1. Introduction
depression, anxiety
RECRUITMENT
The rise in mental health concerns of university students is causing a serious hinderance to their wellbeing, impeding their functioning. The socio-economic and political friction in low- and middle-income countries adds to their vulnerability and calls for a cost-effective indigenous intervention. Consequently, this study aimed to inform a large definitive trial by assessing the feasibility and acceptability of a randomized controlled trial (RCT) design evaluating a culturally adapted online Mindfulness Training Course (MTC) used to improve stress and wellbeing among Pakistani university students. A two-arm pilot randomized controlled trial was conducted. University students (Mindfulness-based interventions (MBI) have shown benefits in improving the mental health of university students. The empirical evidence indicates their usefulness in enhancing wellbeing [The effects of MBIs in low- and middle-income countries (LAMICs) have also been studied through RCTs, indicating small to moderate effect sizes for emotional intelligence [In the context of LAMICs, low-resource interventions are needed. Online mindfulness-based interventions are cost effective and may be beneficial [In Pakistan, rising mental health awareness has raised concern among university students, who have been reported to suffer from academic stress and mental health problems including depression, anxiety, and suicide attempts [In this context, we set out to culturally adapt an MBI that can be delivered online for Pakistani university students and has a human interaction element, and to test it in an initial pilot RCT. We ensured that systematic and methodological rigor was present [(a) To inform a larger definitive trial by assessing:Which of the four recruitment methods has more registrations?What is the recruitment rate?Is the online mode of delivering intervention sessions feasible?Are the eligibility criteria of trial participants feasible?Are the randomization procedures feasible?Are online data collection procedures feasible?Are worksheet submissions feasible?Are the outcome measures being used feasible?(b) To examine the acceptability of the trial:Is the online mode of delivery (videoconferencing) acceptable? Is randomization acceptable to participants?What is the attrition rate?(c) To evaluate the acceptability of the intervention:What is the dropout rate?Is participant attendance maintained through the intervention?Is home practice completed by participants?What is the participants’ perceived acceptability of different elements of intervention, barriers, and facilitators to practice?(d) To examine the mean difference in mental health outcomes (stress, psychological wellbeing, and mindfulness) between the two trial arms.This is the first study to use questionnaires as well as interviews along with descriptive statistics to assess feasibility and acceptability of the MTC in a pilot RCT.