JMIR Publications

ABSTRACT

Background:

Online mindfulness programs may be beneficial in improving wellbeing outcomes of those living with chronic illness. Adherence to programs is a key indicator in improving outcomes, however with digitization of programs it is necessary to enhance engagement and encourage people to return to digital health platforms. More information is needed about how engagement strategies have been used within online mindfulness programs to encourage adherence.

Objective:

To develop a list of engagement strategies for online mindfulness programs and to evaluate the impact of engagement strategies on adherence.

Methods:

A narrative systematic review was conducted across the Medline complete, CINAHL complete, APA PsycInfo and Embase databases and followed PRISMA guidelines. Articles were screened using a P.I.C.O framework. Population. Adults over 18 years of ages with a chronic health condition. Intervention. Mindfulness interventions including those in combination with mindfulness based cognitive therapy, delivered online, through the internet or smartphone technology. Interventions of at least two weeks in duration. Comparator. Studies with a randomized controlled trial design or pilot randomized controlled trial design were included. Outcome. Engagement strategies including interactive program features and facilitator-led strategies, adherence and retention.

Results:

A total of 1265 articles were screened by title and abstract of which 19 were relevant and were included into the review. On average 71% of study participants were females with a mean age of 46 (SD 13). Most commonly mindfulness programs were delivered to people living with mental health conditions (42%, 8/19). Of all, eight studies used only program features to encourage adherence (42%), five used facilitator- led strategies (26%) and six used a combination of the two (32%). Encouraging program adherence was the most common engagement strategy used which was utilized among 10/13 facilitator-led studies (77%) and 8/14 (57%) of program feature studies). Nearly two-thirds of studies (63%) of studies provided a definition of adherence which varied between 50-100% completion across studies. Overall, across studies mean participant compliance to the mindfulness programs was 56% (SD15). Most studies (53%, 10/19) had long term follow up, from which the most common follow up period was 12 weeks post intervention (30%, 3/10). At post-intervention mean retention was 78% (SD 15).

Conclusions:

Engagement strategies in online mindfulness programs largely comprise of reminders to use the program. Other features may be suitable for encouraging adherence with interventions and a facilitator-led component may have higher retention. There is variance in the way adherence is measured, and intervention lengths and follow-up periods are inconsistent. More thorough reporting and a standardized framework for measuring adherence is needed to more accurately assess adherence and engagement strategies. Clinical Trial: This review was registered with Prospero ID CRD42020201677