| الوصف: |
Background: There is compelling evidence that higher subjective wellbeing contributes to a longer life and better health. Yet in 2020, wellbeing in the UK declined for the first time since annual records began. There is now a drive in the UK to promote wellbeing as part of a preventative strategy for mental health problems. Mindfulness-based interventions (MBIs) can improve wellbeing, however there are challenges with participation in standard 8-week MBIs. Brief MBIs that are shorter and less demanding may provide health and wellbeing benefits to participants while requiring fewer resources to implement at scale. There is preliminary evidence that brief MBIs are beneficial, however they are typically developed in ad-hoc ways and lack a clear rationale for the components they include. The aim of the current research is to addresses these issues by developing a brief MBI in a rigorous and systematic way. Methods: This research utilises a theory-, evidence-, and Person-Based Approach to intervention development. Mindfulness teachers and mindfulness course attendees were recruited to a mixed methods online survey (N=42) and an 'INDIGO' study (N=21). INDIGO (INtervention DesIGn with stakehOlders) is a novel mixed methods approach that combines timelining and storyboarding. INDIGO was developed specifically for this research to enable users to create a visual representation of a complex intervention. Data were collected regarding attitudes to brief MBIs and MBI components. Data were analysed using mixed methods and combined with the Mindfulness-to-Meaning Theory to create a prototype intervention plan. The prototype plan was presented to focus group participants (N=12) for discussion and suggestions for changes. The intervention was then refined. Results: The resulting brief MBI comprises five 90-minute sessions and includes focused attention practice, informal mindfulness, the three-step breathing space, group discussion and psychoeducation. The intervention is person-centred as it promotes flexibility and participant choice, for example by providing options for how to practice mindfulness. Qualitative findings highlighted mixed opinions regarding the body scan practice, open monitoring practice, and the 'sitting with difficulty' practice. Brief MBIs were seen as a way of increasing access to mindfulness training, however there were concerns about the training and supervision of mindfulness teachers, and safeguarding of participants. Overarching themes from across the thesis indicate that scientific literacy in MBI teachers could be improved, the group and teacher elements of MBIs are important, and there is considerable debate around the purpose and meaning of a brief MBI. Conclusion: This research has developed a novel MBI to improve wellbeing. The intervention will undergo feasibility testing and further optimisation, and will be of benefit to multiple settings including primary care. In addition, a novel mixed method (INDIGO) was developed to support intervention design with stakeholders. As a whole, this thesis contributes to the fields of mindfulness research, mixed methods research, and intervention design. |
