Mechanisms of sustained mindfulness practice in stroke survivors: A critical realist secondary analysis of the HEADS: UP intervention

BACKGROUND AND PURPOSE: Post-stroke anxiety and depression symptoms are common after stroke and can persist long-term. Despite this, there is a lack of long-term psychological support for post-stroke anxiety and depression. Mindfulness-based interventions are emerging as feasible, acceptable and potentially effective interventions for post-stroke anxiety and depression. Sustained use of mindfulness practice can help stroke survivors to self-manage their anxiety and depression in the long-term. However, stroke survivors' experiences of continued practice following a mindfulness-based intervention have yet to be explored. This study aims to identify mechanisms underpinning sustained mindfulness practice by stroke survivors following completion of an adapted, stroke-specific mindfulness-based intervention called HEADS: UP (Helping Ease Anxiety and Depression After Stroke). MATERIALS AND METHODS: A secondary analysis of 6-month follow-up qualitative data from course participants (n = 12) in the HEADS: UP randomised controlled trial was analysed using critical realist thematic analysis. RESULTS: Seven mechanisms were identified as determining sustained mindfulness practice: 1) Believing continued practice brings benefits, 2) Personal preferences and accessibility, 3) Continued learning, 4) Attitudes of others and society, 5) Togetherness and connection, 6) Structuring and scaffolding practice, and 7) Competing priorities. CONCLUSION: The mechanisms provide explanations behind stroke survivors' experiences of sustained mindfulness practice following HEADS: UP. The findings highlighted the potential benefit of providing support following a mindfulness-based intervention to facilitate sustained practice. Awareness of the mechanisms could aid future intervention design and help clinical practitioners and stroke support professionals support continued mindfulness practice.