title: Challenges to Enrollment and Participation in Mindfulness-Based Stress Reduction Among Veterans: A Qualitative Study.
abstract: BACKGROUND
  Mindfulness-Based Stress Reduction (MBSR) is associated with reduced depressive symptoms, quality of life improvements, behavioral activation, and increased acceptance among veterans. This study was conducted to increase the reach and impact of a veterans' MBSR program by identifying barriers to enrollment and participation to inform modifications in program delivery.
  
  
  OBJECTIVE
  Verify or challenge suspected barriers, and identify previously unrecognized barriers, to enrollment and participation in MBSR among veterans.
  
  
  METHODS
  A retrospective qualitative analysis of semistructured interviews.
  
  
  METHODS
  VA Puget Sound Health Care System (Seattle, WA).
  
  
  METHODS
  68 interviewed, and 48 coded and analyzed before reaching saturation.
  
  
  METHODS
  Content analysis of semistructured interviews.
  
  
  RESULTS
  Of the participants who enrolled, most (78%) completed the program and described MBSR positively. Veterans identified insufficient or inaccurate information, scheduling issues, and an aversion to groups as barriers to enrollment. Participants who discontinued the program cited logistics (e.g., scheduling and medical issues), negative reactions to instructors or group members, difficulty understanding the MBSR practice purposes, and struggling to find time for the practices as barriers to completion. Other challenges (cohort dynamics, teacher impact on group structure and focus, instructor lack of military service, and physical and psychological challenges) did not impede participation; we interpreted these as growth-facilitating challenges. Common conditions among veterans (chronic pain, posttraumatic stress disorder, and depression) were not described as barriers to enrollment or completion.
  
  
  CONCLUSIONS
  Women-only MBSR groups and tele-health MBSR groups could improve accessibility to MBSR for veterans by addressing barriers such as commute anxiety, time restrictions, and an aversion to mixed gender groups among women. Educating MBSR teachers about veteran culture and health challenges faced by veterans, adding psychoeducation materials that relate mindfulness practice to conditions common among veterans, and improving visual aids for mindful movement exercises in the workbook could better accommodate veterans who participate in MBSR.
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, WA.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Martinez
authors.affiliation: 2 Department of Medicine, VA Puget Sound Health Care System , Seattle, WA.|3 Department of Medicine, University of Washington School of Medicine , Seattle, WA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Kearney
authors.affiliation: 4 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, WA.|5 Department of Mental Health, VA Puget Sound Health Care System , Seattle, WA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Simpson
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, WA.
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Felleman
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, WA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Bernardi
authors.affiliation: 1 VA Puget Sound Health Care System , Seattle, WA.|6 Department of Health Services, University of Washington School of Public Health , Seattle, WA.
authors.forename: George
authors.initials: G
authors.lastname: Sayre
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D064866:Mindfulness / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000628:therapy*; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D014861:Washington; D055815:Young Adult