Facilitators, Barriers, and Cultural Appropriateness of Mindfulness-Based Interventions Among Saudi Female University Students: Qualitative Study.

Background: Mindfulness-based interventions (MBIs) have been shown to improve university students' well-being. However, previous studies have not systematically explored factors that can facilitate or hinder engagement in MBIs among Saudi university students, nor how MBIs can be culturally adapted to meet their needs. Objective: This study aimed to (1) explore the perspectives of Saudi female university students about factors influencing engagement with MBIs, (2) explore the cultural appropriateness of MBIs, and (3) systematically identify recommendations for developing a culturally appropriate MBI. Methods: A qualitative research approach was used to collect data using semistructured individual interviews and focus groups. Two established frameworks for behavioral interventions were applied to guide the interview topics and data analysis. The COM-B (Capability, Opportunity, and Motivation Domains of Behavior Change) model was applied to identify potential enablers and barriers influencing students' engagement with MBIs. The cultural adaptation framework by Bernal et al was used to explore the cultural appropriateness of MBIs. Subsequently, recommendations for developing MBIs, with a specific focus on an online version, were systematically formulated using the Theory and Techniques Tool. Data were analyzed using mixed inductive-deductive thematic analysis. Results: Fourteen Saudi female university students (mean age 24, SD 4.9 years) participated in semistructured interviews and focus groups. Numerous potential enablers and barriers to MBI engagement were identified. Factors that may influence engagement pertained to capability (variation in knowledge of mindfulness), opportunity (anticipated difficulty finding time), and motivation (variation in anticipated and experienced benefits of mindfulness). Participants also highlighted several considerations that may enhance the cultural relevance of MBIs, drawing on the cultural adaptation domains by Bernal et al. These included the importance of aligning MBIs with the local cultural context, incorporating metaphors and examples rooted in Saudi and Arab culture, and accommodating students' preferences for the duration of MBIs. Key recommendations for developing culturally appropriate MBIs for Saudi university students included providing clear information to improve understanding of mindfulness, providing practical strategies and skills to overcome barriers such as time constraints, delivering MBIs in both Arabic and English, and ensuring that MBIs' content aligns with local cultural values and contexts. Conclusions: Findings and recommendations aim to enhance the feasibility, acceptability, engagement, and effectiveness of MBIs among Saudi university students, particularly female students. However, whether they do in fact achieve these aims is unknown. Future research should endeavor to evaluate the effectiveness of proposed recommendations and explore the enablers and barriers to MBI engagement in a broader population of Saudi students.