Relating Instructional Design Components to the Effectiveness of Internet-Based Mindfulness Interventions: A Critical Interpretive Synthesis

Abstract

BackgroundInternet-based mindfulness interventions are a promising approach to address challenges in the dissemination and implementation of mindfulness interventions, but it is unclear how the instructional design components of such interventions are associated with intervention effectiveness.ObjectiveThe objective of this study was to identify the instructional design components of the internet-based mindfulness interventions and provide a framework for the classification of those components relative to the intervention effectiveness.MethodsThe critical interpretive synthesis method was applied. In phase 1, a strategic literature review was conducted to generate hypotheses for the relationship between the effectiveness of internet-based mindfulness interventions and the instructional design components of those interventions. In phase 2, the literature review was extended to systematically explore and revise the hypotheses from phase 1.ResultsA total of 18 studies were identified in phase 1; 14 additional studies were identified in phase 2. Of the 32 internet-based mindfulness interventions, 18 were classified as more effective, 11 as less effective, and only 3 as ineffective. The effectiveness of the interventions increased with the level of support provided by the instructional design components. The main difference between effective and ineffective interventions was the presence of just-in-time information in the form of reminders. More effective interventions included more supportive information (scores: 1.91 in phases 1 and 2) than less effective interventions (scores: 1.00 in phase 1 and 1.80 in phase 2), more part-task practice (scores: 1.18 in phase 1 and 1.60 in phase 2) than less effective interventions (scores: 0.33 in phase 1 and 1.40 in phase 2), and provided more just-in-time information (scores: 1.35 in phase 1 and 1.67 in phase 2) than less effective interventions (scores: 0.83 in phase 1 and 1.60 in phase 2). The average duration of more effective, less effective, and ineffective interventions differed for the studies of phase 1, with more effective interventions taking up more time (7.45 weeks) than less effective (4.58 weeks) or ineffective interventions (3 weeks). However, this difference did not extend to the studies of phase 2, with comparable average durations of effective (5.86 weeks), less effective (5.6 weeks), and ineffective (7 weeks) interventions.ConclusionsOur results suggest that to be effective, internet-based mindfulness interventions must contain 4 instructional design components: formal learning tasks, supportive information, part-task practice, and just-in-time information. The effectiveness of the interventions increases with the level of support provided by each of these instructional design components.

Comparing Web-Based Mindfulness With Loving-Kindness and Compassion Training for Promoting Well-Being in Pregnancy: Protocol for a Three-Arm Pilot Randomized Controlled Trial

“…For example, dismantling studies have supported the theory that acceptance is a necessary component for MBIs to improve positive emotions [ 66 ], whereas perspectives and empirical data on loving-kindness and compassion meditation highlight the central role of self-soothing, caring motivations, and socioaffective processes (eg, directing loving thoughts toward another) [ 37 , 67 - 69 ]. Finally, the structure of the intervention conditions was informed by the instructional design model for internet-based MBIs proposed by Lippmann et al [ 54 ]. These include the use of formal and informal practices, provision of educational and supportive material, and the use of reminders (via text message) at least once a week.…”

“…There are a number of potential benefits of delivering MBIs and CBIs via the internet [ 52 , 54 ], such as the capacity to implement across populations, to reach individuals who might struggle to access face-to-face services, the potential to improve cost-efficiencies, and the ability to provide greater flexibility to service users [ 55 ]. Meta-analyses have found small-to-moderate effect sizes for web-based and self-guided MBIs in promoting well-being and reducing symptoms of psychological distress [ 56 ].…”

“…The MMM study will involve a three-arm RCT comparing web-based mindfulness training, web-based loving-kindness and compassion training (LKCT), and web-based progressive muscle relaxation (PMR; active control) to improve positive mental health and psychological distress among pregnant women. Both experimental conditions in the study were developed with input from consumers (ie, women who had been pregnant) and were designed in line with the instructional design framework for MBIs proposed by Lippmann et al [ 54 ]. PMR was selected as an active control condition as it is considered safe for pregnant women, is associated with physical and psychological benefits in the perinatal period, and could be matched to the format and duration of the experimental conditions [ 61 ].…”

A Critical Interpretive Synthesis to Develop Quality Assessment Tools for E-Cigarette Reviews: Scope and Protocol

“…Critical interpretive synthesis has been employed previously for the creation of standards and guidelines in health research and healthcare (Ako-Arrey et al, 2016; Catalano et al, 2018; Lippmann et al, 2019; Morgan et al, 2018; Mothupi et al, 2018; Plamondon et al, 2019). Considering the fitness-for-purpose of critical interpretive synthesis, we have chosen it to develop REQUIRE.…”

Comparing Web-Based Mindfulness With Loving-Kindness and Compassion Training for Promoting Well-Being in Pregnancy: Protocol for a Three-Arm Pilot Randomized Controlled Trial (Preprint)

“…For example, dismantling studies have supported the theory that acceptance is a necessary component for MBIs to improve positive emotions [66], whereas perspectives and empirical data on loving-kindness and compassion meditation highlight the central role of self-soothing, caring motivations, and socioaffective processes (eg, directing loving thoughts toward another) [37,[67][68][69]. Finally, the structure of the intervention conditions was informed by the instructional design model for internet-based MBIs proposed by Lippmann et al [54]. These include the use of formal and informal practices, provision of educational and supportive material, and the use of reminders (via text message) at least once a week.…”