_______________________________________________

International Journal of Islamic Educational Psychology
Vol. 4, No. 1, June 2023
DOI: https://doi.org/10.18196/ijiep.v4i1.16513

The Efficacy of the Persian Version of the Mindfulness-Based
Stress Management App (Aramgar) for College’s Mindfulness
Skills and Perceived Stress

Somaieh Borjalilu

Shahid Behshti University, Iran

Corresponding email: sborjalilu@gmail.com

Citation:
Borjalilu, S. (2023). The efficacy of the persian version of mindfulness-based stress management

app (aramgar) for college’s mindfulness skills and perceived stress. International Journal
of Islamic Educational Psychology, 4(1), 1-16. https://doi.org/10.18196/ijiep.v4i1.16513

A R T I C L E I N F O

A B S T R A C T

Article History

Received : 14/10/2022
Revised : 07/03/2023
27/03/2023
06/04/2023
Accepted : 08/04/2023

Functional mobile applications are regarded as one of the brand-new
approaches to psychological interventions in different areas,
including stress. The study aims to analyze a mobile application for
Persian users on perceived stress and improve mindful skills. This
study was a one-group pretest-posttest design with a quasi-
experimental research design. Three instruments were used in this
study: the Five Factor Mindfulness Questionnaire (FFMQ), the
Perceived Stress Scale (PSS-10), and the Mobile App Rating Scale
(MARS). Eighty-five students participated in an 8-week mindfulness
mobile app (Aramgar) for at least 10 minutes per day intervention.
They responded to validated outcome measures of stress and
mindfulness at baseline after the 8-week continued access period. The
mobile application, Aramgar, was designed based on Mindfulness-
based stress reduction. Paired t-tests showed significant differences
in general perceived stress (P = 0.03) and total score of mindfulness
(P = 0.002) before and after Aramgar. The results of analyzing the
quality of Aramgar in terms of engagement, functionality, aesthetics,
and information quality showed that specialists assessed the quality
of the application appropriately. Using functional mobile apps
provides ease of use for mental health services. Therefore, to
strengthen and develop the mentioned services, it is recommended
that the necessary information technology infrastructures be
provided and the existing limitations for designing and running
mental health mobile apps be removed.

Keywords:
Mobile Health,
Stress Management,
Adolescence,
Mindfulness Skills,
Notifications.

This work is licensed under
a CC BY-SA 4.0
International license.

https://doi.org/10.18196/ijiep.v4i1.16513
mailto:sborjalilu@gmail.com
https://doi.org/10.18196/ijiep.v4i1.16513
http://creativecommons.org/licenses/by-sa/4.0/
https://creativecommons.org/licenses/by-sa/4.0/

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

2 International Journal of Islamic Educational Psychology, 4(1), 2023

INTRODUCTION

Some research has discovered that higher stress levels are usually reported
among college students compared to people in other age groups (Neely et al.,
2009). In this regard, factors such as making career choices, increasing academic
workload, and autonomy from families can be highlighted (Jayarajah et al., 2020).
Nowadays, using programs related to stress reduction has been emphasized on
college campuses. Recently, mindfulness-based interventions have become
prioritized on college campuses, which can be considered an effective strategy
for decreasing stress among college students (Bai et al., 2020).

Mindfulness refers to the attention and awareness of what occurs in the present
moment without any judgment. Mindfulness-based cognitive therapy (MBCT)
and mindfulness-based stress reduction (MBSR) are considered two of the most
popular mindfulness-based interventions (Arlt Mutch et al., 2021). Based on the
results of some studies, a significant decrease occurred in self-reported stress
among college students (Sousa et al., 2021; Sturgill et al., 2021) and improved the
well-being of undergraduate students (Chiodelli et al., 2022). Almost all college
students use the Internet and smartphones (Huberty et al., 2019). Regarding the
scope of mental health services, studies showed that college students seek help
with online counseling (Lungu & Sun, 2016).

New trends like Mobile health, or M-health, provide a promising approach to
supporting functional health behaviors. Since cellphone users are ubiquitous
(Atienza & Patrick, 2011), certain cellphone applications can be used as platforms
for behavioral interventions (Backinger & Augustson, 2011). Besides therapeutic
benefits, M-health provides chances to overcome regular constraints regarding
psychological and behavioral health treatment (Lindhiem et al., 2015).

Clinical information like texts, videos, audio files for skills, diaries, discussion
boards, and pop-up reminders are some common features of health apps used
for communication (Gustafson et al., 2014; Jones, 2018). By applying different app
features in frequent order, clients encounter meaningful means of motivation to
practice skills during treatment sessions. In addition, some apps send reminders
and notifications to users (Lindhiem et al., 2015).

Some features of apps, like assessments and behavior diaries, can help clinicians
identify their clients’ typical behaviors (Pramana et al., 2014). Another feature is
related to real-time management, which allows learning and applying coping
strategies in ecologically valid contexts. Among mental health apps aiming to
enhance the coping abilities of clients, a few can use the real-time capabilities of
smartphones (Donker et al., 2013; Harrison et al., 2011).

Mental health apps are similar to internet interventions, which use different
notifications, for instance, Short Message Service (SMS), as reminders through a
certain time (Bleau et al., 2014). These prompts are successful in motivating initial
enrollment for changes in health behavior (Bardus et al., 2014) and also induce
repeated cases of interventions, specifically when these notifications carry

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

3 International Journal of Islamic Educational Psychology, 4(1), 2023

feedback, theoretically informed content, or behavior change techniques (De
Leon et al., 2014; Morrison et al., 2012).

As mental health mobile apps have been developed greatly, they are known to
be applicable for managing stress and anxiety (Preziosa et al., 2009; Villani et al.,
2013). Cyber interventions based on Stress Inoculation Training methodologies
(cyber-SIT), like Mindful Apps and Mind Apps (Plaza et al., 2013), enhance up-
to-date technologies to educate individuals on how to cope with psychological
stress effectively (Carissoli et al., 2015). There are different formats for delivering
mindfulness courses, including self-directed digital (i.e., mobile, online) delivery
(Dawson et al., 2020).

Mindfulness is a mind-training skill whose effectiveness requires regular practice
and persistent efforts (Parsons et al., 2017), which is considered a challenge for
both app-based and face-to-face mindfulness training (Borjalilu et al., 2019).
Mindfulness apps can create 24/7 access to mindfulness-based practices like
Mindfulness, Buddhify (Huberty et al., 2019), Headspace, and Smiling and Calm,
which have high quality (Mani et al., 2015). Donovan and colleagues (Huberty et
al., 2019) showed that users were highly satisfied with using a mobile app
(BodiMojo) to train adolescents about self-compassion and mindfulness. An
internet- and mobile-based intervention, StudiCare Mindfulness is a low-
threshold, effective, and safe tool for enhancing students’ psychological well-
being. (Küchler et al., 2023). In another study, Emmerik et al. (2018) used a
mindfulness-based mobile app (VGZ Mindfulness Coach) to increase the quality
of life, general psychiatric symptoms, and mindfulness.

Plaza et al. (2013) suggested the need for developing apps in languages other
than English; only 22%, or about 11/5 of the apps studied, allow other languages.
Due to the rapid growth of stress among Iranian adults (Borjalilu et al., 2015;
Hashemian et al., 2015; Hezomi & Nadrian, 2018), developing the Persian version
of the functional mobile stress management app is necessary. The present study
aims to evaluate the efficacy of the Persian Version of the Mindfulness-Based
Stress Management Mobile Application (Aramgar) for Iranian college students
to improve mindful skills and reduce perceived stress.

METHODS

Research Design

This study was a one-group pre-test and post-test design with a quasi-
experimental research design. The mindfulness mobile app services (Aramgar)
program was the independent variable. The dependent variables were
mindfulness skills and perceived stress. Participants were medical students
recruited from Tehran University. The study was promoted on the university’s
email distribution list and in leaflets distributed throughout campus. A total of
120 people volunteered for the study. Each volunteer was eligible if (1) they had
a smartphone, (2) they were not practicing mindfulness regularly, (3) they

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

4 International Journal of Islamic Educational Psychology, 4(1), 2023

completed the pre-test and post-test, and (4) they were committed to 8 weeks of
regular practice. Finally, 85 students were selected and enrolled in the study.
Participants consented to participate in the survey by emailing a link to a pre-
test. Participants also provided an email address where a link to the smartphone
app could be sent. They were also asked about their age, gender, level and type
of education, and current educational background (undergraduate or graduate).
Then, they received an email providing a link to mindfulness mobile app services
(Aramgar). Students received mindfulness mobile app services (Aramgar)
according to their stress level for 8 weeks, daily. Aramgar is a mindfulness-based
stress reduction app for stress management that elicits learning and intervention
contents via non-intelligent notifications and evaluates the validity of the
application. It was developed to run on Android phones.

Figure 1. Process chart from the study

Before starting the study, the students had to download and install instructions
for the Aramgar mobile app, which were emailed to the participants. After
registration, a video would be displayed on Aramgar to reduce stress and explain
how the application is accessed. Then, primary education was performed with
written content to inform users about stress. In this section, users measured their
stress using questionnaires and a perceived stress scale (PSS-14) based on self-
assessment. Assessment feedback was provided for users.

In the second stage and the next application layer, Aramgar provided
notifications based on mindfulness-based stress reduction (MBSR) and users’
stress levels (severe, medium, and low). The mentioned notification would be
delivered daily in audio, video, and text formats of approximately 40 characters
for 20 days.

Finally, the timetable was delivered to the programmers and developers of the
application so that they could regulate the sending of messages. In the end, the
observation of the whole process of developing the application and testing the
system’s modules, as well as the final tests of the application and recognizing the
potential gaps and bugs, were done. Figure 2 shows screenshots of various stress
management app modules. All subjects completed the Mindfulness Inventory
and Perceived Stress Scale at the beginning and end of the 8-week study. Also,
subjects completed the Mobile App Rating Scale at the end to assess the app’s
quality.

Participation

(n=85)

Pre Test
mindfulness

skills and
perceived

stress

Intervation
mindfulness
mobile app

services
(Aramgar)

Post Test
mindfulness

skills and
perceived

stress

One-Group Pre-Test and Post-Test

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

5 International Journal of Islamic Educational Psychology, 4(1), 2023

A B C

D E F

G H I

Figure 2. Stress Management App Screenshots

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

6 International Journal of Islamic Educational Psychology, 4(1), 2023

Note. Picture (A) shows a stress management splash screen, and (B, C) shows a
sample of educational content apps. These contents include stress, the process of
stress formation, the physiology of stress, stress management such as adaptation,
controlling and stopping thoughts, time management, reading skills, and
preparation for exams, as well as interpersonal relationships, nutrition, and
sport. (D, E) illustrate a sample of self-assessment advice for stress. The perceived
stress scale (PSS-14), the weekly stress inventory, the Holmes and Rahe Stress
Scale, physiological measures of stress, and stress coping strategies
questionnaires are included so that users measure themselves according to their
needs for self-assessment and self-measurement. (F) Does the same for a sample
of text message notifications about stress management. Notifications to deliver a
short set of questions to users daily to assess their stress levels in real time so they
could self-monitor their behaviors. (G) Depicts a detailed view of the video
Mindfulness," self-management advice for stress. (H, I) shows a detailed view of
the video "Muscle Relaxation and Deep Breathing," self-management advice for
stress.

Research Subject

Subjects included college-age students. Eighty-five students with full-time
undergraduate degrees in Tehran University medical science were recruited by
email from January to April 2021.

Data Collection Method

Mindfulness: The Five Factor Mindfulness Questionnaire (FFMQ) consisted of a
39-item self-report scale from 1 to 5 utilized to evaluate multiple constructs
related to mindfulness skills. Observing, non-judgment of inner experience,
acting with awareness, and no reactivity to inner experience were considered
subscales in this questionnaire. The reliability of FFMQ was high at baseline (r =
0.83-0.89).

The Perceived Stress Scale (PSS-10): The PSS-10 is a 10-item test that has five
responses from "0 = never" to "4 = very often." The scores ranged from 0 to 40,
and higher scores indicated higher perceived stress. The Cronbach’s alpha was
0.9 in the present study sample.

Mobile App Rating Scale (MARS) to check out the qualifications of m-Health
apps (Stoyanov et al., 2015). MARS has 23 items rated on a 5-point Likert scale.
This scale had four objective quality subscales: engagement, functionality,
aesthetics, and information, and a fifth subjective quality dimension. The
Cronbach’s alpha (α) coefficients ranged from 0.83 to 0.88.

Ethical Considerations

Shahid Beheshti University and the Iran National Science Foundation (INSF)
approved this study. All participants provided written informed consent for
participation.

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

7 International Journal of Islamic Educational Psychology, 4(1), 2023

Statistical Analysis

Paired t-tests were used to analyze whether the Aramgar apps were.

RESULT & DISCUSSION

Result

The mean age of the study participants who reported was 22.62 ± (SD) 1.37 years;
37% were male, 63% were female, 43% were single, and 31% of the students were
employed. Significant demographic differences existed between groups.

Table 1. Mean differences between perceived stress, mindfulness

Variable
Baseline Post-intervention

P value
Mean SD Mean SD

PSS-10 33.31 (3.54) 29.15 (5.44) .03

Observe 21.16 (4.48) 26.54 (4.65) .01

Describe 22.42 (5.34) 27.23 (4.76) .005

Act aware 23.35 (4.43) 25.35 (4.56) .03

Non -judgment 19.72 (3.54) 22.43 (4.34) .05

Non-reactivity 21.47 (3.79) 25.34 (4.22) .001

FFMQ 108.12 (16.45) 128.89 (17.38) .002

Table 1 contains the descriptive statistics of study outcomes. It was performed to
assess whether statistically significant differences occurred based on their pre-
and post-test scores on the PSS-10. The results were statistically significant (t84 =
2.55; P =.03; Cohen d = 0.52). The FFMQ was assessed further for statistically
significant differences between the pre-test and post-test on subscales. Table 1
shows that the inventory values for observe (t84 = 1.24; P = .01; Cohen d = 0.46),
describe (t84 = 3.13; P = .005; Cohen d = 0.44), act aware (t84 = 2.65; P = .03; Cohen
d = 0.34), non-judgment (t84 = 1.85; P = .05; Cohen d = 0.63), non-reactivity (t84
= 2.36; P = .001; Cohen d = 0.38), and total score (t84 = 2.56; P = .002; Cohen d =
0.75) significantly improved from pre-test to post-test, also at follow-up.

Table 2 reports the analysis concerning the quality of Aramgar by the students.
As shown, the overall mean score in scale engagement (M = 4.428, SD = 1.12),
functionality (M = 4.575, SD = 1.1), aesthetics (M = 4.716, SD = 0.79), and
information quality (M = 4.484, SD = 1.12) shows that specialists assessed the
quality of the application as appropriate. As shown in the subjective quality
subscale, the students with high mean scores (4.65± 1.23) were highly keen on
recommending this application to others. In general, Aramgar was rated as one
of the most suitable applications in the mental health area (M = 4.64, SD = 1.11).

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

8 International Journal of Islamic Educational Psychology, 4(1), 2023

Table 2. Assessing the Quality of Aramgar Mobile Apps
(Mean and Standard Deviation)

Subscale/item M and SD

Engagement

1. Entertainment 4.43± 1.2

2. Interest 4.63± 1.03

3. Customization 4.43± 1.16

4. Interactivity 4.64± 1.01

5. Target group 4.01± .81

Total mean score 4.428± 1.12

Functionality

6. Performance 4.85±.82

7. Ease of use 4.01±1.12

8. Navigation 4.61± .95

9. Gestural designs 4.83±.71

Total mean score 4.575±1.1

Aesthetics

10. Layout 4.84±.89

11. Graphics 4.4±.56

12. Visual appeals: How good does the app look? 4.91±.93

Total mean score 4.716±.79

Information

13. Accuracy of app description 4.21± 1.2

14. Goals 4.56± 1.07

15. Quality of information 4.87± 1.02

16. Quantity of information 4.54± 1.23

17. Visual information 3.45± 1.65

18. Credibility 4.87± .67

19. Evidence base 4.89± .78

Total mean score 4.484± 1.12

Subjective quality

20. Would you recommend this app? 4.65± 1.23

21. How many times do you think you would use this app? 4.56± 1.32

22. Would you pay for this app? 3.34±.65

23. What is your overall star rating for the app? 4.64± 1.11

Discussion

This study aims to determine the efficacy of the Persian Version of the
Mindfulness-Based Stress Management Mobile Application (Aramgar) for
Iranian college students to improve mindful skills and reduce perceived stress.

The applied cellphone application, Aramgar, regarding a psycho-educational
approach, has been designed for users with stress perception who are exposed to

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

9 International Journal of Islamic Educational Psychology, 4(1), 2023

stress-making events. Regarding this, as has been mentioned, the application has
been designed and developed in three stages: (a) training and informing,
including the whiteness of stress, the process of causing stress, and managing it;
(b) self-assessment and self-control, including using the daily stress test protocol
for Aramgar; and (c) daily intervention via notifications-based mindfulness skills
for each stress level. Hence, the main difference between Aramgar and the
business version is that after assessing users’ stress levels according to their stress
perception, the necessary intervention will be done automatically.

Students who used Aramgar after 8 weeks showed decreased stress over time
and increased mindfulness skills. Also, users engaged and interacted with the
Aramgar app for longer. Champion et al. (2018) showed a significant
improvement in stress, resilience, and satisfaction with life among adults after 10
days of using a mindfulness-based smartphone app. Also, Sturgill et al. (2021)
showed that Ajivar is an app that utilizes artificial intelligence to deliver
personalized mindfulness and emotional intelligence training that improves
anxiety, depression, and EI in the college student population (Sturgill et al., 2021).
Three mindfulness meditation apps, Headspace, Smiling Mind (Flett et al., 2019),
and Wildflowers (Walsh et al., 2019), led to improvements in mental health.

One of the aims of Aramgar is to improve mental health literacy in stressful areas
and increase mindfulness skills. Norman and Skinner defined e-Health literacy
as applying electronic sources to seek, find, understand, and acknowledge health
information and putting it into solving a health problem (Norman & Skinner,
2006). Based on the definition of e-Health Literacy, by having a better
understanding of online health information, one is likely to be motivated to use
health apps as electronic sources (Cho et al., 2014). Hence, through Aramgar, we
are willing to increase Persian users’ knowledge regarding stress and train them
to manage it. It also promotes self-help among users to help them avoid and
control stress.

Another large area in Aramgar is self-assessment. In this regard, there are two
important objectives. The first is emotional self-awareness, considered one of the
goals of mental health applications. Bakker et al. (2016) proved that mental health
apps could lead to better emotional self-awareness and increase satisfactory
means of encouragement for users to report their reflections, feelings, and
behaviors. Furthermore, Runyan et al. (2013) discussed the existing evidence of
using such apps to promote self-reflection through tracking, which can increase
emotional self-awareness. In this domain, Aramgar helps users assess their daily
perceived stress and also enables them to realize the sources of stress and
recognize ways of coping with it through other surveys. Thus, it is believed that
users reach an acceptable level of emotional self-awareness. So, it is necessary to
deal with this in further studies.

On the one hand, Aramgar deals with the level of stress perceived by users by
sending messages containing different questions at different intervals during the
day and night. At last, it provides a level of stress perception for users. The

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

10 International Journal of Islamic Educational Psychology, 4(1), 2023

existing potentials in this application provide the chance for the researchers to
realize the psychological conditions of clients in real-time and cause them to
improve their ability to monitor and modulate emotional reactions, i.e., self-
regulation, which impacts both mental and physical health (Fessl et al., 2012;
Morris et al., 2010). So, the applied application, Aramgar, like the Mood Map app,
which provides the same rooted feedback, deals with mood tracking (Morris et
al., 2010).

Finally, Aramgar has been designed so meticulously that users receive
notifications based on the level of stress perception and psychoeducational
interventions. The following review indicates that 32 apps of this kind with
satisfactory functionality are available in the iOS app store (Coulon et al., 2016).
Besides patients, universities and institutions could take advantage of apps like
DeStressify and mindfulness-based ones, as well as M-Health ones, especially for
students who are fond of stress management (Choudhury et al., 2023; Dolbier et
al., 2022; Lee & Jung, 2018; Plaza et al., 2017). Additionally, the intended
interventions were based on non-intelligent notifications, and it is necessary to
study the efficacy of the intended interventions in future studies.

CONCLUSION

Based on the results, Aramgar could play a role in decreasing stress and
enhancing mindfulness skills among college students. In addition, high
satisfaction was observed among the students after using Aramgar to decrease
stress. The results could provide important information that can be implemented
for other studies or the centers of mental health universities. Finally, Aramgar
can be considered a user-friendly and convenient mobile phone for managing
stress among Persian adolescents and developing mindfulness skills.

The present study has some limitations. First, the participants were not
controlled beyond several post-intervention weeks. Thus, there was ambiguity
about whether participants continually used the app or the long-term effects of
the intervention. Another limitation of Aramgar was that notifications were sent
to users to manage stress in this version. Yet, it was not analyzed whether users
did practice managing stress, and this limitation also needs to be fixed in future
versions. At last, Aramgar has been designed for Persian adults who must design
and develop other functional applications with various features for teaching
necessary skills to manage stress for Persian children and teenagers.

REFERENCES

Arlt Mutch, V. K., Evans, S., & Wyka, K. J. J. o. C. P. (2021). The role of acceptance
in mood improvement during Mindfulness‐Based Stress Reduction. Journal
of Clinical Psychology, 77(1), 7-19. https://doi.org/10.1002/jclp.23017

https://doi.org/10.1002/jclp.23017

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

11 International Journal of Islamic Educational Psychology, 4(1), 2023

Atienza, A. A., & Patrick, K. (2011). Mobile health: the killer app for
cyberinfrastructure and consumer health. American Journal of preventive
medicine, 40(5), S151-S153. https://doi.org/10.1016/j.amepre.2011.01.008

Backinger, C. L., & Augustson, E. M. (2011). Where there’s an app, there’s a way?.
American Journal of preventive medicine, 40(3), 390-391.
https://doi.org/10.1016%2Fj.amepre.2010.11.014

Bai, S., Elavsky, S., Kishida, M., Dvořáková, K., & Greenberg, M. T. J. M. (2020).
Effects of mindfulness training on daily stress response in college students:
ecological momentary assessment of a randomized controlled trial.
Mindfulness, 11, 1433-1445. https://doi.org/10.1007/s12671-020-01358-x

Bakker, D., Kazantzis, N., Rickwood, D., & Rickard, N. (2016). Mental health
smartphone apps: review and evidence-based recommendations for future
developments. JMIR mental health, 3(1), e4984.
https://doi.org/10.2196/mental.4984

Bardus, M., Blake, H., Lloyd, S., & Suzanne Suggs, L. (2014). Reasons for
participating and not participating in an e-health workplace physical
activity intervention: A qualitative analysis. International Journal of
Workplace Health Management, 7(4), 229-246.
https://doi.org/10.1108/IJWHM-11-2013-0040

Bleau, D. N., Vaughan, G. B., & Davey, J. T. (2014). Message push notification
client improvements for multi-user devices. U.S. Patent No. 8,924,489.
Washington, DC: U.S. Patent and Trademark Office.

Borjalilu, S., Mazaheri, M. A., Talebpour, A. J. I. J. o. P., & Sciences, B. (2019).
Effectiveness of mindfulness-based stress management in the mental health
of Iranian university students: a comparison of blended therapy, face-to-
face sessions, and mHealth app (Aramgar). Iranian Journal of Psychiatry and
Behavioral Sciences, 13(2). https://doi.org/10.5812/ijpbs.84726

Borjalilu, S., Mohammadi, A., & Mojtahedzadeh, R. (2015). Sources and severity
of perceived stress among Iranian medical students. Iranian Red Crescent
Medical Journal, 17(10). https://doi.org/10.5812%2Fircmj.17767

Carissoli, C., Villani, D., & Riva, G. (2015). Does a meditation protocol supported
by a mobile application help people reduce stress? Suggestions from a
controlled pragmatic trial. Cyberpsychology, Behavior, and Social Networking,
18(1), 46-53. https://doi.org/10.1089/cyber.2014.0062

Champion, L., Economides, M., & Chandler, C. J. P. O. (2018). The efficacy of a
brief app-based mindfulness intervention on psychosocial outcomes in
healthy adults: A pilot randomised controlled trial. PloS one, 13(12),

https://doi.org/10.1016/j.amepre.2011.01.008
https://doi.org/10.1016%2Fj.amepre.2010.11.014
https://doi.org/10.1007/s12671-020-01358-x
https://doi.org/10.2196/mental.4984
https://doi.org/10.1108/IJWHM-11-2013-0040
https://doi.org/10.5812/ijpbs.84726
https://doi.org/10.5812%2Fircmj.17767
https://doi.org/10.1089/cyber.2014.0062

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

12 International Journal of Islamic Educational Psychology, 4(1), 2023

e0209482. https://doi.org/10.1371/journal.pone.0209482

Chiodelli, R., Mello, L. T. N. d., Jesus, S. N. d., Beneton, E. R., Russel, T., &
Andretta, I. (2022). Mindfulness-based interventions in undergraduate
students: A systematic review. Journal of American College Health, 70(3), 791-
800. https://doi.org/10.1080/07448481.2020.1767109

Cho, J., Park, D., & Lee, H. E. (2014). Cognitive factors of using health apps:
systematic analysis of relationships among health consciousness, health
information orientation, eHealth literacy, and health app use efficacy.
Journal of Medical Internet Research, 16(5). https://doi.org/10.2196/jmir.3283

Choudhury, A., Kuehn, A., Shamszare, H., & Shahsavar, Y. (2023). Analysis of
Mobile App-Based Mental Health Solutions for College Students: A Rapid
Review. Healthcare, 11(2), 272. https://doi.org/10.3390/healthcare11020272

Coulon, S. M., Monroe, C. M., & West, D. S. (2016). A systematic, multi-domain
review of mobile smartphone apps for evidence-based stress management.
American Journal of Preventive Medicine, 51(1), 95-105.
https://doi.org/10.1016/j.amepre.2016.01.026

Dawson, A. F., Brown, W. W., Anderson, J., Datta, B., Donald, J. N., Hong, K.,
Allan, S., Mole, T. B., Jones, P. B., & Galante, J. (2020). Mindfulness‐based
interventions for university students: A systematic review and meta‐
analysis of randomised controlled trials. Applied Psychology: Health and Well‐
Being, 12(2), 384-410. https://doi.org/10.1111/aphw.12188

De Leon, E., Fuentes, L. W., & Cohen, J. E. (2014). Characterizing periodic
messaging interventions across health behaviors and media: Systematic
review. Journal of Medical Internet Research, 16(3), e2837.
https://doi.org/10.2196/jmir.2837

Dolbier, C., Conder, L., Guiler, W., & Haley, E. (2022). A mindfulness-based
intervention for university students: A feasibility study. Building Healthy
Academic Communities Journal, 6(1), 47-62.
https://doi.org/10.18061/bhac.v6i1.8980

Donker, T., Petrie, K., Proudfoot, J., Clarke, J., Birch, M.-R., & Christensen, H.
(2013). Smartphones for smarter delivery of mental health programs: a
systematic review. Journal of Medical Internet Research, 15(11), e247.
https://doi.org/10.2196/jmir.2791

Fessl, A., Rivera-Pelayo, V., Pammer, V., & Braun, S. (2012). Mood tracking in
virtual meetings. In 21st Century Learning for 21st Century Skills: 7th European
Conference of Technology Enhanced Learning, EC-TEL 2012, Saarbrücken,
Germany, September 18-21, 2012. Proceedings 7 (pp. 377-382). Springer Berlin

https://doi.org/10.1371/journal.pone.0209482
https://doi.org/10.1080/07448481.2020.1767109
https://doi.org/10.2196/jmir.3283
https://doi.org/10.3390/healthcare11020272
https://doi.org/10.1016/j.amepre.2016.01.026
https://doi.org/10.1111/aphw.12188
https://doi.org/10.2196/jmir.2837
https://doi.org/10.18061/bhac.v6i1.8980
https://doi.org/10.2196/jmir.2791

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

13 International Journal of Islamic Educational Psychology, 4(1), 2023

Heidelberg. https://doi.org/10.1007/978-3-642-33263-0_30

Flett, J. A., Hayne, H., Riordan, B. C., Thompson, L. M., & Conner, T. S. J. M.
(2019). Mobile mindfulness meditation: a randomised controlled trial of the
effect of two popular apps on mental health. Mindfulness, 10, 863-876.
https://doi.org/10.1007/s12671-018-1050-9

García, I. P., Sánchez, C. M., Espílez, Á. S., García-Magariño, I., Guillén, G. A., &
García-Campayo, J. (2017). Development and initial evaluation of a mobile
application to help with mindfulness training and practice. International
journal of medical informatics, 105, 59-67.
https://doi.org/10.1016/j.ijmedinf.2017.05.018

Gustafson, D. H., McTavish, F. M., Chih, M.-Y., Atwood, A. K., Johnson, R. A.,
Boyle, M. G., Levy, M. S., Driscoll, H., Chisholm, S. M., & Dillenburg, L.
(2014). A smartphone application to support recovery from alcoholism: a
randomized clinical trial. JAMA psychiatry, 71(5), 566-572.
https://doi.org/10.1001/jamapsychiatry.2013.4642

Harrison, V., Proudfoot, J., Wee, P. P., Parker, G., Pavlovic, D. H., &
Manicavasagar, V. (2011). Mobile mental health: Review of the emerging
field and proof of concept study. Journal of mental health, 20(6), 509-524.
https://doi.org/10.3109/09638237.2011.608746

Hashemian, S. M. R., Farzanegan, B., Fathi, M., Ardehali, S. H., Vahedian-Azimi,
A., Asghari-Jafarabadi, M., & Hajiesmaeili, M. (2015). Stress among Iranian
nurses in critical wards. Iranian Red Crescent Medical Journal, 17(6).
https://doi.org/10.5812%2Fircmj.22612v2

Hezomi, H., & Nadrian, H. (2018). What determines psychological well-being
among Iranian female adolescents? Perceived stress may overshadow all
determinants. Health Promotion Perspectives, 8(1), 79.
https://doi.org/10.15171%2Fhpp.2018.10

Huberty, J., Green, J., Glissmann, C., Larkey, L., Puzia, M., Lee, C. J. J. M., &
uHealth. (2019). Efficacy of the mindfulness meditation mobile app “calm”
to reduce stress among college students: Randomized controlled trial. JMIR
mHealth and uHealth, 7(6), e14273. https://doi.org/10.2196/14273

Jayarajah, U., Lakmal, K., Athapathu, A., Jayawardena, A. J., & de Silva, V. J. J. o.
T. U. M. S. (2020). Validating the medical students' stressor questionnaire
(MSSQ) from a Sri Lankan medical faculty. Journal of Taibah University
Medical Sciences, 15(5), 344-350.
https://doi.org/10.1016/j.jtumed.2020.08.003

Jones, D. J. (2018). Future directions in the design, development, and

https://doi.org/10.1007/978-3-642-33263-0_30
https://doi.org/10.1007/s12671-018-1050-9
https://doi.org/10.1016/j.ijmedinf.2017.05.018
https://doi.org/10.1001/jamapsychiatry.2013.4642
https://doi.org/10.3109/09638237.2011.608746
https://doi.org/10.5812%2Fircmj.22612v2
https://doi.org/10.15171%2Fhpp.2018.10
https://doi.org/10.2196/14273
https://doi.org/10.1016/j.jtumed.2020.08.003

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

14 International Journal of Islamic Educational Psychology, 4(1), 2023

investigation of technology as a service delivery vehicle. In Future Work in
Clinical Child and Adolescent Psychology (pp. 51-65). Routledge.
https://doi.org/10.4324/9781315187914

Küchler, A.-M., Schultchen, D., Dretzler, T., Moshagen, M., Ebert, D. D., &
Baumeister, H. (2023). A three-armed randomized controlled trial to
evaluate the effectiveness, acceptance, and negative effects of studicare
mindfulness, an internet-and mobile-based intervention for college
students with no and “on demand” guidance. International Journal of
Environmental Research and Public Health, 20(4), 3208.
https://doi.org/10.3390/ijerph20043208

Lee, R. A., & Jung, M. E. (2018). Evaluation of an mhealth app (destressify) on
university students’ mental health: pilot trial. JMIR mental health, 5(1),
e8324. https://doi.org/10.2196/mental.8324

Lindhiem, O., Bennett, C. B., Rosen, D., & Silk, J. (2015). Mobile technology boosts
the effectiveness of psychotherapy and behavioral interventions: a meta-
analysis. Behavior modification, 39(6), 785-804.
https://doi.org/10.1177/0145445515595198

Lungu, A., & Sun, M. J. T., (2016). Time for a change: college students’ preference
for technology-mediated versus face-to-face help for emotional distress.
22(12), Telemedicine and e-Health, 22(12), 991-1000.
https://doi.org/10.1089/tmj.2015.0214

Mani, M., Kavanagh, D. J., Hides, L., & Stoyanov, S. R. (2015). Review and
evaluation of mindfulness-based iPhone apps. JMIR mHealth and
uHealth, 3(3), e4328. https://doi.org/10.2196/mhealth.4328

Morris, M. E., Kathawala, Q., Leen, T. K., Gorenstein, E. E., Guilak, F., DeLeeuw,
W., & Labhard, M. (2010). Mobile therapy: case study evaluations of a cell
phone application for emotional self-awareness. Journal of medical Internet
research, 12(2), e1371. https://doi.org/10.2196/jmir.1371

Morrison, L. G., Yardley, L., Powell, J., & Michie, S. (2012). What design features
are used in effective e-health interventions? A review using techniques from
critical interpretive synthesis. Telemedicine and e-Health, 18(2), 137-144.
https://doi.org/10.1089/tmj.2011.0062

Neely, M. E., Schallert, D. L., Mohammed, S. S., Roberts, R. M., & Chen, Y. J.
(2009). Self-kindness when facing stress: The role of self-compassion, goal
regulation, and support in college students’ well-being. Motivation and
Emotion, 33, 88-97. https://doi.org/10.1007/s11031-008-9119-8

Norman, C. D., & Skinner, H. A. (2006). eHealth literacy: essential skills for

https://doi.org/10.4324/9781315187914
https://doi.org/10.3390/ijerph20043208
https://doi.org/10.2196/mental.8324
https://doi.org/10.1177/0145445515595198
https://doi.org/10.1089/tmj.2015.0214
https://doi.org/10.2196/mhealth.4328
https://doi.org/10.2196/jmir.1371
https://doi.org/10.1089/tmj.2011.0062
https://doi.org/10.1007/s11031-008-9119-8

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

15 International Journal of Islamic Educational Psychology, 4(1), 2023

consumer health in a networked world. Journal of medical Internet
research, 8(2), e506. https://doi.org/10.2196/jmir.8.2.e9

Parsons, C. E., Crane, C., Parsons, L. J., Fjorback, L. O., & Kuyken, W. (2017).
Home practice in mindfulness-based cognitive therapy and mindfulness-
based stress reduction: a systematic review and meta-analysis of
participants' mindfulness practice and its association with
outcomes. Behaviour research and therapy, 95, 29-41.
https://doi.org/10.1016/j.brat.2017.05.004

Plaza, I., Demarzo, M. M. P., Herrera-Mercadal, P., & García-Campayo, J. (2013).
Mindfulness-based mobile applications: literature review and analysis of
current features. JMIR mHealth and uHealth, 1(2), e2733.
https://doi.org/10.2196/mhealth.2733

Pramana, G., Parmanto, B., Kendall, P. C., & Silk, J. S. (2014). The SmartCAT: an
m-health platform for ecological momentary intervention in child anxiety
treatment. Telemedicine and e-Health, 20(5), 419-427.
https://doi.org/10.1089/tmj.2013.0214

Preziosa, A., Grassi, A., Gaggioli, A., & Riva, G. (2009). Therapeutic applications
of the mobile phone. British Journal of Guidance & Counselling, 37(3), 313-325.
https://doi.org/10.1080/03069880902957031

Runyan, J. D., Steenbergh, T. A., Bainbridge, C., Daugherty, D. A., Oke, L., & Fry,
B. N. (2013). A smartphone ecological momentary assessment/intervention
“app” for collecting real-time data and promoting self-awareness. PloS
one, 8(8), e71325. https://doi.org/10.1371/journal.pone.0071325

Sousa, G. M. D., Lima-Araújo, G. L. D., Araújo, D. B. D., & Sousa, M. B. C. D.
(2021). Brief mindfulness-based training and mindfulness trait attenuate
psychological stress in university students: a randomized controlled trial.
BMC psychology, 9, 1-14. https://doi.org/10.1186/s40359-021-00520-x

Stoyanov, S. R., Hides, L., Kavanagh, D. J., Zelenko, O., Tjondronegoro, D., &
Mani, M. (2015). Mobile app rating scale: a new tool for assessing the quality
of health mobile apps. JMIR mHealth and uHealth, 3(1), e3422.
https://doi.org/10.2196/mhealth.3422

Sturgill, R., Martinasek, M., Schmidt, T., & Goyal, R. (2021). A novel artificial
intelligence-powered emotional intelligence and mindfulness App (Ajivar)
for the college student population during the COVID-19 pandemic:
quantitative questionnaire study. JMIR Formative Research, 5(1), e25372.
https://doi.org/10.2196/25372

van Emmerik, A. A., Berings, F., & Lancee, J. (2018). Efficacy of a mindfulness-

https://doi.org/10.2196/jmir.8.2.e9
https://doi.org/10.1016/j.brat.2017.05.004
https://doi.org/10.2196/mhealth.2733
https://doi.org/10.1089/tmj.2013.0214
https://doi.org/10.1080/03069880902957031
https://doi.org/10.1371/journal.pone.0071325
https://doi.org/10.1186/s40359-021-00520-x
https://doi.org/10.2196/mhealth.3422
https://doi.org/10.2196/25372

Borjalilu| The Efficacy of the Persian Version of the Mindfulness-Based Stress Management App
(Aramgar) for College’s Mindfulness Skills and Perceived Stress

16 International Journal of Islamic Educational Psychology, 4(1), 2023

based mobile application: a randomized waiting-list controlled
trial. Mindfulness, 9(1), 187-198. https://doi.org/10.1007/s12671-017-0761-
7

Villani, D., Grassi, A., Cognetta, C., Toniolo, D., Cipresso, P., & Riva, G. (2013).
Self-help stress management training through mobile phones: an
experience with oncology nurses. Psychological services, 10(3), 315.
https://psycnet.apa.org/doi/10.1037/a0026459

Walsh, K. M., Saab, B. J., & Farb, N. A. (2019). Effects of a mindfulness meditation
app on subjective well-being: active randomized controlled trial and
experience sampling study. JMIR mental health, 6(1), e10844.
https://doi.org/10.2196/10844

https://doi.org/10.1007/s12671-017-0761-7
https://doi.org/10.1007/s12671-017-0761-7
https://psycnet.apa.org/doi/10.1037/a0026459
https://doi.org/10.2196/10844