Adaptation and pilot randomized controlled trial of an online mindfulness-based-intervention for stress reduction and wellbeing of young adults in Pakistan.

Abstract

Young adults' mental health concern in low- and middle-income countries (LAMICs) is a major public health issue. However, the access to a non-stigmatizing and accessible evidence-based intervention is limited in low resource settings like Pakistan. Mindfulness based interventions (MBIs) appear to be a promising stress reducing intervention for this population. Therefore, this study aimed for cultural adaptation of MBI "Finding Peace in a Frantic World" for Pakistani young adults and assessed the feasibility and acceptability of the adapted mindfulness training course (MTC). It further evaluated its preliminary effectiveness for improving stress and wellbeing using a pilot randomized controlled trial (RCT). The study was informed by the Medical Research Council (MRC) framework making it a two-phased research. The cultural adaptation of the MBI was carried out through the four-step Heuristic framework. Results of the adaptation phase indicated relevance and comprehension of the core principles of intervention components. However, major surface structure modifications were language, length of the reading material, culturally relevant explanation of concepts including an additional orientation audio recording and online mode of delivery. In the second phase of the study 156 young adults were randomized into online 8-week MTC (n=80) or a waitlist control group (n=76). The quantitative and qualitative findings of the feasibility and acceptability indicators showed ease of randomization and online data collection procedures with high recruitment rates, compliance, and adherence to MTC. Online mode was acceptable to participants as evidenced by high ratings of overall satisfaction, perceived effectiveness, understandability, relatability, effectiveness of the meditation exercises and 87% attendance. The feedback from participants indicated high adherence to home meditation practice (92%), and everyday viii mindfulness activities (100%). Despite attrition (32%), online mindfulness training (MTC) showed significant increase in mindfulness (MD=12.5 (p=0.005), 95% CI [3.93 to 21.06]) and psychological wellbeing levels (MD=11.75 (p= 0.05), 95% CI [-0.12 to 23.63]) and decrease in stress levels (MD= -28.2 (p= 0.000), 95% CI [-37.28 to – 19.11]) in the MTC group compared to the control group. Reflexive thematic analysis revealed that formal and informal practices appeared to promote self-compassion with personal growth and transformation, even in the face of challenges, cultivating resilience, enriching interactions, and intrapersonal wellbeing. This study significantly contributes to the evidence base of MBIs in Pakistani context by demonstrating the acceptability and feasibility of online MTC. This innovative online approach lays the foundation for a large-scale RCT to evaluate the efficacy of a viable and accessible MTC in improving Pakistani young adults' stress and well-being.