Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study (Preprint)

Abstract

BACKGROUND Psychological distress (depression, anxiety, and stress) is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low-middle income countries (LMICs), including Indonesia. Internet-delivered mindfulness-based interventions that reduce distress have potential for treating university students’ distress at scale. Unfortunately, evidence-based online mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based online mindfulness interventions is needed. OBJECTIVE The aim of the study is to describe the process of culturally adapting an Australian online mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students’ distress. METHODS We describe a systematic cultural adaptation process using the Barrera theoretical framework that includes information gathering and preliminary design. In study 1, we administered an online questionnaire to Indonesian university students (N= 248) to examine their preferences regarding an online mindfulness intervention. In study 2, to evaluate the initial design of the intervention, we conducted interviews and focus groups with relevant stakeholders (including local Indonesian clinical psychologists or mindfulness professionals, and university students). Stakeholders also completed the Cultural Relevance Questionnaire (CRQ) to assess the cultural congruence of the mindfulness program. RESULTS Results suggested that an internet-delivered mindfulness intervention was relevant and feasible for treating Indonesian university students’ distress. In study 1, most Indonesian university students (96.8%) reported openness towards an online-mindfulness program. Most students (52.9%) preferred the length of the program to be 3-4 sessions, with 45.8% preferring brief lessons taking only 15-30 minutes to complete. Most students (78.2%) recommended that the program be accessible by website and mobile phone. In study 2, Indonesian stakeholders (six mindfulness/mental health professionals and nineteen university students) identified specific adaptations regarding delivery model, cultural components, program practicality, and design elements were required. CONCLUSIONS This study highlights the importance of cultural adaption of an evidence-based mindfulness treatment and demonstrates how this may be achieved for online psychotherapy programs. Future research is now needed to evaluate the efficacy of our culturally adapted Indonesian online mindfulness intervention for university students (PSIDAMAI).