Developing and evaluating a culturally adapted internet-delivered mindfulness intervention for Indonesian university students experiencing psychological distress

Abstract

Psychological distress is prevalent among university students worldwide, including in Low-and-middle income countries, such as Indonesia. Considering its promising scalability, a culturally relevant Internet-delivered mindfulness intervention has potential to treat psychological distress among Indonesian university students. However, there is no previous research into the development and impact of culturally relevant internet-delivered mindfulness interventions for Indonesian university students, leaving a gap in the research literature. The current thesis aims to: a) develop a culturally adapted internet-delivered mindfulness intervention and evaluate its relevancy for Indonesian university students; b) assess its feasibility and acceptability in a pilot open trial, and c) investigate its effectiveness for treating distress among Indonesian students in a randomised controlled trial. To achieve the thesis objectives, the systematic cultural adaptation framework proposed by Barrera and colleagues (2006; 2013) was employed as a guiding framework for culturally adapting an Australian internet-delivered mindfulness program to be more relevant for Indonesian university students.

The development of a culturally adapted internet-delivered mindfulness intervention was achieved through two studies using mixed-methods approach. Study 1 was an online cross-sectional survey of Indonesian students’ openness and preferences toward an internet-delivered mindfulness program. Study 2 engaged Indonesian university students, as well as mindfulness or mental health experts in focus group discussions, structured interviews, and the completion of cultural relevancy questionnaires. The purpose of Study 2 was to gain feedback on an initial version of the culturally adapted program. These studies showed that an internet-delivered mindfulness intervention is relevant for Indonesian university students, but some adjustments needed to be made to enhance its cultural suitability and engagement. Based on these studies, an Indonesian counsellor-guided internet-delivered mindfulness program, called PSIDAMAI (Program Intervensi Mindfulness Daring Mahasiswa Indonesia) was developed. Subsequently, Study 3 assessed the feasibility, acceptability, and preliminary clinical outcomes of counsellor guided PSIDAMAI using a pre-post open trial study design. Study 3 showed that PSIDAMAI was feasible, acceptable, and associated with significant improvements in psychological distress between baseline and post-treatment, with good completion rates (70%). In Study 4, the clinical efficacy of PSIDAMAI was tested in a randomized controlled trial using a wait-list control group as a comparator. Study 4 found that PSIDAMAI was more effective at improving psychological distress compared to the wait-list control group with medium to large between-group effect sizes. The improvements were maintained up to one-month follow-up.

In summary, the thesis is the first to demonstrate evidence that a culturally adapted internet-delivered mindfulness intervention is relevant, acceptable, feasible, effective, and has positive impacts for Indonesian university students’ mental health. Thus, strategies for wider implementation within the Indonesian higher education mental health system are now needed.