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Pacific Cultural Enhancement of Mindfulness-Based Cognitive Therapy: Insights from Clinical and Cultural Experts

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Abstract

Objectives

Mindfulness-Based Cognitive Therapy (MBCT) is an evidence-based mental health intervention with a robust body of research substantiating its efficacy, but concerns exist around its applicability to ethnically diverse and under-represented minority populations such as Pacific peoples. Cultural adaptation is important to increase engagement in such populations and frameworks recommend qualitative expert consultation studies to inform preliminary adaptation design. This study aimed to examine the perspectives of two Pacific clinical and cultural experts on MBCT and its potential for cultural adaptation for Pacific populations.

Methods

The perspectives of experts in Pacific mental health and culture who had also experienced MBCT were explored using in-depth semi-structured interviews. These interviews were qualitatively analysed using reflexive thematic analysis with the aim of producing a comprehensive, primarily descriptive analysis.

Results

Five themes were identified pertaining to acceptability, cultural adaptation, communication, connectivity, and spirituality. Experts considered MBCT an acceptable mental health intervention that could benefit Pacific communities. Cultural adaptations suggested by experts primarily referred to language, spirituality, and the incorporation of Pacific cultural values and protocols. The group delivery format of MBCT was identified as a potential point of synergy and resonance with the Pacific worldview.

Conclusions

Experts suggest that MBCT is a relevant, compatible, and acceptable intervention for Pacific populations with significant potential for further adaptation. Co-design approaches to cultural adaptation were advocated. Further research is required to examine the perspectives of more diverse and representative Pacific populations as part of the co-design process.

Preregistration

This study is not preregistered because it is a preliminary exploration.

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Data Availability

Transcripts for this study are not publicly available because this is potentially identifiable qualitative data and ethics approval does not allow this.

References

  • Agnew, F., Pulotu-Endemann, F., Robinson, G., Suaalii-Sauni, T., Warren, H., Wheeler, A., Erick, M., Hingano, T., & Schmidt-Sopoaga, H. (2004). Pacific models of mental health service delivery in New Zealand (“PMMHSD”) project. Waitematā District Health Board Auckland: Clinical Research and Resource Centre.

    Google Scholar 

  • Amaro, H. (2014). Implementing mindfulness-based relapse prevention in diverse populations: Challenges and future directions. Substance Use & Misuse, 49(5), 612–616. https://doi.org/10.3109/10826084.2014.856624

    Article  Google Scholar 

  • Anae, M. (2016). Teu Le Va: Samoan relational ethics. Knowledge Cultures, 4(3), 117–130.

    Google Scholar 

  • Barrera, M., Jr., Castro, F., Strycker, L., & Toobert, D. J. (2013). Cultural adaptations of behavioral health interventions: A progress report. Journal of Consulting and Clinical Psychology, 81(2), 196–205. https://doi.org/10.1037/a0027085

  • Benish, S., Quintana, S., & Wampold, B. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counselling Psychology, 58(3), 279–289. https://doi.org/10.1037/a0023626

    Article  Google Scholar 

  • Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806

    Article  Google Scholar 

  • Carrière, K., Khoury, B., Günak, M., & Knäuper, B. (2018). Mindfulness-based interventions for weight loss: A systematic review and meta-analysis. Obesity Reviews, 19, 164–177. https://doi.org/10.1111/obr.12623

    Article  PubMed  Google Scholar 

  • Clarke, V., & Braun, V. (2013). Successful qualitative research: A practical guide. Sage Publications.

  • DeLuca, S. M., Kelman, A. R., & Waelde, L. C. (2018). A systematic review of ethnoracial representation and cultural adaptation of mindfulness- and meditation-based interventions. Psychological Studies, 63(2), 117–129. https://doi.org/10.1007/s12646-018-0452-z

    Article  Google Scholar 

  • Dobkin, P. L., Hickman, S., & Monshat, K. (2014). Holding the heart of mindfulness-based stress reduction: Balancing fidelity and imagination when adapting MBSR. Mindfulness, 5(6), 710–718. https://doi.org/10.1007/s12671-013-0225-7

    Article  Google Scholar 

  • Fa’alili-Fidow, J., Moselen, E., Denny, S., Dixon, R., Teevale, T., Ikihele, A., & Clark, T. (2016). Youth’12 the health and wellbeing of secondary school students in New Zealand: Results for pacific young people. The University of Auckland

  • Faleafa, M. (2020). Core elements of pacific primary mental health and addiction service provision. Niu Mindworks Limited.

  • Foliaki, S., Kokaua, J., Schaaf, D., & Tukuitonga, C. (2006). Twelve-month and lifetime prevalences of mental disorders and treatment contact among Pacific people in Te Rau Hinengaro: The New Zealand mental health survey. Australian & New Zealand Journal of Psychiatry, 40(10), 924–934. https://doi.org/10.1080/j.1440-1614.2006.01912.x

    Article  Google Scholar 

  • Goodyear-Smith, F., Jackson, C., & Greenhalgh, T. (2015). Co-design and implementation research: Challenges and solutions for ethics committees. BMC Medical Ethics 16, 78. https://doi.org/10.1186/s12910-015-0072-2

  • Griner, D., & Smith, T. (2006). Culturally adapted mental health interventions: A meta-analytic review. Psychotherapy: Theory, Research, Practice, Training, 43(4), 531–548. https://doi.org/10.1037/0033-3204.43.4.531.

  • Haidar, A., Nwosisi, E., & Burnett-Zeigler, I. (2023). The role of religion and spirituality in adapting mindfulness-based interventions for Black American communities: A scoping review. Mindfulness, 14(8), 1852–1867. https://doi.org/10.1007/s12671-023-02194-5

    Article  Google Scholar 

  • Hofmann, S., & Gómez, A. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008

    Article  PubMed  Google Scholar 

  • Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., Lewis, G., Watkins, E., Brejcha, C., Cardy, J., Causley, A., Cowderoy, S., Evans, A., Gradinger, F., Kaur, S., Lanham, P., Morant, N., Richards, J., Shah, P., & Byford, S. (2015). Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial. Lancet, 386(9988), 63–73. https://doi.org/10.1016/S0140-6736(14)62222-4

    Article  PubMed  Google Scholar 

  • Le, T., & Proulx, J. (2015). Feasibility of mindfulness-based intervention for incarcerated mixed- ethnic native Hawaiian/Pacific Islander youth. Asian American Journal of Psychology, 6(2), 181–189. https://doi.org/10.1037/aap0000019

  • Le, T., & Shim, P. (2014). Mindfulness and the Aloha response. Journal of Indigenous Social Development, 3(2), 1–11.

    Google Scholar 

  • Madill, A., Jordan, A., & Shirley, C. (2000). Objectivity and reliability in qualitative analysis: Realist, contextualist and radical constructionist epistemologies. The British Journal of Psychology, 91(1), 1–20. https://doi.org/10.1348/000712600161646

    Article  Google Scholar 

  • Malhi, G. S., Bassett, D., Boyce, P., Bryant, R., Fitzgerald, P. B., Fritz, K., Hopwood, M., Lyndon, B., Mulder, R., Murray, G., Porter, R., & Singh, A. B. (2015). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Australian and New Zealand Journal of Psychiatry, 49(12), 1087–1206. https://doi.org/10.1177/0004867415617657

    Article  PubMed  Google Scholar 

  • Mulder, R., Petaia, L., Pulotu-Endemann, F., Tuitama, G., Viali, S., & Parkin, I. (2016). Building on the strengths of Pacific mental health: Experience from Samoa. Australian & New Zealand Journal of Psychiatry, 50(5), 397–398. https://doi.org/10.1177/0004867415625816

  • Mulder, R., Sorensen, D., Kautoke, S., & Jensen, S. (2020). Pacific models of mental health service delivery in New Zealand: Part I: What do we know about Pacific mental health in New Zealand? A Narrative Review. Australasian Psychiatry, 28(1), 16–20. https://doi.org/10.1177/1039856219859274

  • Nagy, G., Cuervo, C., Ramos Rodrigues, E., Vilardaga, J., Zerubavel, N., West, J., Falick, M., & Parra, D. (2022). Building a more diverse and inclusive science: Mindfulness-based approaches for Latinx individuals. Mindfulness, 13(4), 942–954. https://doi.org/10.1007/s12671-022-01846-2

  • New Zealand Government. (2018). He Ara Oranga: Report of the government inquiry into mental health and addiction. New Zealand Government.

  • Oman, D. (2023). Mindfulness for global public health: Critical analysis and agenda. Mindfulness. https://doi.org/10.1007/s12671-023-02089-5

    Article  Google Scholar 

  • Pacific Perspectives Limited. (2019). Health system review - Pacific report. Pacific Perspectives.

  • Petaia, L., Stoner, T., Bell, G., Seth, H., & Hatters Friedman, S. (2022). Characteristics of Pacific Island people admitted to a New Zealand inpatient forensic service. Journal of the American Academy of Psychiatry and the Law, 50(1). https://doi.org/10.29158/JAAPL.210031-21.

  • Pulotu-Endemann, F.K. (2001) Fonofale model of health. https://www.d3n8a8pro7vhmx.cloudfront.net/actionpoint/pages/437/attachments/original/1534408956/Fonofalemodelexplanation.pdf?1534408956

  • Statistics New Zealand. (2017). National ethnic population projections: 2013(base)-2038(update). https://www.stats.govt.nz/information-releases/national-ethnic-population-projections-2013base2038-update

  • Statistics New Zealand. (2018). Pacific Peoples ethnic group. https://www.stats.govt.nz/tools/2018-census-ethnic-group-summaries/pacific-peoples

  • Statistics New Zealand, Ministry of Pacific Island Affairs. (2011). Health and Pacific peoples in New Zealand.

  • Tiatia-Seath, J. (2014). Pacific peoples, mental health service engagement and suicide prevention in Aotearoa New Zealand. Ethnicity and Inequalities in Health and Social Care, 7(3), 111–121. https://doi.org/10.1108/EIHSC-10-2013-0023

    Article  Google Scholar 

  • Tiatia-Seath, J., Lay-Yee, R., & Von Randow, M. (2017). Suicide mortality among Pacific peoples in New Zealand, 1996–2013. The New Zealand Medical Journal, 130(1454), 21–29.

    PubMed  Google Scholar 

  • Vaka, S., Brannelly, T., & Huntington, A. (2016). Getting to the heart of the story: Using Talanoa to explore Pacific mental health. Issues in Mental Health Nursing, 37(8), 537–544. https://doi.org/10.1080/01612840.2016.1186253

    Article  PubMed  Google Scholar 

  • Watson-Singleton, N. N., Black, A. R., & Spivey, B. N. (2019). Recommendations for a culturally-responsive mindfulness-based intervention for African Americans. Complementary Therapies in Clinical Practice, 34, 134–138. https://doi.org/10.1016/j.ctcp.2018.11.013

    Article  Google Scholar 

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Funding

This research was funded by a Career Development Award to the PI, Emme Chacko, from the Health Research Council of New Zealand (20/019).

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Authors and Affiliations

  1. Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, New Zealand

    Emme Chacko, Sarah Cullum, Frederick Sundram & Gary Cheung

  2. Te Whatu Ora Counties Manukau, Auckland, New Zealand

    Jullian Carter

Authors
  1. Emme Chacko
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  2. Jullian Carter
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  3. Sarah Cullum
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  4. Frederick Sundram
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  5. Gary Cheung
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Contributions

Emme Chacko: study design, ethics approval, recruitment, interviewing, qualitative analysis, draft preparation. Jullian Carter: transcription, qualitative analysis, draft preparation, cultural expertise. Sarah Cullum: study design, draft editing, supervision. Frederick Sundram: study design, draft editing, supervision. Gary Cheung: study design, draft editing, supervision.

Corresponding author

Correspondence to Emme Chacko.

Ethics declarations

Use of Artificial Intelligence

AI was not used in this study.

Ethics Approval

This study represents the Pacific aspect of a larger consultation study aimed at adapting MBCT for family carers of people with dementia in a New Zealand context. The study received ethical approval by the Health and Disabilities Ethics Committee of New Zealand (approved for 3 years by Northern B HDEC 20/NTB/237 on 22/12/2020).

Informed Consent

Informed consent has been obtained in writing for participants after written information and verbal explanations provided by the PI, Emme Chacko.

Conflict of Interest

The authors declare no competing interests.

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Chacko, E., Carter, J., Cullum, S. et al. Pacific Cultural Enhancement of Mindfulness-Based Cognitive Therapy: Insights from Clinical and Cultural Experts. Mindfulness 15, 120–129 (2024). https://doi.org/10.1007/s12671-023-02277-3

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