Evaluation of the Feasibility of a Yoga and Mindfulness-Based Mental Health Intervention for Latina Immigrant Mothers

Thesis (Master's)--University of Washington, 2016-06

A technique for incorporating dynamic paths in lab-based mobile evaluations

Increasingly, lab evaluations of mobile applications are incorporating mobility. The inclusion of mobility alone, however, is insufficient to generate a realistic evaluation context since real-life users will typically be required to monitor their environment while moving through it. While field evaluations represent a more realistic evaluation context, such evaluations pose difficulties, including data capture and environmental control, which mean that a lab-based evaluation is often a more practical choice. This paper describes a novel evaluation technique that mimics a realistic mobile usage context in a lab setting. The technique requires that participants monitor their environment and change the route they are walking to avoid dynamically changing hazards (much as reallife users would be required to do). Two studies that employed this technique are described, and the results (which indicate the technique is useful) are discussed.

The Role of Home Practice Engagement in a Mindfulness-Based Intervention

Over the last three decades, there has been a precipitous rise in curiosity regarding the clinical use of mindfulness meditation for the self-management of a broad range of chronic health conditions. Despite the ever-growing body of evidence supporting the use of mindfulness-based therapies for both medical and psychological concerns, data on the active ingredients of these mind-body interventions are relatively scarce. Regular engagement in formal mindfulness practice is considered by many to be requisite for generating therapeutic change; however, previous investigations of at-home practice in MBIs have produced mixed results. The equivocal nature of these findings has been attributed to significant methodological limitations, including the lack of standardized, systematic practice monitoring tools, and a singular focus on practice time, with little attention paid to the nature and quality of one’s practice. The present study used a prospective, observational design to assess the effects of home-based practice on dispositional mindfulness, self-compassion, and psychological functioning in twenty-eight people enrolled in an MBSR or MBCT program. To address some of the aforementioned limitations, the present study collected detailed weekly accounts of participants’ home-based practice engagement, including information about practice time (i.e., frequency and duration), exercise type, perceived effort and barriers to participation, and practice quality. Hierarchical multiple regression was used to examine the relative contribution of practice time and practice quality on treatment outcomes, and to explore possible predictors of adherence to at-home practice recommendations. As anticipated, practice quality and perceived effort improved with time; however, rather unexpectedly, practice quality was not a significant predictor of treatment-related improvements in psychological health. Home practice engagement, however, was predictive of change in dispositional mindfulness, in the expected direction. Results of our secondary analyses demonstrated that employment status was predictive of home practice engagement, with those who were unemployed completing more at-home practice on average. Mindfulness self-efficacy at baseline and previous experience with meditation or other contemplative practices were independently predictive of mean practice quality. The results of this study suggest that home practice helps generate meaningful change in dispositional mindfulness, which is purportedly a key mechanism of action in mindfulness-based interventions.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

Mindfulness-Based Cognitive Therapy for older people in a community setting: a mixed methods feasibility study

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Results of a mindfulness-based social-emotional learning program on portuguese elementary students and teachers: a quasi-experimental study

Recently, mindfulness-based social-emotional learning (SEL) approaches have been taught to children in some schools. Due to deficient methodological consistency observed in most studies, their results should be interpreted with caution. Moreover, research on how mindfulness-based SEL approaches benefit teachers is scarce, and the majority of these studies have been conducted in English-speaking countries; therefore, it is uncertain whether these approaches are suited to other cultural backgrounds. The aim of the present study was to evaluate the efficacy of the MindUp curriculum, an SEL program through mindfulness practice for Portuguese students and teachers. Participants included 454 3rd and 4th grade students and 20 teachers from state schools. A quasiexperimental (pre- and post-test) study compared outcomes for an experimental group with a waitlist control group. Data were collected from teachers and children through self-report measures. Results showed that over 50 % of the children who participated in the MindUp program scored above the control group mean in their ability to regulate emotions, to experience more positive affect, and to be more self-compassionate, and over 50 % scored lower in negative affect. In the group of teachers, over 80 % scored above the control group mean in observing, in personal accomplishment, and in self-kindness. Our results contribute to the recent research on the potential added value of mindfulness practices to a SEL program and strengthen the importance for teachers and students of adding to the academic curriculum a SEL program through mindfulness practices.

A multi-view framework for generating mobile apps

This paper demonstrates a multi-view framework for Rapid APPlication Tool (RAPPT). RAPPT enables rapid development of mobile applications. It employs a multilevel approach to mobile application development: a Domain Specific Visual Language to define the high level structure of mobile apps, a Domain Specific Textual Language to define behavioural concepts, and concrete source code for fine grained improvements.

Sustainable futures for learning in a climate of change: mobile apps, social media, and crisis informatics during emergencies and disasters

Emergencies and disasters are different types of crisis events which can affect students and staff in their on-campus roles and off-campus activities. In such events, mobile technologies, mobile software applications (apps), and mobile social networks are becoming increasingly relied upon to communicate, to swiftly send and received information and images, to deliver learning moments, and to check the safety of colleagues and friends. This paper investigates the intersection of mlearning, mobile social media, mobile apps, and crisis informatics in times of emergencies and disasters, using the recent Gipplsand earthquake in south-eastern Australia as an exemplar. It also discusses proactive preparation for educational resilience during emergencies and disasters.

Acceptance of smartphone-based mobile shopping:mobile benefits, customer characteristics, perceived risk and the impact of application context

Despite their generally increasing use, the adoption of mobile shopping applications often differs across purchase contexts. In order to advance our understanding of smartphone-based mobile shopping acceptance, this study integrates and extends existing approaches from technology acceptance literature by examining two previously underexplored aspects. Firstly, the study examines the impact of different mobile and personal benefits (instant connectivity, contextual value and hedonic motivation), customer characteristics (habit) and risk facets (financial, performance, and security risk) as antecedents of mobile shopping acceptance. Secondly, it is assumed that several acceptance drivers differ in relevance subject to the perception of three mobile shopping characteristics (location sensitivity, time criticality, and extent of control), while other drivers are assumed to matter independent of the context. Based on a dataset of 410 smartphone shoppers, empirical results demonstrate that several acceptance predictors are associated with ease of use and usefulness, which in turn affect intentional and behavioral outcomes. Furthermore, the extent to which risks and benefits impact ease of use and usefulness is influenced by the three contextual characteristics. From a managerial perspective, results show which factors to consider in the development of mobile shopping applications and in which different application contexts they matter.

TiltZoom : tilt-based zooming control for easy one-handed mobile interactions

In this paper, we present TiltZoom, a collection of tilt-based interaction techniques designed for easy one-handed zooming on mobile devices. TiltZoom represents novel gestural interaction techniques, implemented using rate-of-rotation readings from a gyroscope, a sensor commonly embedded on current generation smart phones. We designed and experimented three variants of TiltZoom - Tilt Level, Tilt and Hold and Flip Gesture. The design decisions for all three variants are discussed in this paper and their performance, as well as subjective user experience are evaluated and compared against conventional touch-based zooming techniques. TiltZoom appears to be a worthy addition to current established collection of gesture-based mobile interaction techniques for zooming controls, especially when user has only one hand available when moving about.

Social and mobile interaction design to increase the loyalty rates of young blood donors

Young adults represent the largest group of first time donors to the Australian Red Cross Blood Service, but they are also the least loyal group and often do not return after their first donation. At the same time, many young people use the internet and various forms of social media on a daily basis. Web and mobile based technological practices and communication patterns change the way that young people interact with one another, with their families, and communities. Combining these two points of departure, this study seeks to identify best practices of employing mobile apps and social media in order to enhance the loyalty rates of young blood donors. The findings reported in this paper are based on a qualitative approach presenting a nuanced understanding of the different factors that motivate young people to donate blood in the first place, as well as the obstacles or issues that prevent them from returning. The paper discusses work in progress with a view to inform the development of interactive prototypes trialling three categories of features: personal services (such as scheduling); social media (such as sharing the donation experience with friends to raise awareness); and data visualisations (such as local blood inventory levels). We discuss our translation of research findings into design implications.