Using Implementation Science to Bring Mindfulness Interventions into Real-world Settings: A Conversation with A. Rani Elwy, PhD

Roman Palitsky, MDiv, PhD^✉; Integrative Health and Spirituality SIG

A. Rani Elwy, PhD

Implementation science involves the systematic investigation of what it takes to bring an intervention out of the lab and into the more complex world of everyday life. In the wake of the COVID-19 pandemic and increasingly recognized need for adaptation, members of the Integrative Health and Spirituality SIG have focused on implementing mindfulness-based interventions across a range of contexts with the aid of implementation science.

Mindfulness is a meditation technique that involves a focus on present-moment experience without judgment.¹ This technique has become a key component of multiple evidence-based treatments. SIG Leadership Committee Member Dr. Roman Palitsky spoke with Dr. A. Rani Elwy, Professor and Founding Director of the Implementation Science Core at Brown University’s Department of Psychiatry and Human Behavior, and Dissemination Director of the VA’s Complementary and Integrative Health Evaluation Center, discussed some key points about implementation science for mindfulness-based interventions (MBIs).
 

How would you describe the relevance of implementation science for mindfulness-based interventions? What are some new frontiers in this space?

Well, implementation science is important for any evidence-based intervention or evidence-based practice. We often don’t do a very good job of translating our work into actual, real-world care.  We know that mindfulness works, there has been lots of research to show that mindfulness works, it's just a matter of what do we need to do to make these interventions happen effectively. For MBI research, I don’t think that any intervention that’s being delivered outside of where it was developed is ready for deployment in a particular setting with a particular population. Every evidence-based practice has core components. In mindfulness, there has to be present-centered awareness, and so on, but we might have to deliver the core components of mindfulness in ways that may not have been tested in trials.

The new frontiers are virtual interventions. Things that were forced into virtual formats during COVID have actually found a lot of success. So how can we capitalize on that? Many people I know from the VA are not willing to give up the telehealth pieces of mindfulness and meditation and yoga. The Veteran patients like them and they want those to stay, even when people are opening up their hospitals and allowing more small-group classes, they like being able to do those things at home.
 

Do you have any advice for people who are interested in translating mindfulness interventions into digital formats?

Well, it is important to make sure that this is an accessible way of having an MBI for your population. From my VA experience, when we talk to people in rural West Virginia, for example, it is harder for their Veteran patients to access meditation and mindfulness classes online. They just don’t have the bandwidth. Rural West Virginia is one of those places where bandwidth is a major concern because of infrastructure. So that wouldn’t be a way of increasing the scale of mindfulness—digital will not work everywhere. That just brings us to the point of using formative evaluation prior to any adaptation, to make sure that those planned adaptations are actually going to work for that community, wherever you are planning to implement your MBI.
 

Are there any implementation concerns that you think are unique to MBIs, relative to most other interventions?

When we talk about MBIs from a digital perspective, like we were just doing, that can also be hard for many people. It can be hard to create that space, and that time, away from whatever else is happening in people’s lives. Many of my friends are devoted to their virtual yoga, but I still like to go in, I like to have that space. In terms of implementation of mindfulness in general, some people might feel that mindfulness isn’t relevant to them, or that it isn’t going to be the right intervention for them. For example, they may perceive mindfulness as having a religious component. I know that it’s not possible to do formative evaluation work prior to every implementation effort, but if you can do it, even with a small group of people, to understand more about what people’s perceptions of mindfulness are, what they think it can do for them, learn what those potential implementation barriers are going to be, then you can use implementation strategies to address those barriers.
 

How can implementation science help to address challenges in the intersectional equity of mindfulness?

Adaptation is a critical piece. To make any intervention relevant to a group that needs it, you need to understand what is keeping that group away from it and to address those barriers. Cultural adaptations in mindfulness may be important to show that people belong there – I think that’s what it is – that you’re involving them. What are the kinds of things that we talk about in a mindfulness class? How does that resonate with their background, their knowledge, their understanding of their own awareness? For a lot of people it might be hard to hear messages about mindfulness – for example, in mindfulness we want to be accepting. Not try to change feelings, but to accept them. And that might not resonate with everybody. If you feel that these messages are meant for you, you’ll be more likely to adopt them. But you’ll only do that if you were included in the process of creating those messages to begin with

Accessibility is also important. Does practicing mindfulness require sitting on the floor for an hour at a time? Will providers refer people to the intervention? To be accessible, mindfulness needs to be something that people can use frequently throughout the day when they need it, something that’s easy, that doesn’t require someone going somewhere and sitting down, clearing their calendar.

 

References

1. Academic Mindfulness Interest Group M, Academic Mindfulness Interest Group M. Mindfulness-Based Psychotherapies: A Review of Conceptual Foundations, Empirical Evidence and Practical Considerations. Aust N Z J Psychiatry. 2006;40(4):285-294. doi:10.1080/j.1440-1614.2006.01794.x