4. Discussion
RECRUITMENT
The first aim of this study was to examine the feasibility of conducting a full-scale randomized controlled trial of an 8-week online Mindfulness training course for the wellbeing and stress of university students. The second aim was to establish the acceptability of this course for the participants. The study also aimed to assess preliminary effectiveness by examining the differences between the trial arms on mental health outcome measures. There were no prior statistical criteria identified for success of MTC, but in comparison with other similar studies conducted with university students, our results are promising. The identified areas for improvement are attrition and dropout rates.The feasibility indicators of the pilot RCT show very encouraging results, with relatively high recruitment rates for three recruitment methods: The results indicate the weekly online sessions are feasible and acceptable to students, who reported them as “facilitators to mindfulness practice”. In addition to this, there was a small proportion of students who faced technical issues; those who did managed by either taking extra guidance from the facilitator or going through the reading material. Earlier studies examining online mindfulness interventions for students have mostly used web-based or automated self-help online programs [The results of all assessment surveys sent through online links indicate that this online data collection procedure is feasible. The results also indicate that reminders were needed only for mental health outcome surveys, which took more time compared to other surveys. Therefore, to reduce the time and reminders, brief versions for the outcomes (psychological wellbeing and distress) may be used in future trials.The attrition rate for this study, which is seen as a perennial problem for online mindfulness interventions (74% [Regarding the attendance, course completion and home practice, the study results showed good compliance rates. Those who engaged with the MTC attended an average of 7/8 sessions and remained committed to practicing mindfulness throughout the course. This indicates that for those participants who engaged, the course was acceptable. However, the worksheet submission (34%) seemed to pose a problem, as indicated by the decrease in number of participants submitting home worksheets throughout the duration of the course. In the semi-structured interviews, worksheets submissions were reported to be both a challenge as well as supportive of participants’ self-understanding. The students have a busy routine, and filling worksheets seemed like another task to them; however, considering their beneficial role, it might help in future trials to include an incentive for submitting worksheets (e.g., money or gift vouchers). Breath and body meditation seemed to have been practiced consistently throughout the course, whereas 3-minute breathing space was practiced both formally and informally. Carrying out a mindful activity every day was also practiced regularly through the course. With reference to assessment completion, the participants who completed the course completed all surveys, whereas of the participants who withdrew or dropped out of the course, only 4 completed the surveys. This suggests that the assessments used in the study are acceptable to those who commit to the course. This phenomenon has been attributed as a reason for the high attrition rate in non-clinical population studies [The participants who engaged with the MTC reported being highly satisfied with the course, including the material and delivery. Both formal and informal mindfulness practices were perceived to have brought change within the participants, as well as in their relationships, work performance, and productivity. The participants benefited from the course when they practiced flexibly, tailoring it to their needs and work schedules. The internalization of mindfulness process was an important theme, which suggests the possibility of long-term effects of MTC. The facilitators and challenges identified by the participants seem to be connected, as they used mindfulness attitude of non-criticism, non-judgment, letting go, and being mode to manage the difficulties they faced in mindfulness practice, as well as their daily life. The multiple groups held for each weekly session and reminders sent for online sessions and tasks were seen as facilitating their commitment. In future studies, it would be helpful to continue with this format of multiple sessions and reminders to support engagement and practice. The facilitator’s attitude and guidance were seen as critical to participants’ mindfulness practice and understanding their experience, internalizing mindfulness attitude and processes. This finding is in line with studies emphasizing the role of a facilitator in the effectiveness of mindfulness courses [