Mindfulness for people from areas of socioeconomic deprivation: a realist review.

Conference:

SAPC ASM 2024 - Bristol

Talk Code:

10A.1

Presenter:

Kelly Birtwell

Twitter:

@Kelly_B5

Co-authors:

Stewart Mercer, Claire Planner, Caroline Sanders, Jo Protheroe, Sophie Park.

Author institutions:

The University of Manchester, the University of Edinburgh, Keele University, the University of Oxford.

Problem

People from areas of socioeconomic deprivation have poorer physical and mental health, and lower life expectancy than people from more affluent areas. According to the inverse care law, such patients have greater health needs, but experience more challenges accessing care. Mindfulness-based interventions (MBIs) can improve levels of stress, depression, anxiety and chronic pain. Primary care referral pathways for mindfulness may help to improve patient outcomes and ease the burden of the inverse care law. However, there is little research on mindfulness for people from areas of socioeconomic deprivation. In the studies that have been conducted, drop-out rates are high at 40-80%, and little is known about why people withdraw from MBIs.Our aim was to review existing evidence and develop a theory to explain how, why, and to what extent MBIs work (or not) for people from areas of socioeconomic deprivation.

Approach

We conducted a realist review which is a theory-driven systematic review, informed by the principles of scientific realism. Realist reviews develop evidence-informed theories (‘programme theories’) about how complex interventions work, for whom, and to what extent. We developed a programme theory based on evidence from qualitative, quantitative, and mixed methods empirical studies, grey literature, relevant psychological theories, and consultations with stakeholders. Stakeholders were involved throughout and included past mindfulness course participants/patients, GPs, mindfulness teachers, psychologists and therapists.

Findings

Several configurations of contexts-mechanisms-outcomes were developed to inform the programme theory. E.g. where pressure and demands on time (due to work, family, and other commitments) are high (context) mindfulness course attendance and home practice may be seen as ‘extra work’ (mechanism) resulting in additional stress and disengagement from the course (outcomes). Findings suggest that mindfulness-based interventions can help people from areas of socioeconomic deprivation to cope with daily stressors, improve relationships, and can lead to improved wellbeing and mental health. However, in order for people to benefit, it is important that MBIs fit with existing health beliefs, with the practicalities of people’s lives (including the time demands of an MBI), and that people can understand the MBI content and feel safe and supported enough to engage. Key themes include educational approaches, culture and spirituality, and relational aspects.

Consequences

Existing mindfulness-based interventions need to be adapted in order to suit the needs and circumstances of people from areas of socioeconomic deprivation, and alternative approaches to delivering mindfulness should be considered. Brief, flexible approaches that can be delivered via primary care may benefit patients in Deep End practices. This research addresses health inequities and aims to reduce intervention-generated inequalities, which can occur if MBIs are delivered as a ‘one size fits all’ approach. Findings will inform the provision of future psychological support and recommendations for mindfulness teacher training organisations.

Submitted by:

Kelly Birtwell

Funding acknowledgement:

K. Birtwell is funded by a fellowship from the National Institute of Health and Care Research School for Primary Care Research. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.