All feasibility measures were assessed at the postintervention time point (4 weeks). We measured feasibility using the guidelines by Bowen et al [44], including acceptability, demand, practicality, and preliminary efficacy (ie, trends in changes in stress, depressive and anxiety symptoms, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development). Benchmarks for feasibility included (1) acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture; ≥75% of participants reporting satisfaction with the app and that the app was appropriate and fit within their cultural identity or worldview), (2) demand (ie, self-reported app use, expressed interest, and perceived demand; ≥75% of participants adhering to the Pray.com prescription, expressing interest in future use, and perceiving the app as demanded within their community), and (3) practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness; ≥75% of participants reporting ease of use and that they could pay for the app).

The feasibility measures were developed by psychology and behavioral health researchers. Textbox 1 presents a list of the feasibility questions.

A subset of participants (n=15) completed a semistructured qualitative interview that focused on exploring their experiences using the app in a deeper way. The qualitative interview focused on topics similar to those in the feasibility questionnaire (eg, acceptability, demand, and practicality), as well as including an open-ended question asking for general feedback about the app. Textbox 2 presents a list of the interview questions.

The Perceived Stress Scale-10 (PSS-10) [45] was used to measure participants’ subjective levels of stress. The PSS-10 is a 10-item measure in which participants rate items related to stress (eg, “how often have you been angered because of things that happened that were outside of your control?”) on a scale from 0=never to 4=very often within the previous month. A mean perceived stress score was calculated, with higher scores indicating higher levels of perceived stress. Previous research has demonstrated high reliability and construct validity of the PSS-10 [45,46], including in a sample of REM participants [47]. In this sample, the Cronbach α for the PSS-10 ranged from .81 to .84 across time points.

The Hospital Anxiety and Depression Scale (HADS) [48] was used to measure participants’ symptoms of anxiety and depression. The HADS is a 14-item measure in which participants rate 7 items related to anxiety (eg, “I feel tense or ‘wound up.’”) and 7 items related to depression (eg, “I still enjoy the things I used to enjoy” [reverse coded]) on a scale from 0 to 3 (end points vary across items). Mean scores for anxiety and depression were calculated, with higher scores indicating more severe symptoms of anxiety and depression. Previous research has demonstrated evidence for the reliability and construct validity of the HADS [49], including cross-culturally [50]. In this study, the Cronbach α for the anxiety and depression subscales of the HADS ranged from .83 to .83 (anxiety) and from .79 to .84 (depression) across time points.

Participants’ spiritual well-being was assessed using the Spiritual Well-Being Scale (SWBS) [51,52]. The SWBS comprises 20 items divided into 2 subscales: religious well-being (10 items; eg, “I feel most fulfilled when I’m in close communion with God”) and existential well-being (10 items; eg, “I believe there is some real purpose for my life”). Participants rated each item on a scale from 1=strongly disagree to 6=strongly agree, with higher scores indicating higher levels of spiritual well-being. The SWBS has previously demonstrated high internal consistency and construct validity [51,52], including in samples with African American individuals [53]. In this study, the Cronbach α for the SWBS ranged from .91 to .92 across time points.

Participants’ life satisfaction was measured using the Satisfaction With Life Scale (SWLS) [54]. Participants rated 5 items related to life satisfaction (eg, “In most ways my life is close to my ideal”) on a scale from 1=strongly disagree to 6=strongly agree, with higher scores suggesting higher life satisfaction. The SWLS has demonstrated high internal consistency and construct validity in previous research across various populations and contexts [54], including diverse populations [55]. In this study, the Cronbach α for the SWLS ranged from .73 to .83 across time points.

Religious commitment was measured using the Religious Commitment Inventory-10 (RCI-10) [56]. Participants rated 10 items assessing religious commitment (eg, “I spend time trying to grow in understanding of my faith”) on a scale from 1=not true at all of me to 5=totally true of me. Scores were measured using the mean of all 10 items, with higher scores suggesting higher levels of religious commitment. The RCI-10 has shown evidence of internal consistency and construct validity [56], including in diverse samples [56,57]. In this study, the Cronbach α for the RCI-10 ranged from .84 to .88 across time points.

Racial or ethnic identity development was measured using the Multigroup Ethnic Identity Measure–Revised (MEIM-R) [58]. Participants rated 6 items assessing racial or ethnic identity development across 2 subscales—commitment (eg, “I have a strong sense of belonging to my own ethnic group”) and exploration (eg, “I have spent time trying to find out more about my ethnic group, such as its history, traditions, and customs”)—on a scale from 1=strongly disagree to 5=strongly agree, with higher scores indicating higher levels of commitment and exploration, respectively. The MEIM-R has demonstrated evidence of internal consistency and construct validity [58]. In this study, the Cronbach α for the MEIM-R ranged from .79 to .79 across time points.

All the acceptability benchmarks were met. Most participants (64/72, 89%) reported being very satisfied or satisfied with the app and that they were very likely or likely to continue to use the app in the future (63/72, 88%). No significant differences between men and women were observed regarding app acceptability.

The app was perceived as appropriate. Most participants reported that using the app was very relevant or relevant to improving their mental health (57/72, 79%) and spiritual lives (62/72, 86%). Most participants (60/72, 83%) reported that they strongly agreed or agreed that their racial or ethnic identity was well represented on the app and that the content was a good fit with their racial or ethnic identity (53/72, 74%) and cultural worldview (59/72, 82%). Most participants reported that they strongly agreed or agreed that Pray.com was a good fit with their religious beliefs or worldview (58/72, 81%) and cultural identity or worldview (55/72, 76%).

Participants reported that the app was more relevant to improving their spiritual life than their mental health (P=.01). There was no significant difference between fit with religious or cultural worldview (P=.23). Table 3 shows participant ratings of the acceptability of the app.

All demand benchmarks were met except for self-reported use (at least 75% of participants used the app at least 5 times per week for 5 min/d) as this could not be determined from the answer choices selected by the participants. Most participants (58/72, 81%) self-reported that they used the app between 3 and 5 times per week (35/72, 49%) or >5 times per week (23/72, 32%). However, objective use data showed that participants used the app for an average of 45.83 (SD 111.90) minutes and a total of 5.77 (SD 8.19) days throughout the entire study period, suggesting that app use may have been overreported. Regardless of app use, most participants (61/72, 85%) indicated that they were extremely interested or interested in continuing to use the app in the future and that they believed that there would be interest or a great deal of interest in the app in both their religious (59/72, 82%) and cultural communities (56/72, 78%). There was no significant difference between perceived demand in one’s religious community and in one’s cultural community (P=.13). No significant differences were observed between men and women regarding demand for the app. Table 4 shows participant ratings regarding demand for the app.

Almost all participants (58/72, 81%) reported that it was very easy or easy to use the app and that they were very able or able to use and navigate the app (63/72, 88%). The monthly price of the app was perceived to be very cheap or cheap by most participants (55/72, 76%). Although only half (39/72, 54%) reported that paying the monthly fee of the app would be very easy or easy, most participants (56/72, 78%) reported that they would be very likely or likely to pay the monthly fee. No significant differences were observed between men and women regarding the practicality of the app. Table 5 shows participant ratings regarding the practicality of the app.

When the interview participants (n=15) were asked what they liked most about the app, the types of responses fell into 2 main categories: general aspects and specific features.

In total, 80% (12/15) of the interviewees made suggestions for ways of improving the app to make it a better fit for them personally. These fell broadly into the following categories: features, technical improvements, and cost.

Interviewees mentioned specific aspects or features of the app that were easy for them to use. A total of 40% (6/15) of the participants stressed that navigating the app was particularly easy for them. Other individuals commented that the podcasts or live prayers (3/15, 20%), meditations (1/15, 7%), website (1/15, 7%), and registration process (1/15, 7%) were easy to use. A small number of participants did describe some difficulties they had encountered when using the app. In total, 13% (2/15) of the participants explained that they had not realized that there was a notification option that they needed to activate. Others mentioned difficulty in locating the streak data (1/15, 7%) and using the display on the side of the podcasts (1/15, 7%).

The purpose of this study was to determine the feasibility (ie, acceptability, demand, and practicality) and preliminary effectiveness of using the mobile app Pray.com on mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) among REM participants. We also explored the associations between objective app use (total minutes and days) and the outcomes measured. In addition, follow-up interviews were conducted to provide further insight into feasibility outcomes. This is one of the first studies to assess the feasibility and preliminary effectiveness of a faith- and prayer-based app in REM individuals for the purpose of improving mental health and well-being.

Overall, participants reported high levels of satisfaction with the app, intent to continue use, appropriateness of the app, and fit within their culture. Interestingly, most participants (62/72, 86%) did not meet the app use prescription provided by the researchers (ie, at least 5 min/d, 5 d/wk) but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive. Only approximately half (39/72, 54%) of the participants reported that paying the monthly fee would be easy for them, but most (56/72, 78%) said that they would be willing to pay. Even though most participants did not use the app as often as prescribed, the results indicated that app use was associated with significant mental health improvements over time. Critically, with regard to preliminary effectiveness, participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) over the course of the study despite relatively low average levels and high variability of app use. Greater app use was significantly associated with improvements in mental health and spiritual well-being. These findings suggest that Pray.com is feasible for REM adults. Future research is warranted to determine the efficacy of Pray.com on mental health and well-being outcomes in REM populations using randomized controlled trials.

Using a faith and prayer mobile app for mental health and well-being was found to be feasible in REM individuals, particularly for Black and African American adults (who constituted most of our sample). Most of the participants (64/72, 89%) expressed high satisfaction with the app and that the app was a good fit with their cultural and religious beliefs or worldview. A number of interviewees (6/15, 40%) also indicated that they perceived a fair representation of different cultural backgrounds in the app content. The findings related to cultural fit are promising as, historically, REM groups have not been well represented in apps, especially in apps that claim to have health benefits [60]. Ramos et al [61] have suggested that apps with a focus on improving mental health may have the ability to reduce unmet mental health needs if users believe that the content is appropriate for them and fits within their culture. Others have suggested that apps should be adapted to various cultures for increased benefits [42,62]. However, Black and African American populations are still underrepresented in mobile health research, limiting our ability to inform the development and design of apps for REM groups [63]. Our qualitative findings show that a small subset of participants reported that cultural fit could be increased if content such as parenting was improved or potential culturally controversial content such as meditation or options for gift buying on the app were addressed. This is one of the first studies to explore a faith-based app for mental health and well-being among REM groups. These initially promising findings suggest that more research in this area is warranted.

The findings on feasibility and cultural fit in our study are also exciting in light of the sometimes mixed reception of mindfulness and meditation in certain cultural and religious groups [64,65]. The positive reception and perceived cultural fit of the Pray.com app in a sample of religious REM individuals provides evidence that these apps may be an important avenue to help introduce the benefits of prayer, mindfulness, and meditation in a context that is experienced as a good fit with one’s cultural and religious worldview.

Although most participants (>54/72, 75%) reported high levels of feasibility across the board, one area in which responses were mixed was cost-effectiveness. Namely, although approximately three-quarters (56/72, 78%) of the participants expressed willingness to pay the monthly fee for the app, only approximately half (39/72, 54%) expressed that it would be easy for them to do so. This was supported by the qualitative data, in which some participants suggested improvements related to the cost of subscriptions (eg, a payment plan and free trial option). Individuals considering subscribing to an app for the purpose of improving or maintaining mental health and well-being should weigh the costs and potential benefits of subscribing to the app. Thus, when developing or implementing apps to provide access to faith and prayer content to various cultural groups, it is critical to keep cost-effectiveness and affordability in mind.

Previous research has demonstrated that overall product satisfaction and perceived quality are directly linked to increased purchase intentions, whereas increased product involvement may indirectly increase purchase intentions through overall satisfaction and perceived product quality [66,67]. Although only half of the sample expressed that it would be easy to pay the monthly fee, participants did say that paying the monthly fee was feasible and were interested in continuing use. Hence, despite some perceived expensiveness of the app, participants reported intent to continue use, likely based on high satisfaction with the app and its high relevance to improving mental and spiritual well-being.

Participants reported improved mental health as a result of using the Pray.com app. Specifically, participants reported significant improvements in mental health symptoms, including decreased stress, depression, and anxiety symptoms, over the course of the study. This was confirmed in the qualitative interviews; interviewees noted that their stress and depression levels decreased because of their increased hope and enjoyment of the present moment as encouraged by app content (eg, daily podcasts, scripture, and songs). In addition, the qualitative interviews suggested that it was easy to search for and access religious content related to stress, depression, and anxiety on the app. Prior work has demonstrated that spirituality can help operate as a buffer against stress and adversity [68]. To the degree that increased involvement with spiritual content can facilitate coping and help individuals in periods of stress, future research should explore potential mediators responsible for such benefits (eg, spiritual meaning [68]) and the contextual factors in which such benefits are maximized.

Interestingly, participants reported an initial hesitancy toward meditation, but interviewees reported that engagement with the meditation content on the app helped them enter a meditative state, which reportedly helped them face problems directly and better absorb information. This is an important finding given that some conservative Christians may hold negative views toward meditation because of its relationship with Buddhism [65]. For example, some more theologically conservative religious individuals may mistrust practices founded on traditions outside their own religion or view them as taboo. Accordingly, there might be hesitation to engage with content that does not squarely align with one’s religiously endorsed practices or that may not be prescribed by one’s religious teachings. Future work should explore the boundary conditions of these hesitations and what predicts such attitudes toward these practices.

Furthermore, the sample reported significantly greater well-being over time over the course of the study (ie, spiritual well-being, religious commitment, life satisfaction, and racial or ethnic identity development). Along these lines, interviewees expressed that engagement with the app (eg, podcasts, scripture reading, and meditations) positively affected their faith, spiritual well-being, and daily spiritual practices. Such findings are consistent with those of previous research suggesting that religious and spiritual identity and engagement are positively associated with well-being across REM groups [22,24,32]. Our findings are also consistent with those of other app-based mental health interventions that suggest that apps may serve as a self-management tool or adjunctive treatment [69,70]. However, app-based interventions have typically lacked diversity in their samples, and therefore, considering the preliminary nature of this study, outcome consistency cannot yet be determined [61].

The finding that participants reported higher levels of racial or ethnic identity over the course of the study was interesting and warrants further exploration. Religion and spirituality have been theorized to be important cultural factors in promoting positive psychological well-being in people of color [17]. For example, in a sample of African American individuals, religious commitment was related to higher levels of racial or ethnic identity and satisfaction with life [23]. It may be that the religious content on the app can provide a way to help encourage positive messages about one’s racial or ethnic identity and help people of color cope with and counter negative messages or narratives related to one’s racial/ethnic identity that are experienced in the broader culture (eg, racism and microaggressions). To be sure, future research sampling from a broader range of REM groups is important.

Given that the literature consistently demonstrates a significant association between religion or spirituality and well-being among REM populations, this app may provide a supplemental digital avenue to increase mental and spiritual well-being among REM groups, with the potential for greater improvement with increased use. This is especially important given the historical lack of access to mental health resources among African American and other REM individuals [71]. Future research should use rigorous methodological designs that rely on random assignment to experimental and control conditions, such as randomized clinical trials, to establish the causal effect of using a faith and prayer app for the purpose of improving mental health and well-being in REM groups.

There was considerable variability in the degree to which participants used the app. Not all participants adhered to the instructions to use the app 5 minutes a day, 5 days per week. Greater objective app use was associated with decreased stress as well as depressive and anxiety symptoms. On average, participants used the app for 45.83 (SD 111.90) minutes and a total of 5.77 (SD 8.19) days throughout the course of the study. This is not consistent with what participants self-reported, and average app use across the study period was not consistent with what we asked participants to do (use the app for 5 min/d, 5 times/wk). Adherence to web-based and digital interventions is typically lower than that to in-person interventions [72], and future research should implement strategies to promote and ensure participation.

Examining well-being outcomes, objective app use was only significantly associated with an increase in spiritual well-being. Interestingly, improvements in satisfaction with life, religious commitment, and racial or ethnic identity development were not associated with app use. Religious commitment was also high in our sample at baseline as 73% (56/77) always identified with a religion and 26% (20/77) reported that they were new identifiers or reidentifiers, and it may take longer than 4 weeks for a religiously committed sample to observe significant changes in religious commitment. Most participants (57/77, 74%) attended in-person services at least once a week, and almost 25% (18/77, 23%) attended at least once or twice a month, whereas 56% (43/77) participated in a religious group at least once a week and 38% (29/77) participated in a religious group once or twice a month. Religious and spiritual practices outside of an app may be one reason why well-being outcomes significantly improved at the postintervention time point but only spiritual well-being was associated with app use. Future research should consider testing the use of a technology-mediated religious or spiritual practice against samples who attend and do not attend in-person religious services or activities.

In addition, behavior change is complex and may affect individuals in a variety of ways [73]. It is possible that the amount of behavior requested (5 times a week for 4 weeks) was not appropriate for each participant. Although satisfaction with life, religious commitment, and racial or ethnic identity development outcomes were not significantly associated with app use, merely having access to technology-mediated religious or spiritual practices may have contributed to the significant improvements observed. Others have reported that perceived access may be no less valid than actual access and may be a stronger predictor of use than actual access [67,74]. Future research should assess the amount of time spent in digitally mediated religious and spiritual practices that are feasible and elicit changes in well-being outcomes such as satisfaction with life, religious commitment, and racial or ethnic identity development.