been using Calm for 11.49 months (SD 10.49), and 60.03% (7281/12,129) used it 5 or more times per week. Meditations (used by 80.02%, 9497/11,841) and Sleep Stories (55.66%, 6591/11,841) were the most popular components. The frequency of using Calm was associated with incremental increases in the likelihood of noticing changes in mental health (χ22=136.8; P<.001), physical health (χ22=102.8; P<.001), stress (χ22=128.1; P<.001), and sleep (χ22=141.4; P<.001). Respondents who had used Calm longer were also more likely to notice changes in mental health (OR 1.06 [95% CI 1.05 to 1.06]), physical health (OR 1.01 [95% CI 1.01 to 1.02]), stress (OR 1.04 [95% CI 1.04 to 1.05]), and sleep (OR 1.004 [95% CI 1.00 to 1.01]). Subscribers with sleep difficulties used Calm more frequently (χ82=11.5; P=.003), were more likely to use Sleep Stories (χ12=1590.2; P<.001), and were more likely to notice changes in their physical health (χ12=49.2; P<.001) and sleep (χ12=2391.1; P<.001).

Conclusions
Results highlight important demographic characteristics and usage patterns among a self-selected sample of Calm subscribers. Mental health concerns and sleep appear to be top reasons for downloading Calm. Sleep Stories and meditations are the most popular app components. The frequency of using Calm was associated with incremental changes in outcomes. Findings support future randomized controlled trials testing the efficacy of Calm for health, stress, and sleep. Studies should also explore strategies to attract a more diverse sample of subscribers.