Publication year
2015
Citation Title
Challenges to enrollment and participation in mindfulness-based stress reduction among veterans: A qualitative study.
Journal Name
The Journal of Alternative and Complementary Medicine
Journal Volume
21
Issue Number
7
Page Numbers
409-421
DOI
10.1089/acm.2014.0324
Summary
This is a qualitative examination of barriers to completion of a Mindfulness-Based Stress Reduction (MBSR) program for Veterans offered at Veterans Affairs (VA) Puget Sound. Researchers examined barriers to enrollment, barriers to completion, and intervention-related challenges.
Key Findings
Researchers found barriers present in three different broad categories: barriers to enrollment, barriers to completion, and intervention-related challenges.
Barriers to enrollment included lack of time, scheduling difficulties, misinformation from referring providers, and aversion to groups.
Obstacles to completion included difficulties understanding the purpose of the exercises included in the program and negative reactions to others in the group.
Intervention-related challenges included difficulties navigating group dynamics, the instructor’s management of group structure and focus, challenges with the exercises themselves, and difficulties with the environment or materials.
Implications for Program Leaders
Consider group dynamics (including gender and service experiences) when creating group programs for Service members
Include flexible options for participation in programming for individuals who have scheduling difficulties or who may not want to participate in group-based activities
Interview individuals who drop out of programs to identify program-specific barriers to completion
Implications for Policy Makers
Encourage programs that have particularly high attrition rates to examine barriers to completion
Continue to support flexible delivery of programs, including online and other non-traditional methods
Recommend training for professionals who work with military families about how to best facilitate group-based programs for Service members and their families
Methods
Researchers interviewed 68 Veterans who were referred to an MBSR program at VA Puget Sound. Of these, 24 declined participation in the MBSR program, seven dropped out (attended fewer than four of the nine sessions), and 37 were considered to have completed the program (attended at least four sessions).
Semi-structured interviews lasted about 15 minutes for decliners and 90 minutes for other participants.
Interviews were then analyzed by categorizing statements regarding reasons for declining, dropping out, or completing the MBSR program. Through this analysis, researchers identified emerging themes.
Participants
Data included in the analysis came from interviews with 48 Veterans (29% female) who were referred to an MBSR course at VA Puget Sound, with an average age of 54 (SD = 10.3).
Participants were White (71%), Black (23%), Latino (4%) and Asian-American (2%).
They served in a variety of periods, including Persian Gulf (42%), Vietnam (33%), Post-Vietnam (15%), OIF/OEF (8%), and Post-Korea (2%).
Limitations
The sample size of this study was small, with a particularly small number of dropouts included, which makes it difficult to generalize findings to other groups.
This study was specific to VA Puget Sound so the results may not be applicable to other locations.
The focus was an MBSR program; different themes may emerge if examining barriers to other programs.
Avenues for Future Research
Include more dropouts in analyses in order to identify barriers that are specific to people who began the program but did not finish
Examine the efficacy of groups that are specific to gender or service era as well as individual training versus group training
Explore the efficacy of delivering Mindfulness-Based Interventions in new ways, such as through online platforms
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background: Mindfulness-Based Stress Reduction (MBSR) is associated with reduced depressive symptoms, quality of life improvements, behavioral activation, and increased acceptance among veterans. This study was conducted to increase the reach and impact of a veterans’ MBSR program by identifying barriers to enrollment and participation to inform modifications in program delivery. Objective: Verify or challenge suspected barriers, and identify previously unrecognized barriers, to enrollment and participation in MBSR among veterans. Design: A retrospective qualitative analysis of semistructured interviews. Setting/location: VA Puget Sound Health Care System (Seattle, WA). Subjects: 68 interviewed, and 48 coded and analyzed before reaching saturation. Approach: Content analysis of semistructured interviews. Results: Of the participants who enrolled, most (78%) completed the program and described MBSR positively. Veterans identified insufficient or inaccurate information, scheduling issues, and an aversion to groups as barriers to enrollment. Participants who discontinued the program cited logistics (e.g., scheduling and medical issues), negative reactions to instructors or group members, difficulty understanding the MBSR practice purposes, and struggling to find time for the practices as barriers to completion. Other challenges (cohort dynamics, teacher impact on group structure and focus, instructor lack of military service, and physical and psychological challenges) did not impede participation; we interpreted these as growth-facilitating challenges. Common conditions among veterans (chronic pain, posttraumatic stress disorder, and depression) were not described as barriers to enrollment or completion. Conclusions: Women-only MBSR groups and tele-health MBSR groups could improve accessibility to MBSR for veterans by addressing barriers such as commute anxiety, time restrictions, and an aversion to mixed gender groups among women. Educating MBSR teachers about veteran culture and health challenges faced by veterans, adding psychoeducation materials that relate mindfulness practice to conditions common among veterans, and improving visual aids for mindful movement exercises in the workbook could better accommodate veterans who participate in MBSR.
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