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Mindfulness: a systematic review of instruments to measure an emergent patient-reported outcome (PRO)

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Abstract

Purpose

Mindfulness has emerged as an important health concept based on evidence that mindfulness interventions reduce symptoms and improve health-related quality of life. The objectives of this study were to systematically assess and compare the properties of instruments to measure self-reported mindfulness.

Methods

Ovid Medline®, CINAHL®, and PsycINFO® were searched through May 2012, and articles were selected if their primary purpose was development or evaluation of the measurement properties (validity, reliability, responsiveness) of a self-report mindfulness scale. Two reviewers independently evaluated the methodological quality of the selected studies using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist. Discrepancies were discussed with a third reviewer and scored by consensus. Finally, a level of evidence approach was used to synthesize the results and study quality.

Results

Our search strategy identified a total of 2,588 articles. Forty-six articles, reporting 79 unique studies, met inclusion criteria. Ten instruments quantifying mindfulness as a unidimensional scale (n = 5) or as a set of 2–5 subscales (n = 5) were reviewed. The Mindful Attention Awareness Scale was evaluated by the most studies (n = 27) and had positive overall quality ratings for most of the psychometric properties reviewed. The Five Facet Mindfulness Questionnaire received the highest possible rating (“consistent findings in multiple studies of good methodological quality”) for two properties, internal consistency and construct validation by hypothesis testing. However, none of the instruments had sufficient evidence of content validity. Comprehensiveness of construct coverage had not been assessed; qualitative methods to confirm understanding and relevance were absent. In addition, estimates of test–retest reliability, responsiveness, or measurement error to guide users in protocol development or interpretation of scores were lacking.

Conclusions

Current mindfulness scales have important conceptual differences, and none can be strongly recommended based solely on superior psychometric properties. Important limitations in the field are the absence of qualitative evaluations and accepted external referents to support construct validity. Investigators need to proceed cautiously before optimizing any mindfulness intervention based on the existing scales.

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Acknowledgments

This study was supported in part by National Institutes of Health, National Institute of Diabetes and Digestive and Kidney diseases grant P01 DK 13083.

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Authors and Affiliations

  1. College of Pharmacy, University of Minnesota, Minneapolis, MN, USA

    Taehwan Park, Maryanne Reilly-Spong & Cynthia R. Gross

Authors
  1. Taehwan Park
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  2. Maryanne Reilly-Spong
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  3. Cynthia R. Gross
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Corresponding author

Correspondence to Cynthia R. Gross.

Appendix 1: Full search strategy

Appendix 1: Full search strategy

Ovid Medline®, CINAHL®, and PsycINFO® were searched using the following search string:

  1. 1.

    Mindful* OR vipassana OR zen meditation OR insight mediation OR theravada OR Buddhist meditation

  2. 2.

    Research measurement OR questionnaire* OR scale* OR instrument* OR methods OR outcome assessment OR outcome measure OR psychometr* OR reliab* OR valid* OR internal consistency OR (cronbach* AND (alpha OR alphas)) OR (item AND (correlation* OR selection* OR reduction*)) OR (intraclass AND correlation*) OR interscale correlation* OR agreement OR stability OR generaliza* OR concordance OR variability OR kappa OR kappa’s OR factor analysis OR factor analyses OR factor structure OR dimension OR subscale* OR standard error of measurement OR test–retest OR (test AND retest) OR sensitiv* OR responsive* OR reproducib* OR repeatab* OR replica* OR ((minimal OR minimally OR clinical OR clinically) AND (important OR significant OR detectable) AND (change OR difference)) OR interpretab* OR item response OR IRT OR Rasch OR differential item functioning OR ceiling effect* OR floor effect*

  3. 3.

    1 and 2

  4. 4.

    Limit to English language only.

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Park, T., Reilly-Spong, M. & Gross, C.R. Mindfulness: a systematic review of instruments to measure an emergent patient-reported outcome (PRO). Qual Life Res 22, 2639–2659 (2013). https://doi.org/10.1007/s11136-013-0395-8

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  • DOI: https://doi.org/10.1007/s11136-013-0395-8

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