Author ORCID Identifier
Date of Award
Summer 8-7-2024
Degree Type
Dissertation
Degree Name
Doctor of Public Health (DrPH)
Department
Public Health
First Advisor
Dr. Claire Spears
Second Advisor
Dr. Jacque-Corey Cormier
Third Advisor
Dr. Ashli Owen-Smith
Abstract
Abstract
Background:
Most research on mindfulness interventions has focused on relatively affluent, non-Latino White populations, as compared to racial and ethnic minoritized and low-socioeconomic status (SES) populations. There is a pressing need to make mindfulness interventions more accessible and appropriate for underserved populations. There has been a recent proliferation of telehealth programs to deliver mindfulness interventions, largely brought on due to the COVID-19 pandemic. The surge of telehealth programs has raised both challenges and opportunities for delivering mindfulness interventions for more diverse populations. This study focuses on barriers and facilitators of teaching mindfulness via telehealth specifically for underserved populations with a focus on minoritized and low-SES populations who have been historically underrepresented in mindfulness intervention studies.
Methods:
A search of Clinicaltrials.gov was conducted using the following search terms: [mindfulness OR mindfulness-based intervention] AND [mHealth OR online OR digital OR web OR videoconference OR app OR telephone OR text messaging] AND [African American OR Black OR minority OR Latino OR Hispanic OR Asian or income OR education OR socioeconomic]. A total of 33 studies were identified from this search. Additional researchers were recruited through the dissertation chair’s personal contacts and professional listservs and by interviewee recommendations. Eligibility criteria for interviewees included faculty investigators, intervention facilitators, and research staff for studies of various mindfulness interventions including Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, yoga, and other mind-body interventions (e.g. Compassion Cultivation Training, Mindful and Self-Compassionate Care Program, and Mindfulness-Based Addiction Treatment). To be eligible for the interview, intervention mode of delivery had to include technology (videoconference, telephone, apps, text-messaging, web-based). Featured studies included mindfulness interventions for underrepresented populations (adult participants); the study focused on racial and ethnic minoritized groups and individuals with low socioeconomic status. Eligible individuals were invited for a 45-minute interview conducted over videoconference by the PI. The semi-structured interview guide focused on: 1) Key considerations for delivering mindfulness interventions via telehealth (specifically for underserved populations), 2) Barriers and facilitators related to the technology, 3) Barriers and facilitators related to mindfulness practices and the intervention content, 4) Suggestions for promoting attendance and engagement, 5) Suggestions for promoting home/personal practice, 6) Any cultural adaptations needed to teach mindfulness to these populations, and 7) Suggestions for wider dissemination and implementation of such interventions.
Results:
The participants in this study were 21 mindfulness-based practitioners. The interviewees consisted of principal investigators, key research staff, mindfulness interventionists, and a community member. There was diversity among the study sample, 33.3% of participants were African American and 71.4% of participants were women. Almost 43% of the study sample were aged 35-44. About 62% of the study sample had a doctoral degree as their highest level of educational attainment. There was also diversity across the intervention modality for the study participants. About 57% of participants led zoom-based mindfulness interventions, while 23.8% of participants led app-based mindfulness interventions, and 14.3% of participants led telephone-based mindfulness interventions. Research Question 1 examined the facilitators and barriers to teaching mindfulness via telehealth to individuals with low SES and racial and ethnic minoritized groups. Research Question 2 examined culturally responsive adaptations to telehealth-based mindfulness interventions to better serve racial and ethnic minoritized groups and the relevance of hiring a diverse workforce when leading interventions, especially when working within diverse communities. A thematic analysis was conducted, and four major themes emerged with subthemes in each theme. Major themes were as follows: 1) Facilitators of teaching mindfulness via telehealth to individuals with low SES and racial and ethnic minoritized groups; 2) Barriers of teaching mindfulness via telehealth to individuals with low SES and racial and ethnic minoritized groups; 3) Making culturally responsive adaptations to telehealth-based mindfulness interventions to better serve racial and ethnic minoritized groups; and 4) Relevance of hiring a diverse workforce when leading interventions, especially when working within racially and ethnically diverse communities.
Conclusions and Implications:
There is potential for great benefit for racial and ethnic minoritized groups and low-SES populations engaging in telehealth-based mindfulness-based interventions. Technology has strong promise for increasing the accessibility of mindfulness to diverse and under-resourced populations who have not traditionally had access to such services. However, it will take intentional adaptations to current mindfulness-based intervention programming to better reach racial and ethnic minoritized groups and low-SES populations. Based on this work, key suggestions include: spend time building the therapeutic relationship between research staff and participants and cohesion among group-based participants; encourage mindfulness engagement by using clear language about mindfulness and its benefits; incorporate easy-to-use technology and make sure everyone has access; adapt program materials, including imagery, mindfulness practices, and language to be culturally responsive to your focused population; seek diversity among investigators, interventionists, and research staff (and ideally concordance between the professional team and participants in terms of race, ethnicity, and other relevant factors); seek community champions and leaders to partner with in this work; and make equitable modifications for the community you are serving (e.g., adjust scheduling and technological strategies as needed). This work highlights the critical need for more diversity among people who teach and study mindfulness interventions to increase public health impact for under-resourced communities.
Key Words:
Telehealth, mindfulness-based interventions, RACIAL AND ETHNIC MINORITIZED GROUPS, QUALITATIVE RESEARCH, HEALTH EQUITY, CULTURAL ADAPTATIONS
Recommended Citation
Mhende, Josephine, "“If You Build It, Will They Come? Yes.” Enhancing Delivery of Mindfulness Interventions Via Telehealth: Insights From Researchers and Interventionists Serving Racial and Ethnic Minoritized Communities." Dissertation, Georgia State University, 2024.
doi: https://doi.org/10.57709/37408781
DOI
https://doi.org/10.57709/37408781
File Upload Confirmation
1