In this research update, Kathryn Waldegrave explores how mindfulness can be used to effectively manage chronic conditions and looks at the role of faith in fostering good health.
Using mindfulness for self-management of chronic disease in primary care
A large majority of primary care patients who present with chronic physical conditions also experience associated mental health comorbidities such as anxiety or depression. Poor mental health can influence levels of self-efficacy employed to manage the physical illness; individual self-regulation, cognition and attention status may fluctuate.
A US study examined mindfulness meditation as a way of improving self-regulation by increasing cognitive resources: 136 participants receiving primary care interventions for anxiety or depression were recruited to a randomised controlled trial that compared and evaluated the effectiveness of an eight-week mindfulness training for primary care (MTPC) programme against a low-dose comparator (LDC).
Ninety-two participants in the MTPC group underwent weekly two-hour sessions, a seven-hour, all-day session and daily home sessions with guided support. Forty-four participants in the LDC group were encouraged to practise mindfulness skills learned during a 60-minute session, alongside access to digital and community resources. Short-term action plans created by participants in week seven were used to assess initiation at week nine; 57.6% of MTPC participants self-initiated their action plan compared with 31.8% in the LDC group. While secondary outcome analysis of depression reduction demonstrated no differences at week eight, by week 24 both groups showed significant reductions to anxiety and depression, suggesting that favourable results can be obtained by even very modest amounts of mindfulness.
The results demonstrate the effectiveness of MTPC as a method for improving emotional regulation, self-compassion and mindfulness when compared with LDC.
Study reference:
Gawande, R; Ngoc To, M; Pine, E; Griswold, T; Creedon, T; Brunel, A; Lozada, A; Loucks, E; Schuman-Oliver, Z. ‘Mindfulness Training Enhances Self-Regulation and Facilitates Health Behaviour Change for Primary Care Patients: A Randomized Controlled Trial’ J Gen Intern Med 2018, 34 (2), pp.293-302. doi: 10.1007/s11606-018-4739-5
Commentary reference:
Kearney, D. ‘Mindfulness training for primary care patients promotes chronic disease self-management behaviours’. Evid Based Nurs. Published Online First: 25/10/19. doi: 10.1136/ebnurs-2019-103131
Health promotion in places of worship
There is increasing recognition of the important role that faith-based affiliations hold in respect of decisions made about health.
Faith is synonymous with health studies focusing on ‘minority’ or ‘seldom-heard’ groups – for example, in black, Asian and minority ethnic (BAME) communities – but it is still not integrated fully into mainstream health systems. Adhering to faith-based decisions in the provision and acceptance of healthcare can present increasingly complex situations, and decisions made can have varying implications.
Places of worship (PW) are not readily acknowledged as health promotion settings since health is not their core business. A faith setting can, however, provide a unique means of access to members of BAME groups, and the messages communicated have the potential to facilitate changes in health behaviours.
A scoping study, undertaken across two large multicultural northern cities, examined PW as public health settings for individuals from BAME communities. Nineteen semi-structured interviews were completed with religious leaders from the main BAME faiths in the cities, third-sector wellbeing organisations, and local authority public health professionals.
The study highlighted that religious leaders hold high levels of knowledge about the health needs of their communities. A theory of ‘therapeutic landscape’ was developed, demonstrating the health relevance of PW to health professionals and practitioners, as well as members of the PW themselves.
PW as public health settings to share health messages are often overlooked, however it is important that public health professionals understand their importance and forge positive relationships with religious leaders in order to fully engage with the community and shape health behaviours.
Study reference:
Tomalin, E; Sadgrove, J; Summers, R. ‘Health, faith and therapeutic landscapes: Places of worship as Black, Asian and Minority Ethnic (BAME) public health settings in the United Kingdom’ Social Science and Medicine, 2019, 230, pp.57-65. doi: 10.1016/j.socscimed.2019.03.006
Commentary reference:
Ali, P. ‘Places of worship can be health promotion spaces for faith-based black, Asian and minority ethnic (BAME) communities’. Evid Based Nurs. Published Online First: 17 December 2019. doi: 10.1136/ebnurs-2019-103140
