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Integrating Brief Mindfulness Exercises in Virtual Learning Environments to Support Students Mental Health and Wellbeing

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Abstract

The mental health and wellbeing of students in higher education institutions (HEIs) is subject to ongoing international discussion and debate. Higher education study presents a unique set of stressors, often at a transitionary period in students’ lives, and HEIs recognise the need for effective student support service provision to support students through these challenges. However, not all students experiencing study-related mental health difficulties seek, or are able to access, timely support to help manage this proactively. This may be due to a broad variety of reasons, including but not limited to: a lack of sufficient student support service provision; students’ minimisation of issues they are encountering; an unwillingness, or inability, to disclose mental health difficulties; a lack of insight or awareness of mental health difficulties and support services. This can contribute to students experiencing study-related burnout, avoidable distress, course drop-out, and in some cases, clinical anxiety or depression. In the rapidly evolving landscape of higher education, the increasing popularity of online teaching offers potential opportunities for supporting student wellbeing in innovative ways. The use of internet-delivered, self-directed wellbeing interventions has seen a radical uptake over the past decade, and findings are overall very promising. In particular, the use of brief mindfulness exercises has demonstrated improvements in student wellbeing across a range of disciplines. Whilst still recognising the need for traditional and effective student support services, HEIs need to support and encourage students to develop the skills needed to manage some of the stressors of everyday student life. This study trialled the use of brief mindfulness exercises as a method of self-care and self-regulation for students enrolled at King’s College London and Monash University in Melbourne. Mindfulness exercises (six 1-2 minute audio files) were provided to students via existing virtual learning environments. We evaluated the impact of the intervention using pre- and post-intervention questionnaires (including validated measures and self-report data) and compared these with students from a wait-list control group. This presentation will describe the mindfulness intervention as trialled at King’s College and Monash University, and discuss early findings regarding its impact and efficacy. We will also discuss some of the issues surrounding the implementation of, and recruitment to, internet-based interventions of this nature. Keywords: Mindfulness, stress, wellbeing, mental health.
INTEGRATING BRIEF MINDFULNESS EXERCISES IN VIRTUAL
LEARNING ENVIRONMENTS TO SUPPORT STUDENT MENTAL
HEALTH AND WELLBEING
A. Coxon1, K. Dyer1, S. Mckenzie2, J. Chung2
1King's College London (UNITED KINGDOM)
2Monash University (AUSTRALIA)
Abstract
Identifying the most effective means to support the mental health and wellbeing of students in higher
education institutions (HEIs) is subject to ongoing international discussion and debate. Higher
education presents a unique set of stressors, often at a transitionary period in students’ lives, and
HEIs recognize the need for effective student support service provision to support students through
these challenges. However, few students recognize how stress might impact their attainment, or
actively seek support to prevent stress before it occurs. Not all students experiencing study-related
mental health difficulties seek, or are able to access, timely support to help manage stress proactively.
This may be due to a broad variety of reasons, including but not limited to: a lack of sufficient student
support service provision; students’ minimization of issues they are encountering; an unwillingness, or
inability, to disclose mental health difficulties; a lack of insight or awareness of mental health difficulties
and support services. This can contribute to students experiencing study-related burnout, avoidable
distress, course drop-out, and in some cases, clinical anxiety or depression.
In the rapidly evolving landscape of higher education, the increasing popularity of online education
offers potential opportunities for supporting student wellbeing in innovative ways. The use of internet-
delivered, self-directed wellbeing interventions has seen a radical uptake over the past decade, and
findings are overall very promising. In particular, the use of brief mindfulness exercises has
demonstrated improvements in student wellbeing across a range of disciplines. Whilst still recognizing
the need for traditional and effective student support services, HEIs need to support and encourage
students to develop the skills needed to manage some of the stressors of everyday student life.
This study trialed the use of brief mindfulness exercises as a method of self-care and self-regulation
for students enrolled at King’s College London and Monash University in Melbourne. Mindfulness
exercises (six 1-2 minute audio files) were provided to students via existing virtual learning
environments. We evaluated the impact of the intervention using pre- and post-intervention
questionnaires (including validated measures and self-report data) and compared these with students
from a wait-list control group.
This paper will describe preliminary results from the ongoing evaluation of the mindfulness intervention
as trialed at King’s College and Monash University, and discuss early findings regarding its impact and
efficacy. We will also discuss some of the issues surrounding the implementation of, and recruitment
to, internet-based interventions of this nature.
Keywords: mindfulness, stress, wellbeing, mental health
1 INTRODUCTION
1.1 Aims
The aim of the King’s College London (KCL) & Monash University (MU) mindfulness for student
wellbeing study is to explore the uptake and impact of brief mindfulness audio exercises, delivered via
a virtual learning environment (VLE) to students enrolled in higher education courses in the UK and
Australia.
1.2 Background
It has been acknowledged that students in higher education often experience high levels of stress and
poor general wellbeing [1], [2]. However, few students actively seek support to prevent stress before it
becomes unmanageable, or see how stress might impact their attainment. Not all students
experiencing study-related stress seek timely support to help manage this proactively [3], [4], which
can contribute to students experiencing study-related burnout, avoidable distress, and in some cases,
clinical anxiety or depression. The use of internet-delivered, self-directed wellbeing interventions has
seen a radical increase over the past decade, and findings are on the whole very promising [5]–[7]. In
particular, the use of brief mindfulness exercises has demonstrated overall improvements in student
wellbeing across a range of disciplines [5], [8]–[10].
As higher education course content is increasingly being supported or delivered via VLEs such as
Moodle [11], with some courses conducted entirely online, HEIs are challenged to adopt innovative
ways of supporting students’ wellbeing. From this, KCL and MU are committed to balancing a
fundamental duty of care towards students with recognition of the fact that they are adult learning
environments which value autonomy and independence of their students. Whilst providing high-quality
and effective student support services, KCL and MU seek to support and encourage students to
develop the skills needed to manage some of the stressors of everyday student life.
This study aims to trial the use of brief mindfulness exercises as a method of self-care and self-
regulation for students at KCL and MU. Findings from existing research suggested ways in which this
approach might be integrated with existing VLEs used at both universities. By providing brief, guided
aduio mindfulness exercises, embedded in the existing learning environment, we expected that
students would be prompted and motivated to engage with and benefit from this self-directed support.
We anticipate students will be empowered to take ownership of their stress management throughout
the course of their studies.
This manuscript details preliminary findings from the KCL & MU mindfulness for student wellbeing
study, exploring data from the first round of study modules – the project is ongoing at time of writing
and due for completion in December 2019. By highlighting the importance of wellbeing and providing
an effective tool to reduce feelings of stress and anxiousness, improvements in students’ well-being
and attainment are expected. We aim to evaluate this material across a selection of on-campus
undergraduate and postgraduate courses, and for distance learning postgraduate students. This will
inform developing student support at both KCL and MU.
2 METHODS
2.1 Participants
Participants in the study (N=196) were students enrolled in higher education courses at either KCL
(N=77) or MU (N=119). Over three quarters of the participants (77.6%) identified as female.
Participants were recruited from a range of programmes at both KCL and MU, which included a
combination of undergraduate and postgraduate, on campus and online (distance learning) delivery,
from programmes in War Studies, Business Studies, Mental Health & Psychology, Public Health, Data
Science, and Nursing. As an incentive to participate, all participants were offered the opportunity to win
an Amazon voucher worth £20/AUD50, via a prize draw once the study concludes.
2.2 Procedure
This study was approved by the King’s College London Psychiatry, Nursing and Midwifery Research
Ethics Subcommittee, and Monash University Human Research Ethics Committee.
Through informal discussions with academic staff at each institution, suitable programme modules
were identified for inclusion in the study. A quasi-experimental design was used. For each programme
included in the study, at least two modules were identified for inclusion 1. One module was assigned to
a control group, the other to the mindfulness group. Participants were made aware which group their
module was a part of. Modules were selected where there was no overlap between students enrolled
(i.e. students in a mindfulness module were not also undertaking a control module concurrently).
1 With one exception – one programme at MU only had one module running, so this was assigned to the mindfulness group.
This might explain why the mindfulness group was slightly larger than the control group.
Figure 1. Study timeline and procedure
Participants were recruited to the study via a recruitment email sent from module leaders or senior
teaching fellows, to all students enrolled on the candidate module. The email included details about
the study and its aims, a link to the full information sheet, contact details for the researchers, and a
URL link for students to self-enrol to the study. The study materials were delivered via dedicated
module pages hosted on the university’s existing VLE. To maximize participant engagement with the
study, key dates were matched as closely to programme modules as possible (i.e. the study would
conclude before the end of the academic semester).
Due to the study design, it was not possible to randomise allocation of participants to control of
mindfulness groups. However, recruitment to either group was well-matched, with 59.7% of
participants in the mindfulness group (N=117).
2.2.1 Measures - baseline
Upon enrolment to the study module, all participants were again provided with a full information sheet
and contact details for the researchers should they have any comments or questions. If they still
wished to participate in the study, they were then asked to click through a tacit consent form to
proceed to the baseline wellbeing questionnaire. This questionnaire asked students to self-generate a
unique identifier (first three letters of mother’s maiden name, first two digits of birthdate). This was to
ensure that, whilst participant information was kept anonymous, baseline and follow-up questionnaire
data could still be linked. Basic demographic information (gender, age group), their confidence on their
current module, expected grade, and confidence in gaining this grade, was also collected. Participants
in the mindfulness group were asked if they had ever meditated before. Finally, all participants were
asked to complete three validated questionnaires: the Mindful Attention Awareness Scale (MAAS - 15
questions) [12], the Warwick-Edinburgh Mental Well-being Scale (WEMWBS – 14 questions) [13], and
the Perceived Stress Scale (PSS – ten questions) [14].
2.2.2 Mindfulness intervention
Once this baseline questionnaire was completed, the control group had no other activities to complete
until the end of the study period. The mindfulness group were asked to complete self-guided
mindfulness exercises over the course of the study period. These mindfulness exercises were pre-
recorded audio files, each 1-2 minutes in length, made available at set intervals over the course of the
study (one every week or fortnight, depending on the length of the module from which participants
were recruited). The exercises were hosted on the university’s VLE, and participants could listen to the
audio files there, download them to listen later, or read the transcripts, as many times as they wished.
2.2.3 Measures – follow-up
At the end of the study period, all participants were prompted to complete a follow-up questionnaire,
using the same unique identifier they generated at baseline. This questionnaire again asked
participants how confident they felt about the module, their expected grade, and how confident they
were in achieving that grade. They were again asked to complete the MAAS, WEMWBS and PSS.
Finally, participants in the mindfulness group were asked to rate on a scale of 1-10 how likely they
would be to recommend mindfulness practice to their peers (Net Promoter Score or NPS [15]), and
provide some free-text comments about their experience of the exercises, how useful they were, and
how the intervention might be improved in future. Once the study period was complete, all of the
mindfulness materials were made available to all participants across both groups.
3 RESULTS & DISCUSSION
3.1 Participant attrition
Of the 196 participants who enrolled on the study and completed the baseline questionnaire, only 69
(35.2%) completed the follow-up. Although participant drop-out was at similar levels in both
mindfulness and control groups, considerably more participants at MU completed the follow-up
questionnaire than participants at KCL (54.6% and 5.2% respectively). Due to the poor follow-up rate,
a meaningful analysis of the data at this stage is challenging.
3.2 Overview – preliminary results
Descriptive statistics at this stage in the project reveal some general trends: mean scores for
WEMWBS and MAAS in both mindfulness and control groups remained generally stable across the
study period.
Mean PSS scores for the control group likewise remained relatively stable (17.89 (sd=7.22) at
baseline, 18.54 (sd=7.96) at follow-up), but for the mindfulness group there was a general downward
trend (20.40 (sd=6.10) at baseline, 16.98 (sd=6.20) at follow-up). This downward trend suggests
participants in the mindfulness group perceived lower levels of stress after having engaged in the
mindfulness exercises. Although this observation requires corroboration and should be taken with
caution, it is a promising result at this early stage in the project.
At this stage in the project, the NPS is 9 – as NPS can range from –100 to 100, any score above 0 is
considered “good”. However, this score is still relatively low, and suggests a need for improvement.
Granted, NPS is limited by the number of participants who completed the follow-up questionnaire, but
comments and feedback from participants may provide insights for future improvements in the
intervention and its delivery.
3.3 Participant feedback
As part of the follow-up questionnaire, participants were invited to provide free-text comments,
providing feedback on the intervention, the impact they felt it had on their studies, and how the
intervention might be improved. Although some participants provided limited or no feedback in this
section, the majority commented both on aspects of the intervention they enjoyed or found useful, or
aspects that they did not enjoy or felt could be improved. One participant emailed the research at the
end of the study period to provide further positive feedback and asking to be involved in further
research that might see the intervention being expanded in future.
Based on rapid content analysis, three broad themes were developed to help us better understand
participants’ experiences of the mindfulness exercises, to inform future phases of the project.
3.3.1 Supporting study through mindfulness
Although the responses from participants were broad and mixed, many reported positive impacts the
exercises had on their studies. Participants reported that the exercises were “a quick and easy way” to
calm or ground themselves (“safe, secure, without the sky falling in”), provided a “moment of calm”
and reminded them to “slow down and focus on the present”. Participants also related these positive
impacts back to their studies, explaining how they felt it aided concentration and clarity in their work.
Several participants mentioned lasting impacts the exercises had on their attitudes and behaviors. For
example, one participant commented that now, when they feel “stressed and overwhelmed”, they
practice some of the techniques used in the exercises, such as focusing on breathing and bodily
awareness (“these are things I had never done before doing the exercises”).
However, some participants stated that they observed no significant impacts (positive or negative)
from the exercises, with several commenting that the exercises were simply too short (“as I was just
getting into them, they ended”).
3.3.2 Taking time
Several participants commented that they found the exercises particularly useful to remind them to
step back briefly from their studies. Students described the process as “a good opportunity to reset”,
“to take a moment out of the busyness of life” and “a break from thoughts”.
However, two participants commented that they were “unable to find time” to engage in the
intervention. Despite their interest in mindfulness (and reported that their inclusion as part of their
course of study was “a good idea”), study and work demands meant that taking time for mindfulness
was seen as an impossible extra demand. Given the number of participants who did not complete the
follow-up questionnaire, it is possible that this experience was shared by others (that they could not
find the time to engage with the exercises) but it is difficult to explore the extent of this in the absence
of data.
Other participants commented on their busy schedules, with one stating they enjoyed how short the
exercises were: “the length meant I could fit them into my busy schedule”. However, several
participants criticized the exercises as being too short - “useful but a bit short”, “too short to change my
mental state” and “they were over just as my mind had started to settle” were some of the comments
given by participants.
3.3.3 The format of the exercises
While there were many positive comments from participants, there was also a breadth of constructive
feedback. The most commonly occurring criticism of the intervention was that the exercises were too
brief. One participant speculated that “the shorter they are the more likely people are to do them”, but
several participants suggested that longer exercises might have more positive benefits for them - “I
think for them to be more beneficial they should have been at least 5 minutes”. Given this mixed
response to length of exercises, it might be worth considering offering a range to choose from,
dependent on user preference and need. One participant suggested that the guided part of the
exercise was the ideal length, but that the background music could perhaps extend beyond this to
allow for “a consistent space to practice what the instructions offered”. Another suggested “enable it to
loop so can keep going for as long as you want”.
As well as the length of the exercises, participants also comments on other aspects of the
intervention’s format. Although some participants specifically stated that they found the voice soothing,
others did not (“rough and spoke a bit too fast”), and suggested offering options to choose from,
dependent on preference.
4 CONCLUSIONS
The most significant challenge for this project so far has been recruiting participants and then
encouraging them to complete all aspects of the study. Despite healthy recruitment at the start of the
study, participant attrition was steep. With only a third of participants completing the follow-up
questionnaire, results at this stage in the project are inconclusive. Clearly more data is needed, and
this study is ongoing, to this end.
Particularly noteworthy are differences in recruitment and completion between KCL and MU – despite
offering an almost identical intervention and similar methods of recruitment, KCL experienced lower
initial engagement and a much higher rate of participant drop out. The reasons for this are currently
unknown, and worthy of investigation. It is possible that significant contextual differences facilitated
uptake and engagement at one institution, and not the other.
Participant feedback has been particularly useful in highlighting students’ perceived, specific benefits
of engaging in the intervention, as well as identifying areas for change and improvement. Although the
majority of participants that completed the follow-up questionnaire gave positive feedback about their
experiences, some had criticisms, and some stated they were unable to engage in the exercises due
to competing demands on their time. As for the two-thirds of participants who dropped out before
completing the study, their experiences are challenging to know, but unwise to ignore.
The KCL & MU mindfulness for student wellbeing study is ongoing at time of writing and due for
completion in December 2019. In light of these preliminary findings, the research team will explore
alternative means of encouraging recruitment and ongoing participant engagement. We also aim to
undertake a more in-depth qualitative exploration of participants’ experiences of the intervention, to try
to better understand what might be barriers and facilitators to student engagement with wellbeing
support.
ACKNOWLEDGEMENTS
The authors would like to thank all collaborators, module leaders, teaching fellows and students whose
input and time have made this project possible.
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Chapter
Online education is becoming widely accepted in tertiary education including by academics, students and employers. Educators have created new and innovative ways of teaching curriculum to online students that produce academically and employable equivalent graduates. In response to this success, we believe that it is time to shift our online attention onto creating a student experience that is equivalent to the entire on-campus experience, and increasing student well-being, success and satisfaction. In this chapter, we introduce a model of an online education hierarchy of student needs—a novel adaptation of Maslow’s hierarchy of needs. Online education is closing the gap between academic equivalence of on-campus and online education, and we contend that the next phase of meeting online student needs includes addressing academic and general well-being, and a strong sense of community, connection and belongingness, which may eventually result in online self-actualization. We describe the importance of student well-being, provide an example of a mindfulness well-being component of a large online course and discuss how a student’s sense of community, connection and belongingness is impacted on by their fully online education world. In this chapter, we explore what should be next on the online education agenda and what needs to be done to really achieve online–on-campus equivalence.
ResearchGate has not been able to resolve any references for this publication.