The implementation of mindfulness in healthcare systems: a theoretical analysis

Abstract

Objective: Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. Method: This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. Results: We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. Conclusion: In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way.

The Efficacy of Mindfulness-Based Interventions in Primary Care: A Meta-Analytic Review

“…This effect size is similar to that observed across general clinical populations and other settings. 2 Primary care could enhance compliance with and adherence to practice and improve the impact of these interventions, 14 although this was not evident in our findings. We did not observe evidence that MBIs were explicitly adapted for primary care patients, which may explain lack of relatively greater benefit in this setting.…”

“…[11][12][13] MBIs are considered complex interventions because their implementation takes into account behavior change in patients and health professionals, as well as their adaptation to setting and culture. 14 Our objective was to perform, for the first time, a meta-analytic review of RCTs to investigate the application and efficacy of MBIs in primary care patients. We had several initial hypotheses 14 : (1) the number of welldesigned studies in primary care is greater than that in other levels of care, because most patients receive long-term assistance here; (2) the clinical impact of MBIs in primary care patients is greater than that at other levels of the health system, because such patients adhere more to mindfulness programs; (3) the range of health conditions addressed by MBIs is larger in primary care (including health promotion in at-risk population and application in patients with multimorbidity), 15 owing to unrestricted access to such care; and (4) as MBIs are complex interventions in primary care, their program contents are systematically adapted to patients' local needs, services, culture, and epidemiology.…”

Accessibility and implementation in the UK NHS services of an effective depression relapse prevention programme: learning from mindfulness-based cognitive therapy through a mixed-methods study

“…Previous commentators have suggested that MBCT be accommodated within contemporary systems of health-care delivery, such as stepped care, that seek to match the intensity of intervention to the needs of individuals in a series of steps. 52 Lower intensity or self-help approaches (e.g. access to self-help resources such as applications, books, online courses) could be offered at earlier steps, with minimal practitioner support and more intensive teacher-led 8-week courses offered at later steps.…”

“…[49][50][51] An analysis at the level of health-care systems suggests that MBCT might best be accommodated within contemporary systems of health-care delivery, such as stepped care that seeks to match the intensity of the intervention to the needs of individuals in a series of steps. 52 A conducive organisational context is noted as important, [52][53][54] a theme consistent with implementation of other psychological treatments. 55 A number of commentators point to the value of starting implementation by offering MBCT to health-care professionals.…”

“…55 A number of commentators point to the value of starting implementation by offering MBCT to health-care professionals. 52,56 Identified barriers include a lack of agreed standards for MBCT training and teaching, limited access to training and supervision, and resources (time, staff, money.) 50,52,54,56,57 Finally, a number of commentators note the need to fit MBCT to the implementation setting, meaning who is the population MBCT is intended for (client/patient population) and what is the context (health-care system and cultural).…”