Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis

Simpson, R., Simpson, S., Wood, K., Mercer, S. W. and Mair, F. S. (2019) Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis. Chronic Illness, 15(4), pp. 306-318. (doi: 10.1177/1742395318769354) (PMID:29699410)

Abstract

Objectives: To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods: Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results: Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion: Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

• Item Type: Articles
• Additional Information: This project was funded in part by the Scottish Homeopathic Research and Educational Trust (SC006557), and in part the RS McDonald Trust (SC012710).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mercer, Professor Stewart and Mair, Professor Frances and Simpson, Dr Robert and Wood, Miss Karen and Simpson, Sharon
• Authors: Simpson, R., Simpson, S., Wood, K., Mercer, S. W., and Mair, F. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > General Practice and Primary Care; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Chronic Illness
• Publisher: SAGE Publications
• ISSN: 1742-3953
• ISSN (Online): 1745-9206
• Published Online: 26 April 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in Chronic Illness 15(4):306-318
• Publisher Policy: Reproduced in accordance with the publisher copyright policy