University of Maryland, College Park, 1147B Biology-Psychology Building, College Park, MD, 20742, USA.
University of Maryland, College Park, 1147B Biology-Psychology Building, College Park, MD, 20742, USA; Massachusetts General Hospital, 1 Bowdoin Square, Boston, MA, 02114, USA.
Soc Sci Med. 2020 Dec;266:113424. doi: 10.1016/j.socscimed.2020.113424. Epub 2020 Oct 8.
"Thinking too much" is a cultural idiom of distress identified across sub-Saharan Africa, including among people living with HIV (PLWH), which is associated with depression, substance use, and HIV medication nonadherence. Despite the relevance of mindfulness training to address thinking too much, improve HIV-related outcomes, and reduce substance use, efforts to adapt mindfulness training for this context and underserved populations more broadly have been limited.
We explored in this context: (a) the experience of thinking too much among PLWH struggling with adherence and substance use; (b) the appropriateness of mindfulness training to address thinking too much; and (c) potential barriers and facilitators to implementing mindfulness training.
We conducted semi-structured interviews with patients (n = 19) and providers (n = 11) at two clinics in a peri-urban area of Cape Town. Guided by the ADAPT-ITT model, we included an experiential mindfulness practice and participants shared their observations and descriptions of the intervention in the local language (isiXhosa).
Participants found mindfulness relevant, culturally salient, and appropriate for refocusing the mind. Findings provide unique language offered by participants to tailor mindfulness training in the future (e.g., "hearing your veins," "cooling of the mind"). Participants identified potential implementation barriers, including lack of privacy, and facilitators to guide future adaptations.
More research is needed to adapt and increase access to mindfulness training in resource-limited settings globally, while also maintaining treatment integrity and fidelity.
“想太多”是撒哈拉以南非洲地区（包括艾滋病毒感染者）的一种苦恼文化习语，与抑郁、物质使用和艾滋病毒药物依从性差有关。尽管正念训练对于解决想太多问题、改善艾滋病毒相关结局和减少物质使用具有相关性，但针对这一背景和更广泛的服务不足人群改编正念训练的努力一直有限。
本研究旨在探讨：（a）在坚持治疗和使用物质的艾滋病毒感染者中，想太多的体验；（b）正念训练解决想太多问题的适宜性；（c）实施正念训练的潜在障碍和促进因素。
我们在开普敦市区周边的两家诊所对患者（n=19）和提供者（n=11）进行了半结构化访谈。我们遵循 ADAPT-ITT 模型，包括体验式正念练习，参与者用当地语言（isiXhosa）分享他们对干预措施的观察和描述。
参与者认为正念训练是相关的、具有文化意义的、适宜的，可重新集中注意力。研究结果提供了参与者提出的独特语言，以便将来调整正念训练（例如，“倾听你的静脉”、“头脑冷静”）。参与者确定了潜在的实施障碍，包括缺乏隐私，以及指导未来改编的促进因素。
需要进一步研究，以在资源有限的全球环境中改编和增加正念训练的可及性，同时保持治疗的完整性和一致性。
