The Application of Mindfulness for Individuals Living with HIV in South Africa: a Hybrid Effectiveness-Implementation Pilot Study

Abstract

Despite the recent growth of mindfulness research worldwide, there remains little research examining the application of mindfulness-based interventions in resource-limited, international settings. This study examined the application of Mindfulness Based Stress Reduction (MBSR) for HIV-infected individuals in South Africa, where rates of HIV are highest in the world. Mixed methods were used to examine the following over a three-month follow up: (1) feasibility, acceptability, and preliminary adaptation of MBSR for this new context; and (2) effects of MBSR on immune functioning, self-reported mindfulness (MAAS, FFMQ), depression, anxiety, and stress (DASS-21). Ten individuals initiated MBSR, and seven completed all eight sessions. Results indicated medium effect size improvements in immune functioning (CD4 count and t-cell count; d = .5) through the three-month follow up, though the small sample size limited power to detect a statistically significant effect. From baseline to post-treatment, improvements in “Observing” and “Non-reactivity” (FFMQ) approached statistical significance with large effect sizes (observing: d = 1.5; p = .08; non-reactivity: d = .7; p = .07). There were no statistically significant changes in depression, anxiety, or stress throughout the study period. Primary areas for adaptation of MBSR included emphasis on informal practice, ways to create “space” without much privacy, and ways to concretize the concepts and definitions of mindfulness. Feedback from participants can shape future adaptations to MBSR for this and similar populations. Findings provide preliminary evidence regarding the implementation of MBSR for individuals living with HIV in South Africa. A future randomized clinical trial with a larger sample size is warranted.

Patient and provider perceptions of a peer-delivered intervention (‘Khanya’) to improve anti-retroviral adherence and substance use in South Africa: a mixed methods analysis

“…Adaptation of mindfulness training to sub-Saharan Africa has been relatively limited to date and has focused on mental health outcomes (i.e. depression, anxiety, and stress) instead of SU or HIV outcomes (McIntyre et al ., 2018 ; Geda et al ., 2021 ; Musa et al ., 2021 ). Mindfulness training is infrequently included in task-shared psychological interventions in general (Wagenaar et al ., 2020 ).…”

“…Mindfulness training aims to increase awareness of the present moment with the aim of cultivating nonjudgmental awareness of negative affective states and reducing emotional avoidance (Miller, 1999 ). In Khanya , this includes both formal and informal mindfulness exercises that had been adapted to the South African context to promote feasibility and acceptability (McIntyre et al ., 2018 ). Finally, relapse prevention strategies focus on the identification and navigation of high-risk situations (e.g.…”

“…These components included problem-solving strategies, BA, mindfulness training, and relapse prevention strategies. Each had also previously been delivered in isolation, in briefer interventions, and/or integrated with other skills (Andersen et al, 2018;McIntyre et al, 2018;Myers et al, 2019;Safren et al, 2021). These were then adapted for the setting based on key stakeholder input (Magidson et al, 2019(Magidson et al, , 2020a(Magidson et al, , 2020b(Magidson et al, , 2020cBelus et al, 2020).…”

The relationship between mindfulness and individual adaptability in dynamic work contexts

“…Nkomo (2011) has demonstrated the complex tensionfilled but important terrain of better linking African contexts and realities with Western theory. Work on mindfulness in South Africa has shown its relevance in culturally embedded settings (McIntyre, Elkonin, De Kooker, & Magidson, 2018).…”

Mindfulness Enhances Cognitive Functioning: A Meta-Analysis of 111 Randomized Controlled Trials

“…Children, adolescents, as well as young (aged 18 to 40 years), middle-aged (41-64), and older adults (65 years and older) who underwent MBIs experienced neurophysiological or self-and other-rated improvements in physical immunity, inflammation levels, cardiovascular indices, cognitive functions, mood regulation, flexible thinking, and perspective-taking (Abbott et al, 2014;Black & Slavich, 2016;Flook, Goldberg, Pinger, & Davidson, 2015;Flook et al, 2010;Kaunhoven & Dorjee, 2017;Wetherell et al, 2017). These salutary effects of MBIs have been documented in males and females situated in multiple geographical continents, including North America (Hofmann & Gómez, 2017), South America (Manotas, Segura, Eraso, Oggins, & McGovern, 2014;Waldemar et al, 2016), Europe (Abbott et al, 2014), Africa (McIntyre, Elkonin, de Kooker, & Magidson, 2018;Whitesman, Hoogenhout, Kantor, Leinberger, & Gevers, 2018), Asia (Keng et al, in press;Lu et al, 2019;Phang, Chiang, Ng, Keng, & Oei, 2016), and Oceania (Bernay, Graham, Devcich, Rix, & Rubie-Davies, 2016;Hwang et al, 2019). Advancing our understanding of the impact of mindfulness is thus essential.…”