Mindfulness-based programmes to reduce stress and enhance well-being at work: a realist review

Barriers and facilitators to implementing workplace interventions to promote mental health: qualitative evidence synthesis

BACKGROUND

Despite growing interest in workplace mental health interventions, evidence of their effectiveness is mixed. Implementation science offers a valuable lens to investigate the factors influencing successful implementation. However, evidence synthesis is lacking, especially for small-to-medium-sized enterprises (SMEs) and for specific work sectors. The objectives of this review are to establish the scope of research with explicit analysis of implementation aspects of workplace mental health interventions and to identify barriers and facilitators to implementation in general and within SMEs and selected sectors.

METHODS

A systematic scoping review and meta-synthesis of mixed methods process evaluation research from 11 databases, with the evaluation of methodological quality (MMAT) and confidence in findings (CERQual), was conducted. We selected information-rich studies and synthesised them using domains within the Nielsen and Randall implementation framework: context, intervention activities, implementation; and mental models.

RESULTS

We included 43 studies published between 2009 and 2022, of which 22 were rated as information-rich to be analysed for barriers and facilitators. Most studies were conducted in healthcare. Facilitators reflecting 'high confidence' included: relevant and tailored content, continuous and pro-active leadership buy-in and support, internal or external change agents/champions, assistance from managers and peers, resources, and senior-level experience and awareness of mental health issues. Healthcare sector-specific facilitators included: easy accessibility with time provided, fostering relationships, clear communication, and perceptions of the intervention. Stigma and confidentiality issues were reported as barriers overall. Due to the small number of studies within SMEs reported findings did not reach 'high confidence'. A lack of studies in construction and Information and Communication Technology meant separate analyses were not possible.

CONCLUSIONS

There is dependable evidence of key factors for the implementation of workplace mental health interventions which should be used to improve implementation. However, there is a lack of studies in SMEs and in a larger variety of sectors.

SYSTEMATIC REVIEW REGISTRATION

Research Registry ( reviewregistry897 ).

Interventions to promote medical student well-being: an overview of systematic reviews

OBJECTIVE

To conduct an overview of systematic reviews that explore the effectiveness of interventions to enhance medical student well-being.

DESIGN

Overview of systematic reviews.

DATA SOURCES

The Cochrane Library of Systematic Reviews, MEDLINE, APA PsychInfo, CINAHL and Scopus were searched from database inception until 31 May 2023 to identify systematic reviews of interventions to enhance medical student well-being. Ancestry searching and citation chasing were also conducted.

DATA EXTRACTION AND SYNTHESIS

The Assessing the Methodological Quality of Systematic Reviews V.2 tool was used to appraise the quality of the included reviews. A narrative synthesis was conducted, and the evidence of effectiveness for each intervention was rated.

RESULTS

13 reviews (with 94 independent studies and 17 616 students) were included. The reviews covered individual-level and curriculum-level interventions. Individual interventions included mindfulness (n=12), hypnosis (n=6), mental health programmes (n=7), yoga (n=4), cognitive and behavioural interventions (n=1), mind-sound technology (n=1), music-based interventions (n=1), omega-3 supplementation (n=1), electroacupuncture (n=1) and osteopathic manipulative treatment (n=1). The curriculum-level interventions included pass/fail grading (n=4), problem-based curriculum (n=2) and multicomponent curriculum reform (n=2). Most interventions were not supported by sufficient evidence to establish effectiveness. Eleven reviews were rated as having 'critically low' quality, and two reviews were rated as having 'low' quality.

CONCLUSIONS

Individual-level interventions (mindfulness and mental health programmes) and curriculum-level interventions (pass/fail grading) can improve medical student well-being. These conclusions should be tempered by the low quality of the evidence. Further high-quality research is required to explore additional effective interventions to enhance medical student well-being and the most efficient ways to implement and combine these for maximum benefit.

Mindfulness training in medical education as a means to improve resilience, empathy, and mental health in the medical profession

The high rates of depression, burnout, and increased risk of suicide among medical students, residents, and physicians in comparison with other careers signal a mental health crisis within our profession. We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals. Additionally, we posit that mindfulness-based practices are instrumental for the development of major components of mental capital, such as resilience, flexibility of mind, and learning skills, while also serving as a pathway to enhance empathy, compassion, self-awareness, conflict resolution, and relational abilities. Importantly, the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years, and a growing number of medical schools have already integrated mindfulness into their curricula. While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field, we argue that there is currently an unprecedented opportunity to gather momentum, spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.

A protocol for a critical realist synthesis of school mindfulness interventions designed to promote pupils' mental wellbeing

Introduction

The review described in this protocol will be the first critical realist review of the literature reporting on the impact of school-based mindfulness interventions on the mental wellbeing of pupils. Mindfulness interventions are increasingly being introduced into schools to promote children's (and teachers') wellbeing. Findings from impact evaluations, including systematic reviews and metanalysis, suggest that school-based mindfulness interventions promote pupils' wellbeing. However, there is a need for further evidence on the underlying causal mechanisms and contexts that explain program outcomes, to provide insight into how mindfulness programs can be successfully implemented in other contexts.

Methods and analysis

A critical realist review methodology will be used to provide a causal interdisciplinary understanding of how school-based mindfulness interventions promote the mental wellbeing of pupils. This will be done through a systematic literature review and extrapolating context, agency, intervention, mechanisms, and outcome configurations. This will enable an understanding of how, in certain contexts, pupils can use the resources offered by a mindfulness intervention knowingly or unknowingly to trigger mechanisms that promote their mental wellbeing and what mechanisms in the context support, restrict or prevent change. We will then use retrodiction and retroduction to develop the most plausible interdisciplinary middle-range theory to explain the findings.

Discussion

The review findings will inform a critical realist evaluation of a mindfulness intervention in schools. The findings from the review will also enable us to inform policymakers and other stakeholders about what conditions need to be in place for mindfulness interventions to promote pupils' mental wellbeing. We will publish the findings from the review in academic and professional publications, policy briefs, workshops, conferences, and social media.PROSPERO registration number: CRD42023410484.

Twelve tips for creating a multicultural mindfulness-based intervention in diverse healthcare settings

High levels of stress and burnout, low help-seeking behaviour and unhealthy coping in healthcare professionals (HCPs), are a critical concern globally. Mindfulness-based interventions (MBIs) reduce stress, are a healthy coping mechanism and have become increasingly popular among HCPs, especially during the Covid-19 pandemic. Nevertheless, HCPs' busy schedules require the intervention to be accessible, pragmatic, and context specific. Key to this goal is approaching mindfulness from a multicultural perspective, especially in diverse settings such as Africa. This paper aims to provide practical tips to ensure that the MBI offered is effective with multicultural HCPs during intense stress. Four tips each discuss the curriculum, implementation, and sustainability, respectively. The tips are elucidated by practical examples of regulating stress in healthcare settings and to offer a guideline to help structure future MBIs to be culturally and context appropriate.

The influence of mindfulness-based stress reduction on the work life of healthcare professionals - A qualitative study

BACKGROUND

and purpose: Quantitative studies show that mindfulness-based interventions can reduce stress and burnout in healthcare professionals. Few qualitative studies have explored healthcare professionals' experiences with mindfulness training. The aim of the study was to explore healthcare professionals' experiences of how attending a course in Mindfulness-Based Stress Reduction influenced their work life, including their relationship with patients and colleagues.

METHODS

Fifty-six healthcare professionals attended a Mindfulness-Based Stress Reduction course between January and June 2022. Participant observation followed by six semi-structured focus group interviews and 15 individual interviews were conducted. Data were collected in a cardiology department and in an obstetrics and gynaecology department. Thematic data analysis was performed. Reporting followed COREQ guidelines.

RESULTS

Six themes were identified: 1) Allowing a pause and focusing on one thing at a time, 2) Awareness of the freedom to choose, 3) The need for self-compassion, as a prerequisite for taking care of others, 4) The value of presence and calmness in patient encounters, 5) Awareness of how stressful behavior affects oneself and others, 6) The value of practicing mindfulness with colleagues.

CONCLUSION

This study suggests that offering Mindfulness-Based Stress Reduction to healthcare professionals can start a positive process of change from a tendency to neglect personal needs to becoming more compassionate towards oneself and others. Mindfulness training may thus prevent burnout and lead to a more compassionate workplace culture that also manifests in better patient care. However, a collective understanding and knowledge of mindfulness in the work setting may be necessary to sustain these changes.

Experimental Mindfulness Intervention in an Emergency Department for Stress Management and Development of Positive Working Environment

Mindfulness-based interventions have increasingly gained the interest of health professionals in the last decade, especially practices that are short, economical, easily accessible, and physically, cognitively, and psychologically compelling. Nurses of Emergency Departments are a special, dynamic, but at the same time vulnerable group of health professionals who work in shifts and face multiple challenges. Considering the recent literature and the fact that stress and a hostile work environment are the top ranked health professionals’ challenges, there is a need for a further study of the use of mindfulness. This study aimed to investigate the effect of the application of mindfulness on nurses in the Emergency Department on several factors related to daily nursing practice and that directly affect these specific health professionals. This experimental study was performed on 14 participating nurses in the Emergency Department of a Public General Hospital in Athens, randomized into two groups: a control and an intervention group. The data collection tools were two digital smart devices, participatory observation, and semi-structured interviews. By practicing mindfulness meditation, the participating nurses in the intervention group showed improvement in their cognitive functions (attention, thinking, memory, concentration), professional interpersonal relationships, personal satisfaction and communication with patients and caregivers, sleep rate, negative emotions, and behaviors. The findings suggest that the application of mindfulness practices should be considered an easy, affordable, economical, accessible, and effective method that nurses can use to strengthen and empower themselves, enjoying its multiple benefits. The effectiveness of the application of mindfulness remains an important issue for future research in other health professionals as well.

Self-Care for Nurses and Midwives: Findings from a Scoping Review

Self-care for health care professionals is essential in order to optimize the care they provide and to prevent serious consequences for their health. This scoping review aimed to identify (a) the concepts used in the literature to describe self-care; (b) interventions that influence self-care. The scoping review was conducted according to the criteria and methodology by Arksey and O'Malley, from November 2020 to January 2021, by consulting the following databases: Pubmed, CINAHL, Scopus, PsycInfo, Cochrane Library, Joanna Briggs Library. Various keywords and MesH terms were used for the search, including self-care, nurses, midwives, nursing, midwifery, self-compassion, and self-awareness. Eighteen studies were included. The concept of self-care is related to three constructs: (a) Mindfulness; (b) Compassion; and (c) Resilience. In the literature, self-care interventions can be distinguished as (a) mindfulness-based; (b) educational; (c) multimodal approach; and (d) mind-body interventions. In recent years, the concept of self-care is a topic of great interest in the literature; dealing with self-care from both a theoretical and a practical-personal and professional-perspective has become more important in order to promote practitioners' well-being. This scoping review helps to clarify the terms related to self-care and looks at tested interventions to improve the well-being of caregivers.

Health Care Workers’ Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress

Background

Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial.

Objective

This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress.

Methods

This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale–Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence.

Results

Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=–0.31, 95% CI –0.47 to –0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=–0.24, 95% CI –0.40 to –0.08; P=.003), anxiety (b=–0.19, 95% CI –0.32 to –0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=–0.30, 95% CI –0.51 to –0.09; P=.005) but not for burnout (b=–0.19, –0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=–0.06, 95% CI –0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI –0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported.

Conclusions

An unguided digital MBSH intervention (Headspace) can reduce health care workers’ stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions.

Trial Registration

International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc