App Use During COVID-19: Nursing Student Perceptions of Mental Wellness

Emily Ford, BSc, ACSM CEP, Nicole Foster, BSc., Zoe Giannas, BSc., Harpreet Gill, BSc., Mi Ji Lee, BSc., Zalla Safi, BSc., Christina Sall, BA., Priya Sharma, BSc., Amanda Smith, BSc.

Faculty of Health, Kwantlen Polytechnic University

Citation: Ford, E., Foster, N., Giannas, Z., Gill, H., Lee, M., Safi, Z., Sall, C., Sharma, P. & Smith, A. (2021). App Use During COVID-19: Nursing Student Perceptions of Mental Wellness. Canadian Journal of Nursing Informatics, 16(2). https://cjni.net/journal/?p=9076

Abstract

Mental wellness and nursing school do not always mix; this reality combined with the stresses of an unprecedented COVID-19 pandemic suggests that students are particularly vulnerable in the current climate. To compensate for the limitations of social distancing our use of, and relationship to, technology is changing. Therefore, the aim of this study is to investigate how nursing students use digital applications (apps) to support their mental wellness. We focused on the experiences of nine nursing students using a descriptive phenomenological framework to inform the case study methods and analysis. Emerging from the investigation are six main themes: (1) Stress relief through connection; (2) achieving academic goals; (3) ability to spread negativity; (4) physiological self-care; (5) re-establish social interaction; (6) mental health. These themes provide insight into a unique and current phenomenon that has implications for mental health, education, and furthering the understanding of our rapidly changing relationship with technology.

Introduction

We have each been impacted by the current COVID-19 pandemic (Nguyen et al., 2020; Torous et al., 2020). Whether it be wearing a mask, distancing from loved ones, or attending classes, our lives have changed. Universities have shifted to web-based learning which has forced students and faculty to quickly adapt to ensure that student nurses are meeting the necessary academic requirements and practical competencies. Furthermore, many clinical experiences have been postponed or changed due to staff shortages and facility outbreaks, which poses a significant challenge to providing comprehensive nursing education (Jackson et al, 2020). One study suggested that while most nursing students report confidence in their institution’s measures to keep students informed and safe, there is still anxiety about interacting with the general public, the health of loved ones, and the safety of clinical settings (Lovri? et al., 2020).

It is important to consider how nursing students are using technology to mitigate the combined pressures of COVID-19 and school because prior to the pandemic nursing students were already at-risk for mental health concerns. Research demonstrates that nursing students already experienced physical and emotional stressors which increase susceptibility to mental illness. Stress is linked to increased secretions of cortisol which is known to have deleterious effects on the body, one effect being impaired neurological functioning (Pulido-Criollo et al., 2017).

There is increasing evidence to support the claim that apps provide benefits for a range of mental health conditions (Huckvale et al., 2020). Many have found relief from the stressors of COVID-19 using apps; these applications show potential for the promotion of mental wellness due to their accessibility and scalability (Torous et al., 2020). There are a wide range of apps that not only target mental health, but also the connection to friends and family, fitness, and creativity. We have designed our study to examine the perceptions and use of both mental health specific and non-mental health specific apps because we propose that having access to a variety of resources is part of a holistic approach to mental wellness. Since the majority of nursing students own smartphones and use mobile apps (O’Connor and Andrew, 2018) it seems reasonable to theorize that apps are currently being utilized to foster psychological health and resilience. Therefore, in this study, we are investigating how nursing students utilize these applications to support their mental wellness.

Background

Nursing schools are known to come with challenges for students (Oermann & Garvin, 2002). Long hours, competitive conditions for skill acquisition and demanding workloads foster an environment where students frequently report high levels of stress and burnout before their career as a nurse has even started. The effects of high levels of stress can increase feelings of anxiety and depression, which can inhibit student capacity for learning and productivity. If these feelings become chronic and unmanageable, this can have a compounding effect on the academic development and mental wellness of nursing students (Pulido-Criollo et al., 2017). Bakker et al. (2018) found that nursing student dropout rates ranged from 20 to 26.5% between 2002 to 2012 at Rotterdam University of Applied Science. Bakker and colleagues noted that these trends were common across numerous programs within Europe. It is common to see reports of diminished mental wellness for nursing students as evidenced by fatigue, anxiety and musculoskeletal symptoms (Bakker et al., 2018). With relatively high incompletion rates coupled with a shortage of nurses for the current context, it is essential to investigate how nursing students are taking care of their mental wellness throughout their post-secondary education.

The Provincial Health Services Authority has defined mental wellness as “feeling balanced, connected to others, and ready to meet life’s challenges” (Provincial Health Services Authority, n.d. p. 1), which is best realized through the maintenance of healthy lifestyle habits.

Strategies to achieve mental wellness include managing stress levels, staying physically active, and maintaining social interactions. Amattayakong et al. (2020) found nursing students heavily rely on receiving support from family and friends during challenging situations. Additionally, nursing students that maintain social activities and receive social support were more likely to find themselves in a place of well-being. The emotional support provided through social interactions can take place virtually through the evolution and widespread accessibility of technology. In recent years, the number of mobile health apps has increased rapidly; especially apps that are mental wellness oriented (Chandrashekar, 2018). Health apps are any apps that relate to the promotion and implementation of a healthy lifestyle. They provide a convenient and cost-effective way to make mental health services more readily accessible to a larger number of the population (Chandrashekar, 2018). The increasing availability of these health services through mobile apps may help nursing students mitigate the challenges that arise and aid in managing the added stress faced throughout nursing programs.

Mobile applications have been increasingly relied on because of the continuous and unstable restrictions imposed during the COVID-19 pandemic. How this global emergency unfolded has altered the lives of many due to continued social-distancing recommendations (Dos Santos, 2020). Students are one population that has been adversely affected due to the limited availability of practical experiences and the added pressure of self-directed learning (Lovri? et al., 2020). Taken together, our study will further investigate how nursing students have utilized applications to support their mental wellness during the COVID-19 pandemic.

Methods

Design

This qualitative study documented the use of technology by nursing students in support of their mental wellbeing during the COVID-19 pandemic. A descriptive phenomenological framework was used to emphasize and focus on the participants’ lived experience as nursing

students during the pandemic using a case study design. Descriptive phenomenology methodology is useful for the purpose of this study because it “focuses on rich detailed descriptions of the lived world” (LoBiondo- Wood et al., 2018, p. 162). Detailed descriptions of participants’ experience regarding the use of apps during the pandemic provide further insight regarding the research question of interest in this study. The study was approved by the university institutional Research Ethics Board (REB).

Setting and Sample

The study was conducted virtually. An online questionnaire was provided through the learning management software (LMS) setup for participant recruitment. Each participant had access to this software before the start of the study, so it was advantageous to provide the questionnaire through this platform. They were able to complete the questionnaire at their preferred pace and timing when they had internet access. All data (e.g., participant responses) were collected confidentially following protocols determined as appropriate by the university institutional REB.

The sample for this study included nine participants who were concurrently enrolled in a research course with the authors. Given the nature of participant recruitment, this is a sample of convenience. A convenience sample was most beneficial given the accessibility to voluntary participants. “Voluntary participation increased the probability of recruiting individuals who felt strongly about the issue being studied” (LoBiondo-Wood et al., 2018, p. 263). This outcome is advantageous as it provides rich data pertaining to the research question being studied. No one was excluded based on their ethnicity, race, age or sex if they were not enrolled in two groups at a single time. Though this was a convenience sample, all the participating nursing students had knowledge pertaining to the phenomena of interest (i.e., all participants had access to health apps and managed life during COVID-19). All participants in the sample composed one group (no divided focus groups were used for this study) that was entirely female.

Sample Procedure

Participants in this study enrolled themselves into either group 1 or group 2 in the first weeks of the study, prior to knowing the content and application of research assignments.

Participants were informed that their participation was voluntary before completing an online questionnaire regarding the use of technology to support their mental well-being during the COVID-19 pandemic as nursing students. The research course faculty confirmed with participants that their grade in this course would remain unaffected if they chose not to participate. For participants who chose to complete the questionnaire, the purpose and intent of the research was described along with assurance that the authors do not have access to individually identifiable data. The name and contact information of the principal investigators were included to address any potential questions or concerns. We received responses from all nine identified respondents.

Data Collection

Before the questionnaire was accessed, the participants had the opportunity to review the informed consent form, which was also available on the LMS site. Then, participants reviewed and signed a form consenting to their participation. The purpose of the study was explained again on the form, along with the risks, benefits and confidentiality aspects. The contact information for the principal investigator was given to mitigate any issues that the participants may have. It was emphasized in the questionnaire to avoid any personal identifiers to maintain a high level of confidentiality.

The course instructor and primary investigator set up an anonymous questionnaire on the LMS system with questions composed by the student researchers. The questionnaire could be found by participants enrolled in the research course, at the top of the course page. Data was collected asynchronously from this questionnaire, where participants were able to respond to a set of open-ended questions.

Open-ended questions allowed participants to answer in their own words, and freely share their personal experiences regarding the phenomenon of interest. This added to the richness of the data due to the diversity and openness of the responses. Moreover, the questions were predetermined by the research group and allowed participants to respond at their convenience. The responses from the questionnaire were used to identify emerging themes regarding app use to support mental wellness. Questions from the questionnaire are listed in Table 1.

Table 1: Semi-Structured Interview Questions

1. What apps do you use to support your mental wellness? (consider all apps that you use – social, communication, educational, health, lifestyle, gaming, entertainment, etc.)

2. Why did you select these specific apps?

3. How often do you utilize these apps?

4. How do these apps directly or indirectly influence or impact your mental wellness?

5. How have these apps contributed to your overall mental wellness during the Covid-19 pandemic?

6. Has your use of these apps changed since Covid-19 was declared a global pandemic in March 2020? If so, how has your use of these apps changed?

7. Has your use of these apps, for the purposes of supporting your mental wellness, changed since you began nursing school (September 2020)?     If so, how has your use of these apps changed?

Data Analysis

The data were analyzed by a qualitative descriptive approach. This approach met the need of the purpose of this study, because it is simplistic, flexible, and offers utility regarding our phenomenon of interest (Doyle et al., 2020). A qualitative approach allows for improved knowledge translation from participants to researchers, as open-ended participant responses are useful for identifying themes across respondents. The data were analyzed to reveal codes or categories derived from participant responses.

Two members of the research team coded the data. For unclear or questionable data points, the researchers conferred to resolve the coding approach (e.g., a participant response was agreed to constitute x code) and the transcript was reviewed as the common and sole basis to make a coding determination. With respect to coding convoluted participant responses, an audit trail of notes was made based on interpretations of the questionnaire data.

The questionnaire transcripts were read thoroughly and coded line-by-line. Codes that were descriptive and representative of the preliminary data were initially developed. The data was re-reviewed for potential new codes to incorporate for the final coding iteration. The research team collaborated to identify, resolve, and continuously improve the coding process for reliability and validity.

The codes that emerged from the data set were interrelated to compose the following categories: (1) communication and social need related app use; (2) self-care (tracking sleep, nutrition, and physical activity); (3) related app use; (4) entertainment based app use; and (5) mental well-being focused app usage.

 Rigour

To ensure rigour, we followed guidelines from Sandelowski (1993) to attain credibility, auditability, confirmability, and fittingness. The credibility of our findings was achieved by ensuring that the codes we chose were representative of the participant’s responses. We created an audit trail throughout the research process to ensure auditability. To uphold

fittingness, we exclusively selected participants who were enrolled in an online nursing program during the COVID-19 pandemic. Finally, the researchers offered a cognitive schema of how conclusions and interpretations have been made to demonstrate the confirmability.

Results

Participants

A total of nine nursing students participated in the study (N = 9), who are currently enrolled in a hybrid online program. Demographics were not collected in the current study because of the narrow range of participants. That is, all participants were conveniently sampled from a known cohort of nursing students in early adulthood living in the Pacific Northwest. Further identifiable information was intentionally not collected because it is not thought to be of value in the current exploratory study.

Themes

We identified six themes:

(1) stress relief through connection with others on communication apps;

(2) tracking information for academic goals through communication apps;

(3) Use of communication apps for a limited time due to time commitment and easy spread of negativity;

(4) Use of apps for physiological self-care;

(5) Increased use for self-care;

(6) Psychologically therapeutic use of apps.

Stress Relief Through Connection

“Helps with stress relief, keep in contact with friends, family and other students, social interaction”

Being isolated during the pandemic was hard for some students and communicating with their families and friends helped relieve their stress.

Achieving academic goals by using communication apps

“I believe I am completely dependent on my apps since nursing school began as I rely on more school apps to complete assignments and promote my wellness than I ever have before.”

Nursing school includes many assignments to help students better understand the information. The use of applications during the pandemic helped students complete their assignments and stay on track.

Ability to Spread Negativity

There was also a drive to disconnect from technology in the suggested context of all the negative and fear-inducing media coverage of the ongoing pandemic.

“Helpful for connecting with people, but I have also seen a lot of negativity and fear mongering so sometimes they can be overwhelming and I need to disconnect from technology.”

Striking a balance between using applications for entertainment purposes and meeting academic obligations based on effective time management emerged as an area of focus for participants.

“I think it provides brief stress relief. However, as I mentioned, it would often cause further stress in the end. Because it takes up a lot of my time and promotes procrastination. It is not something that I find easy to avoid as well.”

There was also a drive to disconnect from technology in the suggested context of all the online fearful and negative coverage of the ongoing pandemic.

Physiological Self Care

Students used applications such as MyFitnessPal, FitOn, Fitbit, and Period Tracker to monitor and track sleeping behaviour, menstrual cycles, dietary habits, and physical activity. The COVID-19 pandemic has further contextualized the participant’s physiological needs (e.g. sleep, nutrition, and exercise) and their increased use of applications is indicative of this.

“They directly influence my mental wellbeing as they promote my health and provide alerts and updates to my progress, so I stay focused and on task.”

“If I get a good work out, or quality sleep, I feel much better mentally. I feel like I can take on my day, and do not get as overwhelmed.”

“I saw significant changes in my sleeping pattern. I am now able to sleep for a good 5-6 hrs. My stress level has also reduced.”

Re-establish social interaction

Using apps appeared to provide some semblance of control and social access, which was a notable source of deprivation during the pandemic. There was increased use of apps since the beginning of the pandemic and after nursing students began their studies.

“Yes, my use of these apps has become more frequent since the pandemic. I am 50% more reliant on them then before the pandemic as they contain everything I need to stay connected with others and stay healthy while I am at home.”

A significant need for escaping the weight of the present moment was evident among the students. Fulfilling this need seemed to be met by communication- and entertainment-based apps.

“Reddit allows me to be another person as it is anonymous…have an escape from the world, comment and post without having to censor or post as “me” (what say, Facebook friends might expect).”

“I find watching funny videos or my favourite movies as a way to take my mind off of stressful things”.

Social media apps were referred to as social entertainment applications. There was a synergy between the sense of connection facilitated by apps and the engagement they provided. This synergy seemed particularly therapeutic for the students during the ongoing pandemic. Participants equated mental wellness with access to entertainment in the context of the pandemic.

“The social entertainment apps helped me to stay connected to my friends. The fitness apps helped me to stay motivated, healthy and active.”

“However, now that I am unemployed, and housebound – due to the fact that my mom works as a care aide and was exposed to a positive case – I find myself using these apps as a source of entertainment for my mental wellness.”

Many social media applications such as Whatsapp and Instagram supported students’ efforts to remain social while physically distancing. These apps allowed students to connect with friends and family (social support networks) and were referred to as a source of stress relief.

“My stress level has also reduced.”

Mental health

Social media and other apps may not meet all the social needs of each of the participants, but they seem to be allowing them to focus on higher order needs of self-actualization.

“Social apps to connect with friends, health apps that help me stay on track with my goals that I know will help me to feel better mentally as well, and Headspace for meditating when stressed.”

The participants seemed to be using the applications as sources of therapeutic experiences from which they derived meaning and purpose.

“Listening to music during the COVID-19 pandemic, when I have been holed up in my room alone, has been very therapeutic! YouTube has positively contributed to my overall mental wellness.”

According to Akgün et al. (2019) apps are beneficial for promoting mental well-being and can be used as a platform to seek professional help. Similarly, from our study we learned that mental well-being was sought formally through online licensed professionals and informally through meditation and mindfulness applications. An in-depth sense of the nature of pain and mental anguish was reflected upon by a participant during the pandemic.

“BetterHelp supported my mental wellness during the darkest parts of the pandemic by connecting me with a licensed therapist/social worker to talk to and learn strategies for mental self-improvement.”

Seeking online mental health services from licensed professionals in this case nurtured resilience during the pandemic through personal growth and development.

Discussion

The nine nursing students’ use of different apps during this COVID-19 pandemic was for physical, mental, academic self-care purposes including social interactions and entertainment. Six themes emerged: (1) stress relief through connection; (2) achieving academic goals; (3) ability to spread negativity; (4) physiological self-care; (5) re-establish social interaction; and (6) mental health. The apps that participants were using varied in nature from communication to mindfulness to entertainment. Taken together, the commonality observed in the thematic analysis is that using different apps is helpful to overcome the burden of disruption experienced during COVID-19.

First, sending messages on communication apps appears to be helpful for stress relief. The authors believe that because people had limited physical interactions, a digitally mediated communication outlet served the purpose of interpersonal interactions when physical distancing was heavily suggested. One participant shared an impactful experience of connecting with friends and family digitally. According to Kaya and Bicen (2016), expressing mood on social media provides students with a chance for a consultancy from other people. Online communications also played a role as a type of entertainment during this pandemic, which is also supported by Kaya and Bicen (2016) as integral to the successful adaptation to daily enjoyment.

Next, one participant found using communication apps useful for collaborating for group assignments. During the COVID-19 pandemic, face-to-face communications were limited. Thus, the importance of communication apps was illuminated during this pandemic, as it can play a role as nursing students’ only viable mode of communication. Effective group communication through instant messenger apps is consistent with previous research in the area of social psychological functioning with technology (Maushak & Ou, 2007). Indeed, previous research from Maushak and Ou (2007) suggested that graduate student participants could seek feedback and help easily on messenger apps for their group project work. Ease of access to technology with increasing normalization of computer-supported collaborative work helps to change the culture around what is understood as productive academic work in the 21st century.

In conjunction with the previous theme on collaboration, one negative theme for using communication apps was the time commitment and easiness of spreading negatively oriented messages. Although, participants in the current study recognized both the positive and negative sides of using communication apps. They controlled time using communication apps to decrease the negative effects of negative news and increase the positive effects of social connectedness.

Carrier at el. (2015) pointed to heavy online activities as displacing other meaningful real-life activities. This supported our theme drawn from participants’ controlling their time using communication apps which relates to spending too much time on digital platforms. In addition, the fear of contracting COVID-19 can be rapidly spread on social media or by person-to-person messaging. This is especially problematic when considering anxieties arise from the cognitive dissonance of wanting to act according to strict quarantine rules but knowing personal needs for relational engagement will necessarily decrease. Hearing either accurate or misinformation from friends, family, or acquaintances that promote the idea that COVID-19 is likely to spread to individuals personally enhances preexisting anxieties. The easiness of the rapid spreading of misinformation and negativity on social media during a crisis is well described by Huang et al. (2015). The connection between inappropriate social media use and psychological distress among Iranian young adults during the COVID-19 was reported by Lin et al. (2020) and further research on this contemporary topic continues to emerge in the literature.

Next, participants found the use of fitness apps helped with their physiological self-care during the pandemic. This included apps such as MyFitnessPal, VShred, DownDog Yoga, YouTube, FitOn, and Fitbit. Out of the nine participants, six stated that they use apps linked to physiological self-care. Dominski & Brandt (2020) offered the idea that COVID-19 could increase sedentary behaviour through more screen time and reduced levels of physical activity. Physical inactivity is a concern as lack of activity can worsen the risks of vulnerable populations and compound risk factors (Dominski & Brandt, 2020). Apps, such as those listed above, help to build new healthy habits and increase physical activity at home giving a solution to the isolation precautions (Neyenhuis, et.al., 2020). At the very least, having the above-mentioned apps on a smartphone has the potential to prime users to see the health-promoting apps and consider avenues for healthy behaviour change.

Tying together the themes discussed, the pandemic has shown an increase in the use of social apps to keep in contact with family and friends (Nguyen et al., 2020). Apps that were mentioned included Instagram, WhatsApp, Facebook, Messenger, Snapchat, Tik Tok, and Reddit. According to Gonzalez-Padilla and Tortolero-Blanco (2020), social media has become a helpful way to maintain communication with family and friends, reduce isolation and boredom, which is linked to anxiety and long-term distress. According to Nguyen et al., there have been new patterns of communication emerging during the pandemic, where online communication has increased due to isolation and lock down (2020). These new patterns could affect how people use digital media and social apps in the future as it becomes increasingly important for them.

Finally, evidence has shown that longer durations in quarantine have been associated with poorer mental health (Dominski & Brandt, 2020). Apps used by participants to aid in therapeutic psychological use include apps such as BetterHelp, Simple Habits, Calm, YouTube, and Headspace. BetterHelp is reportedly an app to connect virtually with a therapist, counsellor,

or social worker to improve one’s mental health (BetterHelp, n.d.). The British Columbian government lists supports that can be accessed for anyone virtually to help manage mental health challenges faced during COVID-19 (Ministry of Children and Family Development, 2020).

Simple Habits, Calm, and Headspace are apps used for meditation. According to Behan (2020), systematic reviews have shown that meditation and mindfulness practices during the pandemic have improved anxiety, depression and pain scores (Behan, 2020). YouTube is used to find meditation, music, or videos that would help with self-care and therapeutic use. According to Jarboe (2020), many people are going to YouTube to improve their mood and find uplifting, helpful and educational content during the pandemic. Apps that are relevant for psychological and therapeutic uses have shown to make systematic, structural and functional changes within the brain which helps to ease psychological distress (Behan, 2020). The patterns of psychophysiological change associated with apps that promote and enhance mental health is an integral area of inquiry for scaling up resiliency to meet a pressing global need.

Limitations

It was not feasible to conduct in-person interviews due to COVID-19 physical distancing measures, which is why an online questionnaire was the chosen method for data collection. Although the questionnaire consisted of open-ended questions allowing for participant interpretation, and participants were asked to elaborate on their responses with as much detail as possible, this method of data collection does not elicit the same “depth and detail that can be achieved through interviews” (Streubert & Carpenter, 2011, p. 90). As such, the researchers were unable to ask any clarifying questions which may have revealed further detail about participant experiences using apps to support their mental wellness.

Purposive sampling (i.e., convenience sampling) was the method used to select the study participants. The participants were all students of the same nursing cohort due to a sampling scope of students enrolled in a qualitative research course. Resulting responses from the maximum number of potential participants were made available for descriptive analysis, however data saturation could not be achieved based on the data obtained. However, there was some commonality among participant responses, which led to identification of emerging themes in the data.

Ethical considerations such as informed consent, accessibility to means for research study withdrawal, and anonymity of responses were maintained for all participants throughout the study. Although participants volunteered to participate in the study with only a few generalized, encouraging prompts from the course instructor, some degree of social obligation for students in our qualitative research course to participate may have been present. This is likely because students were conducting their own study which relied on participation from the researchers of this study. Since both groups understood that responses were required in order to generate data and shared a collegiality for achieving success in the course, this may have influenced the students’ decision to participate.

Although the participants are all first-year students of a nursing program, that program is unique when compared to standard BSN programs. One of the eligibility requirements for this specific BSN program is that all students must have completed a previous bachelor’s degree in order to enrol. As a result, many of the students (i.e., study participants) are mature students who may use different mental wellness strategies when compared to novice university students. Further, all respondents were female in the current convenience sample. For these reasons, the results of this study may not transfer well to other contexts.

Finally, the replicability of the present study is virtually impossible because of the contextual factors (e.g., global health crisis, BSN program adjustments to educational disruption) that will vary over time. Because replication is the hallmark of empirical research, it is noteworthy that the present study cannot be directly replicated in its current form. As such, treating the analyses and outcomes as a phenomenological grounding for future research is reasonable. The small sample size, unique circumstances, and survey methodology can act as a single data point for better understanding the technologically driven mechanisms that BSN students use to achieve mental wellness.\

Conclusion

Due to the combined stresses of nursing school and a pandemic, students use a wide range of apps to support their mental wellness. After data collection, coding, and analysis, six themes emerged which are related to the use of apps in association with prosocial and functional mechanisms to adapt in the face of adversity. This research may have important implications for understanding how students from a diverse background of academic disciplines support mental wellness. The need for mental wellness resilience is growing across subgroups who traditionally face additive pressures in everyday life (e.g., students in school who also work part-time jobs). Further, there are implications for how students respond to crises that result in dramatic changes to daily routines and education. The current research is preliminary, and the sample of convenience cannot generalize to all students. However, this expanding research line can be clustered with multiple data points to synthesize broad conclusions of the impact of a pandemic on vulnerable subgroups within our population.

There is tremendous potential for future research in this area. For example, conducting a more thorough survey of how students are using these apps regarding duration and frequency, and whether the influence of apps on mental wellness has an impact on academic achievement. That is, theoretical drivers of mental wellness enhancement (e.g., using therapeutic apps) can act as causal mechanisms for human adaptation during a pandemic. Studying this will likely require mixed methods in data collection and analysis such that tools emerge (e.g., internationally accepted survey tools; empirically valid semi-structured interviews) which probe the factor structure of coherent themes in participant responses. Consistency in tools, analysis, and research outputs (e.g., peer-reviewed journal, public health database) provide the evidence-base to better understand our reaction to a pandemic that hopefully gives potential for a preventative approach in the future.

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