JMIR Publications

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:

In this article, we describe the process of culturally adapting an Australian online mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students’ psychological distress.

Methods:

To assist the cultural adaptation process, we used systematic cultural adaptation framework and mixed-methods approach, which combined quantitative and qualitative methods. In study 1 (information gathering), we administered an online questionnaire to Indonesian university students (N= 248, mean age 24 years) to examine their preferences regarding an online mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders included local Indonesian clinical psychologists/mindfulness professionals (N= 6) and university students (N=19) and were selected to maximise sample representativeness with respect to personal and professional characteristics (e.g., gender, religious and ethnic background, study major). To evaluate the initial design and the cultural congruence of the online mindfulness program within the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire.

Results:

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 generally found the online program to be highly culturally appropriate in terms of its language, concepts, context, treatment goals, and depictions of students’ emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the programs’ delivery model (e.g., combining visual and audio modalities when delivering psychoeducation), cultural components (e.g., including more social and spiritual activities), program practicality (e.g., including rewards to promote engagement), and design elements (e.g., including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian online mindfulness program, called PSIDAMAI, was created.

Conclusions:

This study highlights the process and importance of cultural adaption of an evidence-based mindfulness treatment and demonstrates how this may be achieved for online psychotherapy programs. We found that a culturally adapted online mindfulness program is relevant for Indonesian students with some adjustments to the programs’ content and delivery. Future research is now needed to evaluate the clinical benefit of PSIDAMAI.