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Abstract
BackgroundInternet-supported mindfulness-based interventions (MBIs) are increasingly being used to support people with a chronic condition. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes.ObjectiveThe aims of this review were to (1) provide a description of digital characteristics of internet-supported MBIs and examine how these relate to evidence for efficacy and adherence to the intervention and (2) gain insights into the type of information available to inform translation of internet-supported MBIs to applied settings.MethodsMEDLINE Complete, PsycINFO, and CINAHL databases were searched for studies assessing an MBI delivered or accessed via the internet and engaging participants in daily mindfulness-based activities such as mindfulness meditations and informal mindfulness practices. Only studies using a comparison group of alternative interventions (active compactor), usual care, or wait-list were included. Given the broad definition of chronic conditions, specific conditions were not included in the original search to maximize results. The search resulted in 958 articles, from which 11 articles describing 10 interventions met the inclusion criteria.ResultsInternet-supported MBIs were more effective than usual care or wait-list groups, and self-guided interventions were as effective as facilitator-guided interventions. Findings were informed mainly by female participants. Adherence to interventions was inconsistently defined and prevented robust comparison between studies. Reporting of factors associated with intervention dissemination, such as population representativeness, program adoption and maintenance, and costs, was rare.ConclusionsMore comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of MBIs. Gender differences in determinants and patterns of health behavior should be taken into account at the intervention design stage to accommodate male and female preferences. Future research could compare MBIs with established evidence-based therapies to identify the population groups that would benefit most from internet-supported programs.Trial RegistrationPROSPERO CRD42017078665; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=78665 (Archived by WebCite at http://www.webcitation.org/71ountJpu)
Highlights
BackgroundOver the past two decades, mindfulness has become a major focus of research in health care settings for people with chronic conditions [1]
More comprehensive descriptions of digital characteristics need to be reported to further our understanding of features that may influence engagement and behavior change and to improve the reproducibility of mindfulness-based interventions (MBIs)
There is evidence to support the use of mindfulness-based interventions (MBIs) such as mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) for mental and physical symptoms in people with cancer, cardiovascular disease, chronic pain, depression, and anxiety disorders [1]
Summary
BackgroundOver the past two decades, mindfulness has become a major focus of research in health care settings for people with chronic conditions [1]. As highlighted by the authors, interventions varied in their modes of delivery (mobile phone app, website, or Web-based classroom), therapeutic approaches (mindfulness-based vs mindfulness-inspired interventions), and level of therapist involvement (self-guided vs therapist-guided) [6] This makes it difficult to determine which aspects of the Web-based designs optimized intervention delivery and their associated behavior change. Another systematic review involving people with physical conditions showed a positive effect of the intervention compared with usual care on a variety of outcomes such as pain acceptance, coping measures, and depressive symptoms [7]; results were mixed when the interventions were compared with an active control group, such as cognitive behavioral therapy. Sending reminders and providing personalized feedback through emails are both asynchronous functions but may influence intervention engagement differently [8,9] It is, important to examine the technology used in internet-supported MBIs to understand how digital functions optimize intervention delivery and outcomes. Characteristics of MBIs vary greatly in their mode of delivery, communication patterns, level of facilitator involvement, intervention period, and resource intensity, making it difficult to compare how individual digital features may optimize intervention adherence and outcomes
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