A Qualitative Multi-center Study of an App-based Mindfulness Intervention for Critical Illness Survivors

RATIONALE Depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms are common among critical illness survivors and pose substantial barriers to recovery. A recent randomized clinical trial of an app-based mindfulness intervention (LIFT2) for critical illness survivors suggested sustained improvement in depression, anxiety, and PTSD symptoms. However, little has been described about the participants’ experiences with the app and mindfulness as an intervention. METHODS We performed a qualitative study of LIFT2 participants to explore their perspectives on the app's usability and content, as well as factors contributing to recovery from critical illness. We included participants across three study sites who survived an intensive care unit stay for acute cardiorespiratory failure between 2019-2023, purposively sampling based on age, race, and baseline measure of depressive symptoms. We conducted semi-structured interviews between March-June 2024, then performed directed content analysis to identify themes and domains using a combined deductive and inductive approach. RESULTS We conducted 19 semi-structured interviews. Six participants identified as female, and three participants identified as non-white. Median age was 60 (IQR 24). We identified multiple themes within two domains: (1) perceived effectiveness of the mindfulness intervention, and (2) additional facilitators of recovery. Within the first domain, participants reported themes of (1a) app usage: participants felt the app was accessible and technically easy to use; (1b) receptiveness towards the intervention: prior experience with mindfulness affected participants’ buy-in; (1c) app content: breathing techniques and daily meditation videos were most engaging and useful; (1d) impact on mind and body: participants reported less anxiety and improved blood pressure after using the app; (1e) sustained mindfulness practice: participants reported using techniques learned from the app after the intervention concluded. Within the second domain, themes were (2a) physical activity: participants reported substantial benefits of exercise and rehabilitation programs; (2b) support systems: friends, family, and other support groups were key components of recovery; (2c) religion/spirituality: faith and spiritual beliefs were helpful to support recovery from critical illness. CONCLUSION This study found that an app-based mindfulness intervention for critical illness survivors was easy to use, and that techniques learned in the app (particularly breathing techniques and meditation videos) were helpful in recovery. Participants identified mindfulness as one component of a multifaceted approach to facilitate recovery from critical illness, especially when combined with physical activity and social support systems.

Duke Scholars

Author Christopher Ethan Cox Medicine, Pulmonary, Allergy, and Critical Care Medicine