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Abstract and Figures

This randomised controlled trial (RCT) of online mindfulness training compared wellbeing related outcomes for police officers and staff allocated to three separate user groups: • Headspace (a commercially available mindfulness app and website) • Mindfit Cop (a bespoke online eight-week mindfulness course for policing) • the waiting list control (who completed all surveys before receiving access to Mindfit Cop after six months). Both the Headspace and Mindfit Cop online mindfulness resources improved wellbeing, life satisfaction, resilience and performance, compared to the waiting list control group. Headspace provided greater improvement across these wellbeing outcomes compared to Mindfit Cop after 10 and 24 weeks, but Mindfit Cop’s results improved and moved closer to Headspace’s at 24 weeks. Neither online resource reduced absence days or spells within the six months of the trial, but self-reported presenteeism (working while sick) behaviours did reduce. Participants who reported low job control (little control over their tasks and scheduling) benefited most from using the resources
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Mindfulness in policing
A randomised controlled trial of two online mindfulness
resources across five forces in England and Wales
November 2019
Helen Fitzhugh (College of Policing)
George Michaelides (University of East Anglia)
Sara Connolly (University of East Anglia)
Kevin Daniels (University of East Anglia)
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Executive summary
Key findings
Online mindfulness training can improve the wellbeing of police officers and staff.
This randomised controlled trial (RCT) of online mindfulness training compared wellbeing-
related outcomes for police officers and staff allocated to three separate user groups:
Headspace (a commercially available mindfulness app and website)
Mindfit Cop (a bespoke online eight-week mindfulness course for policing)
the waiting list control (who completed all surveys before receiving access to Mindfit
Cop after six months).
Both the Headspace and Mindfit Cop online mindfulness resources improved wellbeing,
life satisfaction, resilience and performance, compared to the waiting list control group.
Headspace provided greater improvement across these wellbeing outcomes compared to
Mindfit Cop after 10 and 24 weeks, but Mindfit Cop’s results improved and moved closer
to Headspace’s at 24 weeks.
Neither online resource reduced absence days or spells within the six months of the trial,
but self-reported presenteeism (working while sick) behaviours did reduce. Participants
who reported low job control (little control over their tasks and scheduling) benefited most
from using the resources.
Background
Police wellbeing has received increased attention over the past five years. Surveys by Mind
(2015) and the Police Federation (Elliott-Davies, 2018) suggest that many in the police
workforce experience stress, low mood, anxiety and/or other mental health issues, but are
less likely than other emergency services to seek help.
Mindfulness has received widespread publicity as a potential way to improve individual
wellbeing. Being mindful involves:
‘paying attention to what’s happening in the present moment in the mind, body and
external environment, with an attitude of curiosity and kindness’.
(The Mindfulness Initiative, 2015)
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This attention has recently been justified by evidence that suggests certain mindfulness
training approaches help improve adult wellbeing. While promising early findings emerged in
the US military and police, from small-scale feasibility studies on mental health and
performance, an evidence gap remained around the usefulness of mindfulness training in
UK policing.
Small pockets of mindfulness activity have emerged in some police forces in England and
Wales. In response to requests for information and support from frontline officers, The
College of Policing decided to test the relevance and impact of mindfulness training in a
police context. The aim was to provide evidence for future investment decisions at force and
national level. A serving officer and mindfulness trainer developed a new police-specific
online mindfulness course for this trial (Mindfit Cop) and it was tested alongside an existing
commercially available app, already in use in some forces (Headspace).
The randomised controlled trial
The College of Policing enlisted the Behavioural Insights Team and members of the What
Works Centre for Wellbeing’s Work and Learning Evidence Programme (based at the
University of East Anglia) to contribute to the design of an RCT. The aim was to assess the
impact of using online mindfulness resources on police wellbeing and related outcomes.
Online resources were selected for testing, as face-to-face training would be limited by the
number of trainers and staff abstraction time available. Online resources allow for large-
scale concurrent rollout of mindfulness training with inbuilt time flexibility.
All police employees across five participating forces were invited to apply to take part. The
forces were Avon and Somerset, Bedfordshire, Cambridgeshire, Hertfordshire and South
Wales. A total of 1,337 participants were accepted onto the study, or around 7 per cent of
the workforce of the combined forces.
Trial participants were randomly assigned to one of three groups: Headspace users (446),
Mindfit Cop users (445) and the waiting list control (446). The waiting list participants were
told that they would receive access to Mindfit Cop after six months had elapsed, but were
asked to complete the trial surveys in order to provide comparison data.
The following data were collected for the study, with informed consent from each participant:
three sets of online survey data (see ‘measures’ below) plus comments
demographic and sickness absence data collected directly from the force HR teams
usage data collected directly from the online mindfulness resource provider
interview data collected via telephone calls with selected participants (n = 29).
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Measures
Data was collected for the study via surveys at the following time points:
Data (Source of survey questions) Baseline 10 weeks 24 weeks
Wellbeing (Short Warwick Edinburgh Mental
Wellbeing Scale)
Resilience (Brief resilience scale)
Performance (Single item from WHO-HPQ survey)
Mindfulness (Short mindful attention awareness scale)
Presenteeism (Single item for this study)
Leaveism (Single item for this study)
Restricted duties (Single item for this study)
Job control (Items from Workplace Employment
Relations Study)
The cohort
Of the 1,337 eligible applicants, 15 formally withdrew within the first 10 weeks of the study.
Not all of the participants made use of their access to the online mindfulness resources.
Twenty-seven per cent of the Headspace group and 21 per cent of the Mindfit Cop group did
not register/activate their access code. There was also response attrition over time. Only 45
per cent of the original participants provided survey responses that could be analysed at
week 24.
The self-selecting cohort of volunteers included more women and staff than would have
been expected from a random sample of the entire police workforce.
Analysis
The University of East Anglia analysed the quantitative survey, sickness absence and usage
data using a range of regression analyses appropriate to the nature of the data.
The College analysed the qualitative data received via the survey open-text comments and
the telephone interviews using framework analyses to identify emerging themes.
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Main results
Hypothesis Results
1 Online training in
mindfulness will improve
wellbeing, resilience and
performance for police
officers and staff.
Headspace improved wellbeing, life satisfaction,
resilience and performance scores at 10 and 24 weeks.
Mindfit Cop improved wellbeing and life satisfaction
scores only at 10 weeks, but improved all of the primary
outcomes (wellbeing, life satisfaction, resilience and
performance) at 24 weeks.
Accept hypothesis
2a Online training in
mindfulness will improve
mindfulness skills.
Headspace improved mindfulness scores at 10 weeks.
Mindfit Cop did not significantly improve mindfulness
scores at 10 weeks.
Mindfulness was not surveyed again at 24 weeks.
Accept hypothesis for Headspace
2b Online training in
mindfulness will reduce
sick leave, presenteeism
(working while sick) and
leaveism (taking annual
leave instead of sickness
absence).
Headspace and Mindfit Cop reduced presenteeism at
24 weeks.
There was no evidence that online training in
mindfulness reduced sick leave or leaveism.
Accept hypothesis for presenteeism but not for
absence days/spells or leaveism
3 Bespoke training aimed at
police officers (Mindfit Cop)
will improve wellbeing,
resilience and performance
for police officers and staff
more effectively than a
generic mindfulness
intervention (Headspace).
The generic mindfulness intervention (Headspace) was
more effective than the bespoke training at 10 weeks
(Mindfit Cop).
At 24 weeks, Mindfit Cop and Headspace were both
effective interventions across the primary outcomes, but
Mindfit Cop did not appear to offer any additional
benefits.
Do not accept hypothesis
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4 Mindfulness training is
more likely to be effective
for people with high levels
of job control in terms of
how they structure their
day and do their tasks.
Mindfulness training was more beneficial to those with
low job control.
Do not accept hypothesis
Feedback from participants
The survey findings suggested that using mindfulness resources had a positive impact on
police employee wellbeing. We interviewed users of Headspace and Mindfit Cop to better
understand why this positive change might have occurred. Users of the mindfulness
resources reported becoming more reflective about their own thoughts and actions, while
learning new techniques to use in stressful situations.
Moving from ‘autopilot’ to a more nuanced awareness of everyday thoughts and behaviours
is one of the key messages of both Headspace and Mindfit Cop. Where trial participants had
used the resources, they had absorbed this message and found it useful:
‘We do all work really really hard and sometimes relentless and just reminding people
that you’ve got to stop and pause and think about yourself for a moment if you’re
going to be effective in what you do it’s a good thing and all too often we forget that
message.’ (Mindfit Cop user)
Participants who had engaged with Mindfit Cop and Headspace reported benefits such as:
feeling less stress and anxiety
sleeping better (while using the sleep sessions on Headspace in particular)
focusing better at work
feeling more supported (because the resources had been provided to them).
Barriers and enablers
It should be noted that mindfulness training is not for everyone, and many trial participants
either did not use the resources or used them very little. We interviewed non-users and low
users to try to found out why. We identified four key challenges:
time (scheduling, not being interrupted)
location (difficulties of open-plan offices, whether it was appropriate to use at home)
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emotion (tackling the guilt of taking time out and embarrassment in front of peers)
technical issues (both IT literacy and login issues).
Some participants addressed these challenges at a personal level by using the resources at
home, in their car or during their breaks. However, others said they would have only felt able
to use the resources if they had received clearer organisational support, through the
allocation of protected time, suitable space and formal supervisor permission.
Conclusion
This RCT has produced strong evidence that online mindfulness training can be beneficial
for the wellbeing of police employees. However, as with any wellbeing intervention,
implementation involves practical considerations. Costs and how to communicate the
opportunity to use the resource require careful thought in any future rollout.
Maximising the benefits to policing of mindfulness training will involve listening to user
feedback on potential barriers to participation: time, location, emotion and technical issues.
Tackling these potential barriers could involve: providing quiet rooms, hosting group
sessions in breaks, providing clear permission to complete the training elements of the
mindfulness resources in work time, easy-to-use online interfaces and simple instructions for
registration and login.
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Contents
Acknowledgements ............................................................................................................ 11
Background ......................................................................................................................... 13
Wellbeing in policing .......................................................................................................... 13
Evidence on the effects of mindfulness ............................................................................. 15
Two relevant mindfulness resources ................................................................................. 17
The randomised controlled trial ........................................................................................ 20
Research aims and hypotheses ........................................................................................ 20
Study design ...................................................................................................................... 22
Outcome measures ........................................................................................................ 24
Flow diagram of participation in the trial ......................................................................... 25
Uptake and demographic profile .................................................................................... 27
Finding out more – user experience ............................................................................... 28
Limitations.......................................................................................................................... 29
Results ................................................................................................................................. 32
Main results ....................................................................................................................... 32
The next step in analysis ................................................................................................ 35
Reporting on the hypotheses ......................................................................................... 35
Going deeper feedback from participants ....................................................................... 37
Understanding usage barriers and enablers ...................................................................... 39
Barriers ........................................................................................................................... 41
Enablers ......................................................................................................................... 43
User experience of online resources ................................................................................. 44
Headspace ..................................................................................................................... 44
Mindfit Cop ..................................................................................................................... 45
Conclusions and implications ........................................................................................... 47
Conclusion ......................................................................................................................... 47
Considerations for rollout ................................................................................................... 48
Challenges ..................................................................................................................... 48
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Communications ............................................................................................................. 48
Costs .............................................................................................................................. 49
Future research ................................................................................................................. 50
References ........................................................................................................................... 51
Appendices .......................................................................................................................... 54
Appendix 1: Technical abstract ......................................................................................... 55
Appendix 2: Survey measures ........................................................................................... 58
Appendix 3: Baseline survey ............................................................................................. 60
Appendix 4: 10-week survey .............................................................................................. 68
Appendix 5: 24-week survey .............................................................................................. 74
Appendix 6: Interview questions ....................................................................................... 79
Appendix 7: Analysis details ............................................................................................. 83
Appendix 8: Regression models ....................................................................................... 87
Appendix 9: Qualitative analysis ....................................................................................... 90
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Acknowledgements
This study would not have been possible without the participation of a wide range of people.
The College would particularly like to thank the following for their invaluable contributions.
Trial
Catherine Owens from the College of Policing was responsible for the initial design and set-
up of the trial, including all preparatory work to involve forces and liaise with the providers of
the mindfulness resources.
Dr Pantelis Solomon and Dr Mark Egan from The Behavioural Insights Team developed the
trial design and prepared the trial protocol, project managed by Catherine Owens and Dr
Helen Fitzhugh of the College of Policing. Peter Carlyon provided administrative support.
Dr Helen Fitzhugh implemented the trial design, oversaw all data collection and wrote this
report. Julia Morris and Nerys Thomas provided internal review.
Dr George Michaelides, Professor Sara Connolly and Professor Kevin Daniels of the
University of East Anglia analysed the quantitative data and provided analysis reports
summarising the findings of the study, which formed the basis of this report.
Dr Helen Fitzhugh designed and carried out the supporting qualitative research component,
with interviewing and transcription support from: Anika Ludwig, Gill Sims, Karen Moreton,
Hannah Kennedy and Jenny Kodz.
Dr Jonathan Houdmont and Dr Paul Flaxman provided external peer review.
Mindfulness resources
DI Jenni McIntyre-Smith of Bedfordshire Police and mindfulness trainer Michael Chaskalson
developed the eight-week online mindfulness course Mindfit Cop. DI McIntyre-Smith liaised
with the College of Policing to provide advice and support the trial.
Judith Broug, from MissyRedBoots, provided graphic and web design for Mindfit Cop and
supported the trial by providing data and technical support.
Janis Martman and Emily Durden of Headspace supported the trial by providing usage data.
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Champions and participants
Avon and Somerset Constabulary Jacquita Mead acted as our mindfulness trial champion
and advised on implementation and communications. Sarah Cook provided our link into HR.
Lucy Greenberry provided communications support.
Bedfordshire, Cambridgeshire and Hertfordshire DI McIntyre-Smith acted as our
mindfulness trial champion. Stephen Mellowes provided our link into HR. Nikki Royall
provided communications support.
South Wales Police DS Debbie Zeraschi acted as our mindfulness trial champion and
advised on implementation and communications. Chris Martinson provided our link into HR.
Ceri Doyle provided communications support and planning.
This trial could not have been completed without the participation of over 1,300 officers and
staff. Thanks to everyone who completed the surveys and gave feedback on the resources.
Particular thanks must go to those on the waiting list who provided the data necessary to
allow us to complete this study as an RCT, while waiting six months to gain access to the
resource themselves.
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Background
The wellbeing of police officers and staff has received increased attention over the past
five years, alongside growing interest in wellbeing in society as a whole. Surveys by Mind
and the Police Federation suggest that high proportions of the police workforce
experience extreme stress, low mood, anxiety and/or other mental health issues, but are
less likely than other emergency services to seek help for these issues.
Mindfulness has received widespread publicity as a potential way to improve individual
wellbeing. This attention has recently been justified by evidence that suggests certain
mindfulness training approaches help improve adult wellbeing. While promising early
findings emerged in the US military and police, from small-scale feasibility studies on
mental health and performance, an evidence gap remained around the usefulness of
mindfulness training in UK policing.
Small pockets of mindfulness activity were being carried out in different ways across
police forces in England and Wales. The College of Policing identified that it would be
useful to test the relevance and impact of mindfulness training in a police context, in order
to provide evidence for future investment decisions at force and national level. A new
police-specific online mindfulness course was developed (Mindfit Cop) for this trial,
alongside an existing commercially available app and website already in use in some
forces (Headspace).
Wellbeing in policing
Over the past five years, police employee wellbeing has received increased attention.
Relevant initiatives include:
the establishment of the National Police Chiefs’ Council wellbeing and engagement
working group in 2013
the charity Mind’s Blue Light Programme of activities, from 2015 to 2019, aimed at
reducing stigma and promoting wellbeing for emergency services employees
the development and launch of the Oscar Kilo wellbeing hub website and the Blue Light
Wellbeing Framework in 2017, a wellbeing-focused self-assessment and learning
framework at the organisational level
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the publication of ‘A Common goal for police wellbeing’ by the Home Office (2018a),
aimed at ensuring police employees can ‘realise their potential, be resilient, and be able
to make a productive contribution to the police workforce’
the launch of the National Police Wellbeing Service (NPWS) in April 2019, developed by
the College of Policing with investment from the Police Transformation Fund.
This activity has happened in the context of a trend towards acknowledging the impact of
poor wellbeing in society as a whole, and UK working culture in particular.
The influential Stevenson and Farmer ‘Thriving at work’ review concluded that ‘the UK faces
a significant mental health challenge at work’ (2017, p 5), with serious implications for
human flourishing, work productivity and the economy. The holistic concept of wellbeing at
work includes more than just mental health. It also covers issues of inclusion, physical
health, open and collaborative organisational culture, meaningful work and skilled
management – as outlined in the British Standards Institute Publicly Available Standard
3002. However, individual mental health is an important component of overall workplace
wellbeing that requires significant attention across UK organisations.
Recent surveys have confirmed that this issue requires attention within the police service.
The Police Federation’s Demand and Welfare Survey (Elliott-Davies, 2018) suggested that
four in every five police employees in the federated ranks (constable to chief inspector) had
experienced low mood, anxiety or stress in the past year, largely caused or made worse by
their work. This matches earlier evidence collected via Mind’s Blue Light police scoping
survey (2015), which suggested that the police had the highest levels of personal experience
of mental health issues of all the emergency services, but were the least likely to ask for help
with those issues.
Presenteeism (working while sick) and leaveism (taking annual leave instead of sickness
absence) hide the extent to which poor mental health affects employee performance and
attendance (Hesketh and Cooper, 2014). These behaviours are widespread in the police
service, with 70 per cent of respondents to the Police Federation’s survey (Elliott-Davies,
2018) suggesting they had attended work when experiencing issues related to mental
health. Forty-two per cent suggested they had taken annual leave/rest days off, rather than
sick days, due to their mental health.
Police wellbeing is influenced not only by operational factors – the nature of the job and
exposure to potentially traumatic situations but also by organisational factors the way the
work is carried out, organised and managed (Penalba et al, 2008; Mind, 2015). As such,
organisational-level interventions to address systemic pressures and cultural support
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barriers must be part of any wellbeing programme. However, interventions targeted at
individual level may play a role too. Individual skills training may allow police employees to
consider their own reactions to difficult situations and their workload. This awareness can
help them become more skilled at dealing with work-related emotions. For these reasons,
mindfulness training has been proposed as one way of supporting police employee
wellbeing.
Evidence on the effects of mindfulness
Mindfulness involves:
‘paying attention to what’s happening in the present moment in the mind, body and
external environment, with an attitude of curiosity and kindness’ (The Mindfulness
Initiative, 2015)
Research evidence of the wellbeing benefits of practising mindfulness has grown over the
past decade. The quality of the research overall has been mixed, but reliable evidence has
been identified via systematic review processes. Systematic Reviews examine not only the
findings of multiple studies, but also make judgements based on the quality of the research.
Just over 100 RCTs were examined in a Campbell systematic review (de Vibe et al, 2017),
which provided a high-quality overview of the research into the widespread Mindfulness-
Based Stress Reduction (MBSR) group intervention. MBSR was developed by Jon Kabat-
Zinn in the late 1970s as an eight-week programme of activities focused on developing
people’s awareness and non-judgemental attention to everyday situations. The systematic
review drew on evidence from studies, with a total of 8,135 participants across multiple
countries and sample groups. It concluded that, in comparison to adults who received no
intervention, the MBSR improved wellbeing-related outcomes such as quality of life, mental
health and social functioning:
‘If 100 people go through the MBSR program, 21 more people will have a favourable
mental health outcome compared to if they had been put on a wait-list or gotten only
the usual treatment.’ (de Vibe et al, 2017, p 2)
The MBSR also performed favourably on these outcomes compared to other active forms of
treatment. In general, the effects appeared to last, with follow-ups months and/or years later
continuing to suggest positive change.
The MBSR is a structured approach to learning about mindfulness, typically delivered in a
group setting by trained facilitators. However, there are many other ways of gaining skills
and knowledge of mindfulness, including self-guided work with books, audio and online
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resources. A systematic review of mindfulness self-help interventions (Cavanagh et al, 2014)
evaluated the effectiveness of this type of lower-intensity engagement. The review examined
the findings of 15 RCTs, and found that even low-intensity interventions could produce small
to moderate improvements in anxiety and depression symptoms. The scale of the review
and the limitations of the included studies indicated that further research on low-intensity
interventions was necessary. However, the findings to date suggested that mindfulness
training outside of more formal and structured settings may also be considered beneficial for
adult wellbeing.
These findings offer good news for workplace-based mindfulness training, which is often not
delivered via one of the proven structured training courses (such as MBSR), but with a
variety of different emphases and approaches (Bartlett et al, 2019). A systematic review of
27 papers on workplace mindfulness RCTs (Bartlett et al, 2019) suggested that, even taking
into account this variety of approaches, workplace mindfulness training appeared effective in
reducing stress and improving mental health and wellbeing. However, the state of the
evidence was not yet sufficient to provide clear findings on whether this also improved work
performance.
While the evidence in the general population and in generic workplace settings is promising,
the number, size and quality of studies of the effects of workplace mindfulness training on
military and police personnel has not yet reached the same critical mass.
In the US military, Mindfulness-based Mind Fitness Training (MMFT) has been feasibility
tested in high-stress deployment situations. Findings from small-scale studies with
convenience samples (Jha et al, 2010; Stanley et al, 2011) suggested that MMFT increased
mindfulness, and the increase in mindfulness supported the participants to experience
reduced stress in high-pressure environments. Qualitative findings (Stanley et al, 2011)
suggested reasons for this positive impact: participants reported feeling more able to focus
and take time to reflect on their biological responses to stress before they turned to unhelpful
coping behaviours. More recent work in this area (Jha et al, 2017) has suggested that
mindfulness training can improve military personnel performance by helping maintain
working memory, and therefore the ability to pay attention and not become distracted under
stress.
A feasibility study of an alternative approach, Mindfulness-Based Resilience Training
(MBRT), with a cohort of 62 US police officers (Christopher et al, 2016) found significant
improvements in resilience, perceived stress, burnout, anger, fatigue and sleep disturbance.
A further small pre- and post-intervention study of 47 US police officers and 22 firefighters
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also explored the benefits of the MBRT and found that increased mindfulness was related to
increased resilience and decreased burnout.
A German RCT of 267 members of the Federal Armed Forces was published after this study
was completed (Krick and Felfe, 2019). It addressed potential limitations common to many
mindfulness studies, including this one, of researching self-selecting volunteers and using
only subjective self-report measures. Even when these potential limitations were addressed,
the study reported positive physical and psychological benefits for the participants (including
improved self-care) from a mindfulness intervention, in comparison to the control group.
In UK policing, there have been pockets of mindfulness activity, largely built on the
enthusiasm and skills of individual police officers and staff located in particular forces. While
the extent of mindfulness activities is unknown, a number of forces approached the College
of Policing to explain their current practices on hearing about this mindfulness trial.
To our knowledge and at the time of writing, the only mindfulness activity in UK policing to
provide a written evaluation report (Wiffin and McIntyre-Smith, 2017, unpublished) was the
eight-week programme delivered face-to-face to small cohorts of police employees in
Bedfordshire in 2016 to 2017. There were some limitations to the research, but the
quantitative study suggested that participation in mindfulness training reduced feelings of
burnout in comparison to a control group. Focus groups provided richer feedback on the
positive effects, including willingness to reflect and gain perspective on situations, make time
to relax and make conscious (rather than reactive) use of time.
Two relevant mindfulness resources
In response to requests for information and support from frontline officers, The College of
Policing decided to test the impact of mindfulness training on the wellbeing, resilience and
performance of police officers and staff. As pockets of practice were emerging across the UK
– sometimes incurring costs to forces for purchasing different types of training or resources
the College responded to requests to provide a robust evidence base for future decision-
making around investing in mindfulness training. In order to address the evidence gap, a
large-scale RCT was planned. Two relevant routes to testing were identified from existing
practice:
a. Assessing the impact of using Headspace, a well-established, commercially available
mindfulness app that some UK forces had already paid to use or were considering
purchasing in the future.
b. Creating a police-specific online mindfulness course based on the structure of the MBSR
and assessing its impact. Course development was first suggested and then led by a
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police officer who was also a qualified mindfulness trainer at Bedfordshire Police. The
online course came to be known as Mindfit Cop.
The intention behind both of these resources is to foster mindfulness, which can be
understood as a combination of conscious awareness of everyday situations (rather than
acting on autopilot), an accepting attitude and therefore a greater ability to self-regulate in
stressful situations (de Vibe et al, 2017).
Online resources were tested because of their potential for quick scaling across the country
if they were found to be effective. The flexibility of using online resources was also intended
to avoid the logistical issues created by the need to abstract officers and staff from duty for
face-to-face interventions.
Headspace
Headspace is an online subscription service that offers training packages of audio and
animated video sessions. Basic training courses are available on subscription. Further
packages range from short ‘bite-size’ pieces of a few minutes, to longer guided meditations
and topic-specific audios. The topics include sleep, grief, difficult conversations, mindful
running, mindful eating and more. The user can decide which type and length of session to
complete at any time, and there is no set route for completion of sessions, beyond the basic
introduction packages.
Headspace is offered via a website and a smartphone app. See www.headspace.com
Although Headspace offers free access to its first basics course, the full paid subscription
was offered to users for this trial, to ensure they could explore the mindfulness resource
fully.
Mindfit Cop
Mindfit Cop is a bespoke police-specific online eight-week course, which offers videos,
audios and documents to cover similar ground to the MBSR, but with police-oriented
examples. The course must be followed in the given order. Each week of the course is only
released a week after the participant first accessed the previous week’s material. This delay
is to allow participants to absorb the lessons and try them in home practice, before moving
on to the next week’s tasks.
Mindfit Cop is offered via a website but can also be viewed as a web app (a website that is
accessible on a smartphone). The audio sessions are downloadable to a smartphone via a
podcast provider. Previously available at www.mindfitcop.uk, now at oscarkilo.org.uk/mindfit-
cop/.
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While the intention is completion in eight weeks, once the website is available to the
participants, they can proceed at their own pace. This allows them to miss a week, but still
access that content later and continue through the course when they choose.
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The randomised controlled trial
The College of Policing planned a robust research study to test the impact of online
mindfulness resources in policing. An RCT design was adopted.
The research team elicited expressions of interest from a total of 1,710 police employees
across the five participating forces: Avon and Somerset, Bedfordshire, Cambridgeshire,
Hertfordshire and South Wales. They were invited to complete an initial survey with
questions on wellbeing, resilience, performance, mindfulness, job control, presenteeism,
leaveism and restricted duties. This ‘baseline’ was compared to later responses to identify
what changed.
Of the original 1,710, 296 chose not to complete the questionnaire and 77 were excluded
from the study because they were already following a structured mindfulness course
and/or they were already receiving a therapeutic mental health intervention (such as
counselling or cognitive behavioural therapy). Those who were excluded from the
research were given the opportunity to use the free resource after the trial ended. The
remaining 1,337 participants were randomly assigned to one of three groups: Headspace
users (446), Mindfit Cop users (445) and the waiting list control (446).
The following data were collected for the study, with informed consent from each
participant:
three sets of online survey data baseline (prior to allocation), 10 and 24 weeks
demographic and sickness data collected directly from the force HR teams
usage data collected directly from the online mindfulness resource provider
interview data collected via telephone calls with selected participants.
Limitations of the study included: response attrition (45 per cent of the original participants
provided survey responses that could be analysed at week 24), technical issues with one
of the resources in particular (Mindfit Cop), relying on self-report data in relation to work
performance and using sickness data collected in varying ways by different HR teams.
Research aims and hypotheses
The College of Policing aimed to address the research gap relating to mindfulness in
policing. The specific focus on wellbeing-related outcomes complemented concurrent
initiatives to improve wellbeing in policing, such as the development of the NPWS. In order
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to address the evidence gap, a large-scale RCT was planned with two test conditions
(Headspace and Mindfit Cop use) and one control condition (waiting list). The rationale for
choosing Headspace and Mindfit Cop was covered in the previous section of this report.
The aim of the study was to establish whether mindfulness training was superior to the
status quo in providing wellbeing benefits:
For police officers and staff in England and Wales, is receiving online mindfulness
training via Headspace and/or Mindfit Cop more effective than the status quo
(represented by a waiting list group) in increasing positive wellbeing-related
outcomes, such as mental wellbeing, resilience and performance?
In research of this type, it is useful to set out the expected results of the trial prior to the
study, to provide a focus for study design and transparency in subsequent reporting. The
first two expected results (hypotheses) were worked up based on previous research findings.
1. Online training in mindfulness will improve wellbeing, resilience and performance for
police officers and staff (primary outcomes expected).
2. Online training in mindfulness will improve mindfulness skills, and reduce sick leave,
presenteeism and leaveism (secondary outcomes expected).
The third hypothesis was built on the experience of our mindfulness in policing advisor DI
Jenni McIntyre-Smith in delivering mindfulness training in a face-to-face setting:
3. Bespoke training aimed at police officers (Mindfit Cop) will improve wellbeing, resilience
and performance for police officers and staff more effectively than a generic mindfulness
intervention (Headspace).
An additional hypothesis was added on the advice of Professor Kevin Daniels, of the
University of East Anglia, to ensure that due attention was paid to whether the outcomes
experienced by police employees would vary depending on their ‘job control’ the extent to
which they could determine their own actions and time allocations within the working day.
The rationale behind this was previous evidence (Daniels et al., 2017; Lawrie et al, 2018)
that suggested mindfulness and other self-help work interventions might be more successful
for participants whose job control was already high, which might have consequences in
favouring higher-ranking officers and more senior staff.
4. Mindfulness training is more likely to be effective for people with high levels of job control
in terms of how they structure their day and do their tasks.
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Study design
This three-arm parallel RCT design aimed to maximise confidence in the final research
findings. The aim was to ensure that the results would be reliable, useful and relevant. For
this reason, a number of robust design features were adopted and are explained below.
The study was delivered across five forces: Avon and Somerset, Bedfordshire,
Cambridgeshire, Hertfordshire and South Wales. This ensured that the results were not just
relevant to the particular circumstances in one force (for instance in Bedfordshire, where the
mindfulness lead worked). The forces involved were not randomly selected, but were an
opportunity sample based on interest in the project. However, they ranged in size, location
and previous experience of mindfulness delivery, and any differences between them were
examined in the analysis.
The study was offered to all police employees and volunteers (officers, staff, PCSOs,
specials and other volunteers). This approach ensured that the results were not just relevant
for one type of police employee.
Participation in the study was voluntary, by informed consent. The study was open to anyone
within the five participating forces, as long as they fulfilled two inclusion criteria (see below).
There were just under 20,000 employees within the five forces. Opening up the study to this
volume of employees allowed the research team to understand the potential interest and
take-up within forces if the resources were offered on an open and voluntary basis in the
future. It also ensured a large cohort of participants was available for the study, improving
the chance of detecting effects of using the resources, even after some participants withdrew
or dropped out over time.
Participants were excluded if they:
were currently following a structured mindfulness intervention (eg, a face-to-face course
or using the Headspace app)
were currently involved in receiving counselling, cognitive behavioural therapy or any
other structured talking therapy.
There were two key reasons behind these criteria. The first was to ensure that participants
did not stop, swap or otherwise let the new wellbeing intervention interfere with any current
therapy. The second was to avoid confounding the results of the trial if large volumes of
participants were simultaneously involved in other (unknown) mindfulness- or wellbeing-
focused interventions.
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The study employed randomisation at the individual participant (police employees) level.
Whenever a potential participant expressed an interest in accessing the mindfulness
training, they were offered a unique research ID number. Once the potential participants had
completed the initial survey, they were randomly assigned to either access Headspace,
Mindfit Cop, or to wait for six months before receiving access to Mindfit Cop. Equal numbers
were allocated to each group. By using the research ID and a computerised randomisation
process, the allocation was not based on human judgements. This randomisation increased
our confidence that no unconscious bias or other systematic judgement had compromised
our ability to make useful comparisons between the Headspace, Mindfit and waiting list
groups. This is important, because in less robust trials, those who are easiest to access
often end up being offered new resources first, which can lead to the results being less
relevant to a wider range of people.
The study employed a comparison group who were not receiving access to the resources
during the study period, but completed all the same surveys. The data from this group
provided a comparison reference point of the same range of participants as the other groups
(eg, by age, gender, force and rank/role). This comparison allowed us to check whether the
changes detected in the Mindfit Cop and Headspace groups could be confidently attributed
to their usage of the mindfulness resources, or, alternatively, whether some other event or
circumstance had influenced and changed the wellbeing or sickness absence rates of
everyone in the organisation at the same time.
The study gathered data on the relevant outcomes at three time points:
baseline – before the trial participants were allocated to a resource
10 weeks this survey occurred 10 weeks after the Headspace/Mindfit Cop groups
received access to their mindfulness resources
24 weeks this survey occurred 24 weeks after the Headspace/Mindfit Cop groups
received access to their mindfulness resources.
This ensured that the analysis could assess shorter- and longer-term change over time.
The study employed statistical analysis techniques (regression analyses) that could ‘control’
for key characteristics of participants (eg, by age, gender, force and rank/role) and for their
individual starting points (eg, what their wellbeing score was before they used the
mindfulness resources). The demographic data was collected directly from force HR records
with the informed consent of participants. This meant that the analysis could pick up and
report on any important differences in the usefulness of the resources for different types of
people. For more detail on analysis techniques, see Appendix 6.
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While the original intention had been to survey at 12 and 24 weeks, for logistical reasons (12
weeks would have fallen over the Christmas period) a 10-week follow-up period was
planned. There were no changes to this trial design once the trial was under way.
Outcome measures
The following measures were used in this study:
wellbeingthe Short Warwick-Edinburgh Mental Wellbeing Scale (seven items
aggregated in analysis to form one wellbeing score per response)
life satisfaction – a single item from the Office for National Statistics questions on life
satisfaction (‘Overall, how satisfied are you with your life nowadays?’)
resilience – the Brief Resilience Scale (six items averaged in analysis to form one
resilience score per response)
work performance – a single item from the World Health Organization Health and Work
Performance Questionnaire (‘On a scale of 0 to 10, where 0 is the worst job performance
anyone could have at your job and 10 is the performance of a top worker, how would you
rate your overall performance on the days you worked during the past two weeks?’)
mindfulness – the Short Mindful Attention Awareness Scale (five items averaged in
analysis to form one mindfulness score per response)
presenteeism – ‘Over the last six months have you gone to work when you were sick?’
leaveism – ‘Over the last six months have you taken annual leave instead of calling in
sick?’
restricted duties – ‘Over the last six months have you gone on restricted duties for any
reason?’
sickness absence – absence days and absence spells for each participant, taken from
HR records for the 24 weeks prior to the study and the 24 weeks of the study.
In addition, job control was measured at baseline and 10 weeks, using slightly adapted
questions from the Workplace Employment Relations Study (WERS) 2011 conducted by the
Department for Business, Innovation and Skills.
To reduce the survey burden on participants, data were not collected on all measures at
every survey point. The table below shows when each type of data were collected.
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Table 1: Outcome measures and point of collection
Data Baseline 10 weeks 24 weeks
Wellbeing
Resilience
Performance
Mindfulness
Presenteeism
Leaveism
Restricted duties
Sickness absence
Job control
The origins of each measure are provided in Appendix 2. Examples of the baseline, 10-week
and 24-week surveys are available in appendices 3, 4 and 5 respectively. There were three
slightly different copies of the 10-week and 24-week surveys (for the control group, Mindfit
Cop and Headspace groups) but only one example of each is given in the appendices for
space reasons. The measures were all the same, with the preamble text and comment
questions lightly tailored to the group allocation.
Limited usage data was also collected automatically via the two online mindfulness
resources when people validated their access codes/registered and then proceeded through
the weekly exercises (Mindfit Cop)/sessions (Headspace).
Flow diagram of participation in the trial
CONSORT stands for ‘the consolidated standards of reporting trials’ (http://www.consort-
statement.org/). The flow diagram below follows CONSORT guidance by showing the
different stages of the study and how many participants were involved at each stage.
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Initial interest
1,710
Excluded
373
Did not apply
296
Did not meet criteria
77
On a mindfulness course
23
Receiving talking therapy
46
Both of the above
8
Randomised
1,337
Allocated to
waiting list
control
446
Allocated to
Headspace
446
Allocated to
Mindfit Cop
445
Remained on
waiting list
444
Received
intervention
321
Received
intervention
343
Did not receive
intervention
2
Did not receive
intervention
125
Did not receive
intervention
102
Withdrew
2
Withdrew
5
Withdrew
8
No usage
120
No usage
94
At 10 weeks
Lost to follow-
up
131
Lost to follow-
up
218
Lost to follow-
up
263
Bounce-back
6
Bounce-back
3
Bounce-back
5
No response
125
No response
215
No response
258
Analysed at 10 weeks
Responses
313
Responses
223
Responses
174
At 24 weeks
Total lost
171
Total lost
247
Total lost
307
Bounce-back
11
Bounce-back
11
Bounce-back
11
No response
160
No response
236
No response
296
Analysed at 24 weeks
Responses
273
Responses
194
Responses
130
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Some participants did not use the online resources, so did not receive the intervention. If
they officially withdrew, their participation ended. However, all other participants who did not
use the resource remained part of the trial and were sent invite links for both follow-up
surveys. Participants who did not complete the 10 week survey remained part of the trial and
were given the chance to complete the 24 week survey.
Uptake and demographic profile
Table 2 draws on the 2017 police workforce figures (Home Office, 2017) used in the initial
trial protocol to estimate the pool of available employees from the five forces. It then gives
percentages for a) initial interest ie, the 1,710 people who asked to find out more; b)
allocation within the trial – ie, the 1,322 people who were allocated to one of the trial arms
and did not formally withdraw. Both figures are given, because a) it gives a useful indication
of the extent to which police employees might be interested in mindfulness training if they did
not have to sign up to a research trial to access it, and b) it highlights the extent of the
workforce in each force who were initially actively engaged.
Table 2: The total number of employees in each participating force (as of 2017), with
proportions of interest and participation in the trial.
Police force Total
employees
Initial
interest
Part of
trial
Avon and Somerset Constabulary 5,736 10% 8%
Bedfordshire Police 2,289 11% 8%
Cambridgeshire Constabulary 2,587 6% 4%
Hertfordshire Constabulary 3,793 10% 7%
South Wales Police 5,283 7% 6%
At the start of the trial, it was clear from the breakdown of allocated participants that the self-
selecting volunteering process had not provided a sample that matched the demographics of
the national police workforce. Details are given below, using figures from Home Office
(2018b) workforce statistics on gender and diversity. As any future intervention is likely to be
voluntary, this self-selection difference matters less to the generalisability of the findings than
if the interventions were being considered as compulsory for all employees.
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47 per cent officers/53 per cent staff – If all potential workforce members are taken into
account (including unpaid volunteers) then the overall make-up of the workforce
nationally is 56 per cent officers and 29 per cent staff, suggesting staff are
overrepresented in the sample.
65 per cent female/35 per cent male As of March 2018 only 30 per cent of officers
were female, but 61 per cent of police staff were female. The bias towards female
participants in this trial may have been influenced by, but is not only attributable to, the
high proportion of police staff involved in the trial.
The age profile comparison was not clear-cut, with for instance 58 per cent of the officers
involved in the trial aged 41 to 55 (compared to 45 per cent of all officers being in that
age category nationally), but a far lower proportion of over-55 staff involved than is found
nationally (20 per cent of all staff 10 per cent of all staff participants in the trial).
Around 6 per cent of trial participants were senior officers, similar to 4 per cent of the
workforce nationally.
Finding out more user experience
Additional comment boxes on the survey and telephone interviews provided insight into the
experience of those using the mindfulness resources. This feedback was particularly useful
for trying to understand and interpret usage trends and the main findings.
Over 300 comments were left by participants across the three allocation groups at week 10.
These were analysed for emerging themes.
Telephone interviewees were selected from a pool of volunteers from the 10-week survey,
via a stratification process across participants with different levels of resource usage:
Usage categories
1 – Participant consented to the trial but did not access resource.
2 – Participant used the resource for less than 30 minutes.
3 – Participant used the resource for between 30 minutes and 2 hours.
4 – Participant used the resource for more than 2 hours.
A total of 29 interviews were achieved, as shown in Table 3.
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Table 3: Number of qualitative telephone interviews carried out with participants across four
different usage categories.
Usage category
Group 1 2 3 4 Total
Headspace 3 4 4 4 15
Mindfit Cop 5 3 3 3 14
Total 8 7 7 7 29
The interview questions can be found in Appendix 6. A framework analysis (see Appendix 9)
was conducted to determine key points emerging from the interview data.
Limitations
This RCT incorporated many of the best practice components of impact evaluation, but
some limitations have inevitably arisen from ‘real world’ implementation requirements.
Technical issues
People have varying levels of IT literacy. Police employees also have access to different
devices and software depending on their role and home force. While this RCT aimed to
understand the impact of the training content of online mindfulness resources on police
employees, the final findings represent the impact of the whole process of resource access
and use. This runs from signup and validation of access codes/registration on the site,
through to viewing videos and listening to audio using the devices/software available to the
participant, to continuing to use the resources in among other pressures. This is a fair test,
given that the aim is to implement the resources for police employees who will be affected by
any unresolved technical issues and their level of IT literacy in any future rollout. However, it
is also important to recognise the impact more specific technical problems could have had
on the ultimate results. There was a substantial period of login difficulties with Mindfit Cop for
up to a quarter of allocated participants. All participants who requested help were given
technical support by the website owners and the research team. However, many more may
not have requested help. The potential impact and implications of these technical difficulties
are discussed more in the later section ‘User experience of online resources’.
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Attrition
Forty-five per cent of the original participants provided survey responses that could be
analysed at week 24. The spread of responses was uneven, with a response rate of only 29
per cent in the Mindfit Cop group, compared to 61 per cent in the waiting list control group.
Nevertheless, the response cohorts remain large enough to draw confident conclusions. In
addition, the responding/non-responding groups did not appear to show any systematic
patterns (eg, gender/age). If they had, this would indicate the findings are less generalisable
to police employees as a whole than particular sub-groups. The lower response rate in the
Mindfit Cop group was considered in light of qualitative feedback and the high proportion of
requests for technical support to the project team. The lower response rate may be
explained by participants who had experienced technical difficulties with login and usage
possibly becoming tired of participation earlier than the Headspace and control groups.
Self-report performance data
Using one self-report item to collect data on performance gives a snapshot of user
experience and perception. However, it does not provide substantial objective evidence of
the impact of mindfulness on detailed aspects of police performance. The use of the single
item was previously justified in a relevant mindfulness and productivity study (Shiba et al,
2015). This was on the basis that data on objective performance is difficult to obtain and
significantly complicates the design of studies. This is particularly relevant because more
detailed survey items usually have to be heavily tailored to be comprehensible and relevant
to particular job roles. As our study needed to span officers, staff, PCSOs, specials and
volunteers, tailoring to this detail was not an option. We therefore chose to rely on self-report
data and the potential to interpret wellbeing improvements as likely corroborating evidence
of improvement on performance. This is thanks to the findings that exist on the positive
impact of employee wellbeing on productivity (What Works Centre for Wellbeing, 2017).
Sickness absence data
We requested absence days and spells alongside ‘Dorset 12’ sickness categorisations (a
reporting framework used by the police since 2005 Hayday et al, 2007). There were not
enough of different types of absences classified under the Dorset 12 categories to allow any
useful sub-analyses (eg, by mental health issues only).
In addition, sickness absence data did not cover adapted or restricted duties, where the
employee is working but not deployed as usual. A previous HSE report (Hayday et al, 2007)
noted the difficulty of working with police absence data across forces, due to the range of
ways different aspects of sickness absence are recorded (by supervisors, by HR and by OH
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teams dealing with long-term sickness and disability). This may provide part of the
explanation for why the absence data did not show the same positive trends as the rest of
the findings. However, seasonal change (the trial was delivered over winter while the pre-
trial data was from spring/summer) may also have influenced these findings.
Long-term effects
The trial ended at 24 weeks and the waiting list participants were given access to Mindfit
Cop. It will therefore not be possible to return to the control and treatment groups to report
on long-term effects (one to two years). It will also not be possible to judge whether there is
any difference between the two treatment groups regarding the extent to which any effects
may decrease with time or with removal of access to the resources.
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Results
Both the Headspace and Mindfit Cop online mindfulness resources improved wellbeing,
life satisfaction, resilience and performance, in comparison to the control group.
Headspace provided greater improvement across these wellbeing outcomes after 10 and
24 weeks, but Mindfit Cop’s results improved and moved closer to Headspace’s at 24
weeks.
Neither online resource made a positive impact on absence days or spells within the six
months of the trial, but self-reported presenteeism behaviours did reduce for both.
Interestingly, participants who reported low job control (ie, little control over their tasks and
scheduling) benefited most from using the resources the opposite of what was expected.
Interview feedback provided insight into how these improvements were achieved. Users
reported becoming more reflective about their own thoughts and actions, while learning
new techniques for stressful situations. Positive behavioural changes included: taking time
out in the day to relax, briefly stopping and thinking in very difficult situations, establishing
a meditation practice, and/or returning to or adopting other wellbeing-promoting
behaviours, such as yoga and regular exercise. The end benefits were reported as a
reduction of stress and anxiety, better sleep and greater focus at work.
Not all participants accessed the resources and reported benefits. There were four key
challenges: time (scheduling, not being interrupted), location (difficulties of open-plan
offices, whether to use at home), emotion (tackling the guilt of taking time out and
embarrassment in front of peers) and technical issues (IT literacy and login issues). Some
participants addressed these challenges at a personal level, but others would have only
used the resources if they received organisational support of time, space and supervisor
permission.
Main results
The first analysis investigated the average change in wellbeing, life satisfaction, resilience,
performance, absence days and absence spells for the three different groups in the trial.
Wellbeing, life satisfaction, resilience and performance all improved for the Headspace and
Mindfit Cop groups in comparison to the control group over the 24 weeks (six months) of the
trial. The improvement was consistently greater for Headspace than Mindfit Cop and was
unchanged for the control group. The improvements for wellbeing, life satisfaction, resilience
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and performance are meaningful (for example, improvements of 56 points out of 35 for
wellbeing and 1.52 points out of 10 for life satisfaction and job performance see Appendix
7 for detail).
Understanding the change in absence days and spells was more complicated. The number
of days absent from work in the six months of the trial, compared to the prior six months,
was higher for Headspace and unchanged for Mindfit Cop and the control group. The
number of absence spells was also higher for the control and both mindfulness groups,
though highest for the control group. While a decrease in presenteeism for the Headspace
and Mindfit Cop groups might lead to increased absence spells in the short-term, this
explanation would not account for the increase in the control group. One simple potential
explanation was that the six months of the trial occurred over winter, when sickness absence
is more common. The ‘Limitations’ section outlined potential other reasons for difficulties.
Figure 1 shows the average change in each of these key outcome measures for the control
and two treatment groups. The dots indicate the average for the group and the lines indicate
the 95 per cent confidence intervals. Where the average value and the confidence interval
lies above zero, we can conclude that we are 95 per cent confident that the outcome
measure for that group has improved over the trial period. If the confidence interval includes
zero, we are unable to conclude that the measure has reliably changed over the trial period.
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Figure 1: Difference between pre-intervention and 24-week post intervention scores on all
outcome variables (Y axis) for the Headspace, Mindfit Cop and control groups (X axis). Data
were scaled to one standard deviation.
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The next step in analysis
The research was conducted in a ‘real world’ setting and not in a laboratory. As such, it is
important to check how many of the differences between forces and individuals that exist
naturally had an impact on the changes in wellbeing, resilience, etc. that have been
described above. This approach helps to better understand the relationship between
introducing the resources to participants and them gaining a benefit from it. Could that
relationship be influenced by whether they were male or female, or by whether they started
using the resources when they already had very high or very low wellbeing? Gaining this
understanding is particularly useful to any future rollout. Regression analyses are statistical
modelling approaches that allow us to investigate multiple differences at once to understand
the key relationships.
There were no statistical differences between the five participating forces and the different
age groups involved (details are available from the authors upon request). From the
demographic data, only gender and job roles therefore form part of the testing described in
the following section.
The regression analyses were based on raw scores (instead of the difference scores used in
Figure 1) and controlled for the baseline measurement that was taken before the
intervention. This means that for wellbeing we controlled for baseline wellbeing, for resilience
we controlled for baseline resilience and so on, in order to understand any interactions
between different levels of baseline scores and the resulting outcomes.
Reporting on the hypotheses
Using the findings of regression analyses provides a more rigorous basis to confirm or refute
our original hypotheses. The main headline findings have been summarised below, but for
more detail please see the regression tables in Appendix 8.
Hypothesis Results
1 Online training in
mindfulness will improve
wellbeing, resilience and
performance for police
officers and staff.
Headspace improved wellbeing, life satisfaction,
resilience and performance scores at 10 and 24 weeks.
Mindfit Cop improved wellbeing and life satisfaction
scores (only) at 10 weeks, but improved all of the
primary outcomes (wellbeing, life satisfaction, resilience
and performance) at 24 weeks.
Accept hypothesis
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2a Online training in
mindfulness will improve
mindfulness skills.
Headspace improved mindfulness scores at 10 weeks.
Mindfit Cop did not significantly improve mindfulness
scores at 10 weeks.
Mindfulness was not surveyed again at 24 weeks.
Accept hypothesis for Headspace
2b Online training in
mindfulness will reduce
sick leave, presenteeism
and leaveism.
Headspace and Mindfit Cop reduced presenteeism at
24 weeks.
There was no evidence that online training in
mindfulness reduced sick leave or leaveism.
Accept hypothesis for presenteeism but not for
absence days/spells or leaveism
3 Bespoke training aimed at
police officers (Mindfit Cop)
will improve wellbeing,
resilience and performance
for police officers and staff
more effectively than a
generic mindfulness
intervention (Headspace).
The generic mindfulness intervention (Headspace) was
more effective than the bespoke training at 10 weeks
(Mindfit Cop).
At 24 weeks, Mindfit Cop and Headspace were both
effective interventions across the primary outcomes, but
Mindfit Cop did not appear to offer any additional
benefits.
Do not accept hypothesis
4 Mindfulness training is
more likely to be effective
for people with high levels
of job control in terms of
how they structure their
day and do their tasks.
Mindfulness training was more beneficial to those with
low job control.
Do not accept hypothesis
In the final survey, instead of answering the short mindful attention awareness scale again,
the trial participants were asked questions on their day-to-day mindfulness behaviours at
work or at home in the last month. The majority reported never engaging in mindfulness
practice at work (73 per cent), whereas a majority did report engaging in mindfulness outside
of work (67 per cent). Those engaging in the interventions were more likely to report both
engagement at work (Headspace 35 per cent, Mindfit Cop 33 per cent) and engagement
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outside of work (Headspace 83 per cent, Mindfit Cop 54 per cent). We find no evidence that
the impact of the interventions is enhanced by more frequent self-reported engagement in
mindful practice (results are available from the authors upon request).
Going deeper feedback from participants
The survey findings suggested that using mindfulness resources had a positive impact on
police employee wellbeing. We interviewed users of Headspace and Mindfit Cop to better
understand why this positive change might have occurred.
Interview feedback highlighted two key areas of learning for those who had engaged with the
mindfulness resources:
becoming more reflective about their own thoughts and actions
learning techniques to be ‘here and now’.
Moving from ‘autopilot’ to a more nuanced awareness of everyday thoughts and behaviours
is one of the key messages of both Headspace and Mindfit Cop. Where trial participants had
used the resources, they had absorbed this message and found it useful:
‘We do all work really really hard and sometimes relentless and just reminding people
that you’ve got to stop and pause and think about yourself for a moment if you’re
going to be effective in what you do it’s a good thing and all too often we forget that
message.’
Mindfit Cop user
There was recognition that it was important to understand participants’ common ‘triggers’ for
stress, anxiety and/or depression. As a result of this greater reflection and identification of
difficult thoughts or situations, the interviewees reported three key areas of behavioural
change:
taking time out in the day to relax doing this deliberately and regularly
briefly stopping and thinking in very difficult situations being less reactive even in high-
pressure situations
returning to or adopting wellbeing-promoting behaviours eg, yoga, regular exercise and
general self-care.
The following quotes are illustrative of the types of comments offered by interviewees:
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‘I’ve got much better at little things like I’ll step away from my desk at lunchtime and
I’ll go for a walk a bit more now. It’s just that making time for me type of thing.’
Mindfit Cop user
‘It trains you to accept that it’s OK to take that extra two or three minutes to think this
one through, before you actually take action.’
Headspace user
Being prompted to consider wellbeing and recognise common stressors had wider knock-on
effects for some participants like taking more time to run, walk, go to yoga or even just ask
their kids to give them the space to lie down for 10 minutes on a sofa. This may offer one
explanation of why the analysis did not find a link between the extent of self-reported
mindfulness practice and impact on wellbeing. Even those who only used the resources a
little and did not take to mindfulness may have been reminded of the need for self-care and
therefore prompted to take up or restart other activities beneficial to their wellbeing.
The intention behind both of the resources was to foster conscious awareness of everyday
situations, an accepting attitude and therefore a greater ability to self-regulate in stressful
situations (de Vibe et al, 2017). The feedback from the interviewees suggests that both
Mindfit Cop and Headspace were effective in delivering this learning when participants
engaged with them. This in turn helped some users to:
feel less stress and anxiety
sleep better (Headspace in particular)
focus better at work
feel more supported by policing (because the training/resources had been provided to
them).
‘I’ve felt quite anxious on occasions in the past. Those are fewer and far between
now.’
Headspace user
‘I completely struggle to get to sleep so I use the sleepcastto help that because it’s
quite relaxing, and then it tends to send me off to sleep…’
Headspace user
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‘I was so excited at the thought, you know, that this had been taken seriously, people
are putting their time and effort to create something to look after people’s mental
health in the police environment.’
Mindfit Cop user
Despite glowing reviews from many users, it should be noted that mindfulness training is not
for everyone and many trial participants either did not use the resources or used them very
little. Consequently, usage barriers are explored in more detail in the next section.
Understanding usage barriers and enablers
The results above give a clear sense that when police officers and staff who are interested in
mindfulness are given access to online mindfulness resources, there is likely to be a positive
impact on their wellbeing, life satisfaction, performance and presenteeism behaviours.
However there is unlikely to be a noticeable impact on their sickness absence or leaveism
behaviours (at least in the first six months).
We should note that giving participants access does not mean they use the resources a lot,
or even at all in some cases. The flow diagram on page 20 showed that of the 446 originally
allocated to Headspace, 120 (27 per cent) did not activate their full subscription code
(including the five who officially withdrew). Similarly, of the 445 originally allocated to Mindfit
Cop, 94 (21 per cent) did not register for the site (including the eight who officially withdrew).
These participants were volunteers who took the effort to request information and fill out the
baseline survey, so it is important to question why they did not go on to use the resources.
The following findings, drawn from survey comments and interview feedback, allow us to
highlight barriers to usage. These would need to be resolved for greater accessibility and
uptake, if the resources were rolled out more widely in the future.
First, it is important to understand that different participants had different reasons for signing
up for the training. The reasons were to:
learn more about mindfulness – the participant had previously heard about
mindfulness in another way (reading, courses, apps, hearing from others) and wanted to
learn more about how to apply it
address a difficult situation – the participant was starting a new job, managing a
stressful workload or faced emerging personal problems that made them focus on their
need for wellbeing support. They volunteered for the trial to get it
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address a pre-existing tendency – the participant knew that they experienced anxiety,
stress and/or depression and volunteered to be part of the trial to see if the resources
could help
be able to understand and share the learning with others – the participant thought
mindfulness might benefit their children, partners, or people in the team they manage
take up the offer – the participant was curious to try something new.
There was not enough data to determine patterns in usage according to users’ initial reason
for participation. However, some non-users/low users made it clear that they were already
very busy, stressed or experiencing mental health issues and this meant that their response
to being given the resource was complicated. Introducing a new commitment (to practise
mindfulness) seemed like an additional burden to some, rather than a help. A selection of
quotes from participants with no or low usage are used to illustrate this:
‘I have had some major upheaval in my personal circumstances and have struggled
to use Headspace after the initial couple of weeks. I am very interested in the
programme and the process but this has been a particularly difficult period. It was
just another thing to do in an already overwhelming situation.’
Headspace group, survey comment
‘I kind of felt I was on borrowed time because of the stress I felt at work, there wasn’t
enough hours in the day to do my own work. But I’d go onto the mindful [sic] and kind
of felt under pressure I need to get back to my work.’
Mindfit Cop group, interview comment
‘But when it’s hectic you’re looking for an instant win to persuade you of its
usefulness, not something that have to keep doing over and over.’
Headspace group, interview comment
However, there were equally those who were experiencing difficult times who felt able to
make use of the resources and gain benefit from them, such as the following:
‘This has been a time of change in my life both personally and at work and some of
the techniques have been very beneficial to me. I've got back to being a glass half
full person and am about to take up a challenge that six months ago I would never
have even considered.’
Mindfit Cop group, survey comment
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‘Recently I have been dealing with a difficult [person] and several major issues at
home. Normally I would struggle to deal without starting down the depression road
but with Headspace, I was able to find something for every occasion. I feel I still have
a way to go but my sleeping patterns and ability to deal with stress appears to be
improved.’
Headspace group, survey comment
Regardless of reasons for initial interest, there were a few very important key barriers
common to all the feedback. These actively stopped some participants using the resources.
They were seen as challenges to be overcome by others who went on to use the resources
a lot. Three barriers are given below and are then followed by another list of ‘enabling
actions and thoughts’ that individuals used to try to overcome these challenges.
Barriers
Location
Those who had used the resource more often were much more likely to have used
Headspace/Mindfit Cop at home rather than in work time. Participants generally reported
that using the resources at work was either not possible or did not feel suitable especially
where they worked in busy and noisy open-plan offices and in response/reactive roles.
Participants noted a lack of quiet rooms where they could take time out. Participants who did
not use the resources much either preferred not to carry out work activities at home
(particularly around Mindfit Cop, which was perceived as more like a work duty than
Headspace) or would have liked to, but did not find the time or space in their personal lives
to do so. While a few participants managed to successfully use the resources at work, they
noted that they had to pick their times (eg, start of day/end of the day/lunch break) or that
they worked in small offices/from home anyway, so they were able to complete their
mindfulness training within work time.
‘Open plan is not conducive … I don’t think there’d be anywhere quiet to go. Where
would you … I’m just trying to think where [laughs] where you could go and sit in a
chair and shut your eyes. All of our quiet rooms have got windows that look into
them. Everywhere else is open space.’
Participant who used Headspace extensively at home
‘I did sort of sneak off when I did the early ones and found some quiet space. Again,
there’s a couple of meeting rooms, but again, you know you can’t rely on them for
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exclusive use. Anyone can come along and you can get turfed out, it’s not the best
sort of environment.’
Participant who tried to use Mindfit Cop at work initially
Time
Time barriers were heavily linked with location people who tried to use the resources in
work, in open-plan offices, felt very restricted for time. Simply put, the harder people found it
to schedule in sessions due to workload and unpredictable work days, the lower usage they
achieved. The nature of response roles meant that people reported logging in, starting
sessions and then being called out on urgent jobs. Others noted that they believed that the
course might help them schedule in time to relax/be mindful, but that they almost needed the
training first to be able to work out how to do that scheduling, leaving them with a ‘chicken
and egg’ situation.
‘[At work…] I’ve not really even had a proper break or anything either because
there’s just so much to do. So it, yeah it is kind of trying to make you focus on
yourself sometimes when it’s things like that. Is actually taking 15, 20 minutes away
from your computer, really going to change anything to what you’re doing? It’s hard
sometimes when you’re kind of in that moment.’
Participant who used Mindfit Cop mostly at home
‘Obviously work life is 10 hour shifts it’s very busy. It’s very difficult to get away
from my desk for any length of time. So it took a while. It took a few weeks until I got
into using it but eventually. I used to go out at lunch times and just have 10 minutes I
just sit in my car.’
Participant who used Headspace mostly at work and at bedtime at home
Emotion
While many participants reported being excited by the prospect of learning more about
mindfulness, the training opportunity also roused a range of difficult emotions in some
participants. These included feelings of guilt (if attempting to do the training in work time),
disappointment in one’s own organisational ability (if failing to complete much of the training)
and embarrassment (eg, some participants wanting to keep their participation and/or
practice away from supervisors or partners/family members). These emotions had practical
consequences: for instance one participant reported that as she learnt more about
mindfulness, she learnt to feel ‘brave’ enough to tell her family that she was going off to
spend 10 minutes on mindfulness practice, but at the start she had to use her car for the
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practice to be alone. Others reported that the lack of private rooms without windows in the
station meant that they did not get to participate because people might ‘look in’ and wonder
why they were taking time off.
‘My husband does know I have been doing it but I find it embarrassing when he is
about.’
‘It is hard to take any breaks for Headspace without questions being asked or feeling
guilty.’
Headspace users
‘But I wouldn’t go to my supervisors to ask for help to get into it, because this was
something I wanted to be private. I wasn’t really advertising that I was doing it.’
Mindfit Cop user
Enablers
Some trial participants used the resources extensively, even in the face of the key
challenges described above. Their feedback offered learning points that were summarised
and sent out to the waiting list participants when they received access to Mindfit Cop after
six months. The learning points were paraphrased from interview feedback and summarised
as follows:
Make sure you have some headphones handy before you start, as there will be videos
with talking involved.
Find a quiet and private place to view at least the first week of course materials
whether this is your office, on a laptop in a meeting room, on your phone in a (parked)
car, at home or anywhere else you can comfortably view the website.
Schedule in the times you’ll view the course/practise mindfulness. Some people were
able to schedule time in the working day while others found it easier/preferred to use
breaks or very early in the morning/late at night.
Think of the time you spend on this course as time for self-investment. Relatively small
periods of time can make a big difference.
Stick at it. Once you learn a little bit of mindfulness it gets easier to find the time over
time.
Don’t worry if you like the sound of one presenter’s voice better than the other. All of the
mindfulness practice downloads are available in both voices so you can choose which
one you would prefer to listen to.
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Give yourself space by letting others (work colleagues/family) know how long you’ll be
away for (eg, 10 mins) when practising mindfulness. Ask for no interruptions.
If you miss a daily practice day, don’t worry, but resolve to find the time the next day to
pick it straight back up again.
These are of course enablers aimed at the individual. However, some participants indicated
that they wanted an organisational-level response to provide protected time, space and
reassurance for those who would otherwise find it hard to engage. Not all participants
wanted to extend their use of what they saw as ‘police-related’ activities into their personal
life, while others were much more comfortable using the resources at home than at work.
In addition to all of the above, technical difficulties were also a substantial barrier to usage
for some participants. The user experience of the online resources is summarised below, to
provide learning points for any future rollout.
User experience of online resources
There was a very mixed response to the online resources. Summary of the survey
comments and interview feedback specifically about the two different websites are given
below. However, it should be noted that some participants felt an app or website of any kind
was not their preferred route for learning about mindfulness. They saw person-to-person
training as easier to fit into the working day (assigned time) and remember to do (if it is a
regular weekly meeting).
Headspace
Headspace was generally perceived as attractive, high quality and usefully portioned into
‘bite-size’ sessions. Interview participants seemed particularly keen to recommend the app
to others and some even wanted to recommend it even if they had not used it much
themselves. The app was preferred to the website because it allowed quick and easy access
without the repeated need to log in.
The sleep sessions on Headspace were repeatedly mentioned throughout the interviews and
comments as particularly helpful. As there was no equivalent on Mindfit Cop, this may have
been one of the areas in which Headspace offered an advantage over the website. Those
who used the sleep sessions used them a lot and reported a great deal of difference to their
lives – for example:
‘Where it was particularly good for me was the sleep. It has a whole section on it to
help with sleep and I’ve almost got to the point now where the other night I get a
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bit worried about the fact that I almost can’t get to sleep without it now! [laughs] I
have to have my Headspace sleep time wind down now to get to sleep. It’s been
great, been really good.’
Headspace user, interview comment
Some participants found it hard to validate their subscription code for Headspace. Technical
support revealed that some participants had previously downloaded the Headspace app and
used the free sessions at some time before the trial. This meant that they already had an
existing account name attached to a different email address. Although this issue was easy to
resolve with our support, emails and calls still arriving towards the end of the trial suggested
that some participants had not activated their code properly and had only been using the
basic free sessions. The extent of this issue is unknown, but may suggest why the lack of
use seems so high (over a quarter of the cohort) but the overall effect on wellbeing is still
substantial.
Mindfit Cop
For those who used the course a lot, there was praise for the integrity of the content and the
ability to download the practices to a phone for use outside of the course. However, there
were also complaints of technical issues. Login was a particular problem, with the automatic
validation email not always arriving, even when the website had a record of sending it. This
may have been a firewall or spam protection issue that applied to only some participants, but
we could find no patterns by force or department. While individual help was always given
when requested and a high proportion of the initial issues were down to user error (eg,
spelling their own email addresses wrong or attempting to log in before registering), some
technical issues were unresolved at the end of the trial. The following areas were highlighted
as key for resolution before any future rollout:
make the login process foolproof and check any automatic email processes for issues
ensure that there is a ‘helpdesk’ number for people trying to sign up and use the site as
people are put off very quickly if they cannot start immediately
consider accessibility issues (transcripts/subtitles, etc.) and embed accessibility options
review the aesthetics of the course elements within the site to make it clear that it is not
just another compulsory police course
there was disagreement amongst the different interview participants over which voice
(male/female) they preferred. Provide a note early on that explains why there are two
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versions of each mindfulness practice download and say it is fine to choose the person
with the accent you prefer
provide option control on reminders. Some people liked the reminders, some people
disliked them. Making it easy for people to turn them on and off themselves would be
useful
make it clearer how people can download the audio sessions direct to their phones.
Technical issues may have affected the findings that suggested there was only limited
positive impact at 10 weeks. This explanation is supported in part by the fact that all of the
benefits of Mindfit Cop became larger and more significant after 24 weeks (once most of the
issues had been resolved and were in the past for participants). If people are already
stressed and overloaded (which may be why they want to access the resource) we found
that they were particularly intolerant to any small technical issue, even if resolved on the
same day.
‘I had to ring in several times … just to get logged in and the initial login. I haven’t
bothered with it. In fact I forgot about it, I got bored with it and it wasn’t helpful.’
Mindfit Cop user
For this reason, clear instructions, easy-to-use resources and helplines are vital to ensuring
benefit from any future rollout.
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Conclusions and implications
This trial has produced strong evidence that online mindfulness training can be beneficial
for the wellbeing of police employees. However, as with any wellbeing intervention,
implementation involves practical considerations, like costs and how to communicate the
opportunity to use the resource. These require careful thought in any future rollout.
Maximising the benefits to policing of mindfulness training will involve listening to user
feedback on potential barriers to participation: time, location, emotion and technical
issues. Tackling these potential barriers could involve: providing quiet rooms, hosting
group sessions in breaks, providing clear permission to complete the training elements of
the mindfulness resources in work time, easy-to-use online interfaces and simple
instructions for registration and login.
Conclusion
Both Headspace and Mindfit Cop provide benefits to wellbeing. Headspace provided greater
benefits in the context of this trial.
Mindfit Cop offers a viable option for improving wellbeing, resilience and performance in
police employees. There is currently no evidence that this would have an impact on
deployable resources in the form of reducing sickness absence. However, the wellbeing
benefits could be reasonably expected to have knock-on effects for products for productivity
and performance (What Works Centre for Wellbeing, 2017). The cost of development has
already been absorbed into the cost of the trial, but a budget would be necessary for
ongoing web development, hosting, maintenance and tech support whether this would be
managed externally or under the scope of Oscar Kilo and the NPWS. Success would rely on
the ongoing resolution of any technical barriers to use.
Headspace also offers a viable option for improving wellbeing, resilience and performance in
police employees. As with Mindfit Cop, there is currently no evidence that this would have an
impact on deployable resource. However, the same productivity and performance
consequences could be expected. The Headspace app was attractive and easy to use,
which may have contributed to the fact that the impact of Headspace was consistently larger
than Mindfit Cop, especially during the first few months of use. However, there are significant
ongoing cost implications related to annual licensing. If forces were interested in accessing
Headspace, it is recommended that a mechanism be put in place to allow coordinated bulk
purchasing to reduce unit costs.
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Considerations for rollout
Challenges
Not all participants used the opportunity to access the online mindfulness resources. User
feedback highlighted four key challenges that meant some people did not feel able to make
meaningful use of resources. The challenges were: time, location, emotion and technical
issues. In order to maximise the benefit from making mindfulness resources available in
policing, consideration should be given to mitigating each of these challenges as far as
possible in forces and at national level. Some suggestions are given below for ways in which
the challenges could be addressed:
Ensure that there is a small ‘quiet room’ in each station that could be used for short
breaks away from open-plan spaces. Users suggested that there should not be a window
in the door (allowing the occupants to be watched) or keycard entry recording who used
the room, to ensure that it was a genuine relaxation space.
Ensure that supervisors are briefed on the benefits of mindfulness and clear that if they
are happy to allow users to access short periods of mindfulness training in work time,
they will need to make that permission very clear on multiple occasions.
In forces, book a quiet room for short group lunch- or break-time meditation sessions, to
provide a regular space to practise and reminder about mindfulness.
Ensure that any instructions given to potential users of mindfulness resources are very
clear, to overcome simple login issues.
Ensure that the functionality of Mindfit Cop is reviewed to overcome technical issues,
especially around login and automatic emails for password creation/change.
Advertise that Mindfit Cop’s website is suitable for use on mobile devices.
Communications
For the research trial, mindfulness champions were engaged for each participating force.
They ensured that there was senior buy-in for the trial and they interacted with their
communication teams to promote the research and the resources. This communication
activity was vital for the success of the trial.
For any future rollout, a communication strategy will be required either at a national or
force level, depending on the nature of the offer. This needs to be constructed carefully, with
due consideration for the fact that mindfulness can be seen as ‘soft’, ‘alternative’ or
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‘religious’ by those who are unfamiliar with how it is presented from a secular point of view
and has been developed as a scientifically evidenced option.
Previous experience has suggested that testimonials gathered from ‘people like us’ (ie, a
range of officers, staff and other parts of the workforce) can be useful in persuading police
employees to consider mindfulness. However, a large part of any communications campaign
will include dispelling myths and likening mental fitness to physical fitness. Both are required
to do the job.
Forces need to acknowledge that, to benefit from any future force-wide offer, upfront time
and resourcing will be necessary within the organisation to promote take-up and answer any
questions. Communications strategy at a national level will be discussed after the production
of this report.
Costs
There were one-off costs associated with gaining access to/developing the online resources
for this trial. The Headspace licences for the trial cost £12,000 and the combined costs to
develop Mindfit Cop (covering expert input into the curriculum creation and the development
of the website) totalled £38,000. There were also protocol development and analysis costs
associated specifically with the research trial, as well as research capability provided within
the College. None of these costs would be repeated in any future rollout.
Mindfit Cop
The website was developed using a College grant. Ongoing costs would be relatively low,
but a budget and resourcing would still be essential. Resourcing will be required for limited
web development, web hosting, maintenance and technical support if the content is made
available in future. The findings highlighted the need to make any online offer as easy to use
as possible and make help available to ensure people can access content when they need
to. This is only possible via a monitored and maintained site.
The current plan is for the Mindfit Cop content to be available via the existing Oscar Kilo
website (https://oscarkilo.org.uk/). Oscar Kilo was set up with the aim of being the place to
share learning and best practice on wellbeing amongst the emergency services. Since April
2019, it has also become the home of information on the NPWS. This means that the
website is currently hosted and maintained under the funding available via the NPWS
alongside all of the other NPWS content, so separate costs are not available for the Mindfit
Cop element.
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The consequences of this funding profile are that any future offer or review will take place at
a national level via the NPWS.
Headspace
Headspace costing works on volume-based discounted tiers. If there were any forces that
wanted to continue using or start offering Headspace, the police service would benefit from a
mechanism to allow interested forces to sign up and bulk buy licences.
Headspace is open to negotiating costs of subscriptions and wider service packages, which
include education and training, communication materials and an admin dashboard to
manage subscriptions.
Future research
While male police employees may have been under-represented in this study for reasons of
self-selection, the recently published findings of a German RCT (Krick and Felfe, 2019) give
early indications that mindfulness interventions can also be useful in groups of male
employees who do not self-select.
The trial has been robust enough to provide evidence of wellbeing benefits, so no further
research is proposed at this point. However, if future proposals included face-to-face
training, a comparison study would be beneficial.
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Appendices
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Appendix 1: Technical abstract
Corresponding
authors
Dr Helen Fitzhugh
Senior Research Officer – College of Policing
Helen.Fitzhugh@college.pnn.police.uk
Dr George Michaelides
Senior Lecturer in Work Psychology – University of East Anglia
G.Michaelides@uea.ac.uk
Trial design Three-arm parallel design comparing outcomes for two treatment
conditions and one waitlist control group.
Methods
Participants Police employees (including ranking officers, police staff, police
community support officers, special constables and helpers).
Participants were volunteers from within five forces Avon and
Somerset, Bedfordshire, Cambridgeshire, Hertfordshire, South Wales.
Exclusion criteria:
Already following a structured mindfulness intervention.
Already undertaking a therapeutic wellbeing intervention (such as
counselling and cognitive behavioural therapy).
Did not complete the baseline survey.
Interventions Headspace (a commercially available mindfulness app and website).
Mindfit Cop (a bespoke online eight-week mindfulness course for
policing).
The waitlist (who completed all surveys before receiving access to
Mindfit Cop after six months).
Objective To understand: for police officers and staff in England and Wales, is
receiving online mindfulness training via Headspace and/or Mindfit Cop
more effective than the status quo (represented by a waiting list group)
in increasing positive wellbeing-related outcomes, such as mental
wellbeing, resilience and performance?
Outcome Primary intended outcomes:
Increased self-reported wellbeing
Increased self-reported resilience
Increased self-reported performance at work
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Randomisation Equal proportions allocated to the three arms of the study, using a
unique research ID and a Microsoft Excel random number function.
Blinding
(masking)
No blinding. All participants were aware of their own allocation, as was
the trial manager.
Results
Numbers
randomised
1,337 participants randomised equally to three groups.
15 officially withdrew during the first 10 weeks.
214 did not use the resources (120 Headspace/94 Mindfit Cop) during
the 24 weeks of the trial.
Numbers
analysed
Survey data:
1,322 usable responses from the baseline.
709 from the 10-week survey.
597 from the 24-week survey.
Note: some of these responses were not usable for all analyses
because of missing values to specific questions.
Absence data:
1,322 participants.
Outcome Significant improvement in all three primary outcomes at 24 weeks, for
both Headspace and Mindfit Cop (in comparison to the control group).
As well as the primary outcome variables, the regression analyses
(Appendix 8) incorporated gender, role, job control and the pre-
intervention scores for each relevant variable. A percentage is given
below, based on the R2 for each model, for how much of the variance in
each of the primary outcome measures was explained by this
combination of variables.
Wellbeing 30%
Headspace β = 6.36, SE = 1.45, p<0.001
Mindfit Cop β = 5.10, SE = 1.69, p<0.01
Resilience 28%
Headspace β = 0.99, SE = 0.24, p<0.001
Mindfit Cop β = 0.69, SE = 0.27, p<0.05
Job performance 22%
Headspace β = 1.57, SE = 0.56, p<0.01
Mindfit Cop β = 1.89, SE = 0.66, p<0.01
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Harms None recorded.
Conclusions Using online mindfulness resources helps improve the wellbeing,
resilience and performance of police officers and staff in comparison to
the status quo.
Funding The College of Policing.
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Appendix 2: Survey measures
The surveys used in this RCT were developed by the RCT development team: Pantelis
Solomon and Mark Egan at the Behavioural Insights Team, Kevin Daniels and Sara
Connolly at the University of East Anglia and Catherine Owens and Helen Fitzhugh for the
College of Policing. Choices were made based on the likelihood to be responsive to change
(eg, focusing on scales known to respond more to ‘states’ than ‘traits’) and also to achieve
parsimony in the survey tool, given the chance of survey fatigue. The following sources
provided the basis for the measures in the survey.
Wellbeing – NHS Health Scotland, University of Warwick and University of Edinburgh
(2006) The Short Warwick-Edinburgh Mental Wellbeing Scale. Available for non-commercial
purposes at https://warwick.ac.uk/fac/sci/med/research/platform/wemwbs/about/
Wellbeing scores were aggregates of responses to seven questions on a five-point
scale. Participants could score 735.
Life satisfaction – Office for National Statistics (2018) Surveys using our four personal
wellbeing questions. Available from
https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/methodologies/surveysusi
ngthe4officefornationalstatisticspersonalwellbeingquestions
Life satisfaction scores were from a single item scale ranging 010.
Resilience – Smith, B., Dalen, J., Wiggins, K., Tooley, E., Christopher, P and Bernard, J.,
(2008) The brief resilience scale: Assessing the ability to bounce back. International Journal
of Behavioral Medicine, 15, 194200.
Resilience scores were aggregates of responses to six questions on a five-point
response scale, where some items were reversed to ensure that a higher score
consistently indicated greater resilience. Participants could score 630.
Work performance – a single item from the World Health Organization Health and Work
Performance Questionnaire (WHO HPQ), following the example of: Shiba, K., Nishimoto,
M., Sugimoto, M. and Ishikawa, Y. (2015) The Association between Meditation Practice and
Job Performance: A Cross-Sectional Study. PLoS One, 10(12): e0145140.
Work performance scores were from a single item scale ranging 010.
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Mindfulnessfive-item scale: Osman, A., Lamis, D.A., Bagge, C.L., Freedenthal, S. and
Barnes, S. (2015) The Mindful Attention Awareness Scale: Further Examination of
Dimensionality, Reliability, and Concurrent Validity Estimates. Journal of Personality
Assessment, 98(2), 189199.
Mindfulness scores were aggregates of responses to five questions on a five-point
response scale. Participants could score 525.
Presenteeism, leaveism, restricted duties – custom questions for this study
Yes/no questions.
Job control – questions adapted from: Department for Business, Innovation and Skills
(2011) Workplace Employment Relations Study (WERS). Available from
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_da
ta/file/34814/11-804-wers6-workplace-study-2011-survey-of-employees.pdf
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Appendix 3: Baseline survey
Mindfulness training
1. Mindfulness training information and consent
Thank you for your interest in the mindfulness training. If you take part, you will help
us understand what can improve and support the wellbeing of officers and staff
nationally.
About the training
1. This training is being organised and run by your police force and the College of
Policing. People who apply will either be given free access to online mindfulness
training, or be put on a waiting list for the training. You can use the training as
much as you like, and you can stop any time you want. Nobody in your force will
know how much you have accessed the course. Everyone will use it differently,
however you may find 10-20 minutes a day of mindfulness practice to be useful,
over 8 weeks.
2. To help us evaluate whether the training has been successful, we will ask you
some questions about wellbeing, resilience and performance now, 10 weeks after
the start of the training period (whether you have been given access to the training
or placed on the waiting list) and 6 months after. Each time we ask you questions,
the questionnaire will take no more than 10 minutes to complete.
How we will use your information
The College of Policing cares about your privacy and any data you supply will be held
securely and managed appropriately. Please read the points below carefully to
understand what information we will request if you choose to take part.
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1. By applying, you consent for selected personal data (age, gender, officer/staff
status, rank or equivalent standing, sick leave information) to be gathered from
your HR records and used alongside your survey responses in the evaluation of
the training in an anonymised form. We will use this information in statistical
analysis to help us understand whether the effectiveness of the training is
influenced by any of these characteristics. Your name will not be used in the
analysis, nobody at your force will see your individual survey responses and no
information that could identify you will ever be made public.
2. To validate your log-in to the mindfulness resources, we will need to pass your
email address to the website administrator. By applying, you consent for us to
pass your email address for this reason, and also consent for us to collect usage
data. Usage data will help us understand whether the success of the training
depends on how much people use the online content. How much each individual
has used the content will never be made public or reported back to your force.
3. The College of Policing will hold your data securely. We may recruit an external
evaluator to process the data once the training is complete. They would receive
your anonymised survey responses, HR details and usage statistics for the
purpose of the evaluation only they will never know your name, or who took part.
An evaluator will only be appointed if they conform to our strict security and data
handling requirements. If you would like to find out more about these, please email
Helen.Fitzhugh@college.pnn.police.uk
4. The College carried out a Privacy Impact Assessment and each force reviewed it
before taking part. This document can be made available to you by contacting
Helen.Fitzhugh@college.pnn.police.uk
5. We will keep your email address for a year after the final report for the project has
been published. After that time, your email addresses will be deleted from our
files, but the anonymised data may be retained for further research. The status of
this anonymised data will be reviewed annually.
6. You can withdraw your consent and opt out of the training at any time by
contacting Helen.Fitzhugh@college.pnn.police.uk Your personal data will no
longer be used in the analysis and will be deleted.
7. For more information about your rights please see our full privacy notice on our
website, which can be found on the legal page of our website. You can also
contact our Data Protection Officer by emailing:
Data.Protection@college.pnn.police.uk
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The College of Policing will publish a report on the results of the trial and the results
may also be reported in academic papers.
If you consent to your information being processed in this way, please select the 'yes'
option below and click next to answer the remaining application questions.
Do you consent to your information being processed as described above?
Yes
Page 3
No
Page 2
2. Thank you for your interest
Thank you for your interest in the mindfulness resources.
We're sorry you will not be taking part.
The mindfulness resources are currently only available as part of the research trial.
We cannot make them available to non-participants, until we have tested their
effectiveness via our research study.
There may be further opportunities in the future to access the resources, once we
know how effective they are.
If you have any queries, please contact wellbeingresearch@college.pnn.police.uk
3. Unique research code
When you received our email with the link to this survey, in the same email you will
also have been sent a unique research ID code. This is a five-digit number. Using this
code means we will not have to ask you to enter your email address, name or contact
details here on the survey website alongside your answers to wellbeing, resilience
and performance questions. Please take extra care to make sure you are entering
your code correctly.
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4. Checking eligibility
Are you currently doing any type of structured mindfulness course (eg, Headspace or
an in-person course)?
No
Next
question
Yes
Page 5
Are you currently receiving talking therapy (eg, Cognitive Behavioural Therapy or
counselling)? We are asking this because people who are receiving talking therapy
should finish their course of therapy before beginning mindfulness training.
No
Page 7
Yes
Page 6
5. Sorry you are not eligible at this time
Thank you for your interest in the mindfulness resources we will be trialling.
We're sorry, but we can't accept your application to take part at this time.
We are conducting a research trial to test whether two different mindfulness
resources (Headspace and Mindfit Cop) can improve people's wellbeing, resilience
and perception of their own job performance.
To keep the test fair, we can't accept people into the trial who are currently using
Headspace already or are actively in the process of following a different online/in-
person course, as this would confuse the results. We're sorry this means you are not
currently eligible, but there may be further opportunities in the future to access the
resources, once we know how effective they are.
If you have any queries, please contact wellbeingresearch@college.pnn.police.uk
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6. Sorry you are not eligible at this time
Thank you for your interest in the mindfulness resources we will be trialling.
We're sorry, but we can't accept your application to take part at this time.
We are conducting a research trial to test whether two different mindfulness
resources (Headspace and Mindfit Cop) can improve people's wellbeing, resilience
and perception of their own job performance.
We have been advised that it would benefit anyone currently following a course of
counselling or other therapeutic support to continue with that treatment and complete
it, before embarking on training in mindfulness. This means that unfortunately, we
cannot accept your application at this time, but there may be opportunities to access
these mindfulness resources in the future, once we know how effective they are.
If you have any queries, please contact wellbeingresearch@college.pnn.police.uk
7. Questions
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never
Rarely
Sometimes
Often Always
I’ve been feeling useful
I’ve been feeling optimistic about the future
I’ve been able to make up my own mind about
things
I’ve been dealing with problems well
I’ve
been feeling close to people
I’ve been thinking clearly
I’ve been feeling relaxed
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Overall, how satisfied are you with your life nowadays?
0
Not
at all
satisfied
1 2 3 4 5 6 7 8 9
10
completely
satisfied
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never Rarely
Sometimes
Often Always
It seems I am
running on automatic, without
much
awareness of what I’m doing
It has been hard for me to snap back when
something bad happens
I’ve had a hard time making it through stressful
events
I do jobs or tasks automatically, without
being
aware of what I'm doing
I rush through activities without being really
attentive to them
I get so focused on the goal I want to achieve that
I lose touch with what I’m doing right now to get
there
I’ve come through difficult times with little trouble
I’ve tended to take a long time to get over
setbacks
It has not taken me long to recover from stressful
events
I’ve tended to bounce back quickly after hard times
I find myself doing things without paying attention
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8. Questions II
How much control would you say you have over the following parts of your work?
None A little Some A lot
The order in which you do tasks
The pace at which you work
The time you start or finish your working day
How you do your work
The tasks you do
On a scale of 0 to 10, where 0 is the worst job performance anyone could have at your
job and 10 is the performance of a top worker, how would you rate your overall
performance on the days you worked during the past 2 weeks?
0 1 2 3 4 5 6 7 8 9 10
Over the last six months have you...
Yes No
Gone to work when you were sick?
Taken annual leave instead of calling in sick?
Gone on restricted duties for any reason?
9. What happens next?
Thank you for completing the questionnaire.
Our application window is still open, so please encourage any of your colleagues who
may be interested to apply!
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What happens next?
Once the application window closes, the College of Policing will send you an email
on, or in the five working days following, 20th September 2018. This will let you know
whether you have been given free access to online mindfulness training, or been put
on a waiting list for the training. The email will let you know how to gain access to the
resources assigned to you.
Please bear with us if you don't get your email on 20th September, but someone else
in your force or office does. We will be operating a staggered start so that the online
resources are not placed under too much stress by many people logging in at the
same time. Be reassured that if you completed this questionnaire, you will be
receiving an email from us.
Thanks again for taking part we hope you find it worthwhile!
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Appendix 4: 10-week survey
Mindfulness training II
1. Mindfulness training information and consent
Thank you for taking part in the research trial to assess the effectiveness of
mindfulness training resources.
This short questionnaire is for all participants including those who have used
Mindfit Cop a lot, a little or not at all. Everyone's responses are important because
they will help us determine what works with regard to improving wellbeing in policing.
At the end of the questionnaire you will be given the chance to comment on the
experience of taking part in the research trial.
If you would like to review the privacy notice for trial participation again, it was
included in the email that arrived containing this link. The privacy notice sets out how
your data will be used and your rights with regard to withdrawal from the trial. If you
have any queries after consulting the privacy notice, please contact
wellbeingresearch@college.pnn.police.uk and we will be happy to help.
Please click below to start the questionnaire.
2. Unique research code
When you received our email with the link to this survey, in the same email you will
also have been sent a unique research ID code. This is a five-digit number. Please
enter your code here. Please take extra care to make sure you are entering your code
correctly.
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3. Questions
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never
Rarely
Sometimes
Often Always
I’ve been thinking clearly
I’ve been able to make up my own mind about
things
I’ve been dealing with problems well
I’ve been feeling useful
I’ve been feeling close to people
I’ve been
feeling optimistic about the future
I’ve been feeling relaxed
Overall, how satisfied are you with your life nowadays?
0
Not
at all
satisfied
1 2 3 4 5 6 7 8 9
10
completely
satisfied
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never
Rarely
Sometimes
Often Always
I’ve come through difficult times with little trouble
I find myself doing
things without paying attention
I do jobs or tasks automatically, without being
aware of what I'm doing
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Never
Rarely
Sometimes
Often Always
I get so focused on the goal I want to achieve that
I lose touch with what I’m doing right now to get
there
It has been hard for me to snap back when
something bad happens
It seems I am
running on automatic”, without
much awareness of what I’m doing
I rush through activities without being really
attentive to them
I’ve had a hard time making it through stressful
events
I’ve tended to take a long time to get over
setbacks
I’ve tended to bounce back quickly after hard times
It has not taken me long to recover from stressful
events
4. Questions II
How much control would you say you have over the following parts of your work?
None A little Some A lot
The time you start or finish your working day
The order in which you do tasks
The pace at which you work
The tasks you do
How you do your work
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On a scale of 0 to 10, where 0 is the worst job performance anyone could have at your
job and 10 is the performance of a top worker, how would you rate your overall
performance on the days you worked during the past 2 weeks?
0 1 2 3 4 5 6 7 8 9 10
5. How did it go?
Overall, how easy was it for you to:
0
not at all
easy
1
not very
easy 2 easy 3 very
easy
Find the time to start using Mindfit Cop?
Continue using Mindfit Cop regularly?
Thinking about design and usability, how easy was it for you to:
0
not at all
easy
1
not very
easy 2 easy 3 very
easy
Log in to use Mindfit Cop
Find out what to do next once inside the
course
View videos and graphics
Access it via work computer
Access it via your work phone
Access it via your home computer
Access it via your personal mobile phone
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How relevant was the content for you?
0 – Not at all relevant 1 – Not very relevant 2 Relevant 3 – Very relevant
To what extent do you agree or disagree with the following statements:
Strongly
Disagree
Disagree
Neutral Agree Strongly
Agree
I would recommend Mindfit Cop to a
colleague
It would be useful for more police officers
and staff to use Mindfit Cop
6. Comments welcome
Do you have any other comments about your experience of using Mindfit Cop? Feel
free to comment on any aspect of your involvement positive or negative whether
you used the resource a lot, a little or not at all. We’re interested in hearing the full
range of people’s experiences.
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We will also be carrying out some short telephone interviews for this research. We
will email volunteers to be interviewed in January 2019, to arrange a mutually
convenient time for the telephone call. If you would be willing to take part in a short
telephone interview about your experiences, please select 'yes'.
Yes
No
8. What happens next?
Thank you for completing the questionnaire.
By doing so, you are helping to build the evidence base on what works to improve the
wellbeing of your colleagues in policing.
What happens next?
At the start of March 2019 the College of Policing will send you a final, short survey.
This will let us check whether, six months after our participants were given access to
mindfulness resources, there has been any long-term effect on wellbeing.
In the meanwhile, we will work on analysing the initial data collected for this research
trial. We will look for indications of whether the mindfulness resources have proven
effective in raising wellbeing, resilience and performance in the short-term.
The report for the first phase will be completed by the end of March 2019, with further
analysis of the 6-month survey data taking place in the summer of 2019.
Once we have finalised our research reports, we will email and let people know the
results of the trial.
A big thank you again for taking part we hope you enjoyed using Mindfit Cop!
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Appendix 5: 24-week survey
Mindfulness training – final survey
1. Mindfulness training information and consent
Thank you for taking part in the research trial to assess the effectiveness of
mindfulness training resources. This is the final survey.
Please help us complete our research by responding to this survey.
It doesn't matter if you have used Mindfit Cop a lot, a little or not at all. Everyone's
responses are important because they will help us determine what works with regard
to improving wellbeing in policing.
At the end of the questionnaire you will be given the chance to comment on the
experience of taking part in the research trial.
If you would like to review the privacy notice for trial participation again, it was
included in the email that arrived containing this link. The privacy notice sets out how
your data will be used and your rights with regard to withdrawal from the trial. If you
have any queries after consulting the privacy notice, please contact
wellbeingresearch@college.pnn.police.uk and we will be happy to help.
Please click below to start …
2. Unique research code
When you received our email with the link to this survey, in the same email you will
also have been sent a unique research ID code. This is a five-digit number. Please
enter your code here. Please take extra care to make sure you are entering your code
correctly.
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3. Questions
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never
Rarely
Sometimes
Often Always
I’ve been thinking clearly
I’ve been feeling optimistic about the future
I’ve been feeling relaxed
I’ve been feeling close to people
I’ve been dealing with problems well
I’ve been able to make up my own mind about
things
I’ve been
feeling useful
Overall, how satisfied are you with your life nowadays?
0
Not
at all
satisfied
1 2 3 4 5 6 7 8 9
10
completely
satisfied
Over the last 2 weeks, how often would you say the following statements have been
true about you?
Never
Rarely
Sometimes
Often Always
I’ve come through difficult times with little trouble
I’ve tended to bounce back quickly after hard times
It has not
taken me long to recover from stressful
events
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Never
Rarely
Sometimes
Often Always
I’ve tended to take a long time to get over
setbacks
It has been hard for me to snap back when
something bad happens
I’ve had a hard time making
it through stressful
events
On a scale of 0 to 10, where 0 is the worst job performance anyone could have at your
job and 10 is the performance of a top worker, how would you rate your overall
performance on the days you worked during the past 2 weeks?
0 1 2 3 4 5 6 7 8 9 10
4. Questions II
Over the past 6 months have you…
Yes No
gone to work when you were sick?
taken annual leave instead of calling in sick?
gone on restricted duties for any reason?
Over the last month, how often have you practised mindfulness...
Never A few times
per month
A few times
per week
Daily or more
than daily
at work?
outside of work?
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(For participants in South Wales only) Are you currently involved in the MoveMore
physical activity challenge?
Yes
No
Don't know
N/A (not from South Wales)
5. Comments welcome
Do you have any other comments about your experience of using Mindfit Cop? Feel
free to comment on any aspect of your involvement positive or negative whether
you used the resource a lot, a little or not at all. We’re interested in hearing the full
range of people’s experiences.
6. What happens next?
Thank you for completing the questionnaire.
Your trial access to Mindfit Cop will expire this month.
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We will take a little time to analyse and review the evidence collected during the trial,
during which time the website will be closed and reviewed.
The report for the first phase will be completed by the end of March 2019, with further
analysis of the 6-month survey data taking place in the summer of 2019.
Once we have finalised our research, we will circulate our reports to decision-makers
within the College. They will use the evaluation evidence to decide whether to
recommend or make available any mindfulness resources to Policing in the future.
We will let people know the results of the trial once these decisions have been made.
Your contribution has helped us build the evidence base for what works to increase
wellbeing in Policing.
A big thank you again for taking part we hope you enjoyed using Mindfit Cop!
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Appendix 6: Interview questions
Mindfulness RCT 2018/19 Qualitative interview schedule
Please use the relevant questions:
Group 1 Participant consented to participate in trial but did not access resource [15 mins]
Group 2 Participant used the resource for less than 30 mins [1520 mins]
Group 3 Participant used the resource for between 30 mins and 2 hours [2030 mins]
Group 4 Participant used the resource for more than 2 hours [2030 mins]
Text in square brackets [ ] indicates a note to the interviewer where there is an opportunity to
customise the question to the participant’s situation (eg, if they used Headspace, say
Headspace) or where the interviewer may follow different routes of questioning depending
on the participant’s answers.
Preamble
Thank you for speaking with me today. On behalf of the wellbeing research team at the
College of Policing, I would like to ask you a few questions about your experience of being
part of the mindfulness trial. Your feedback will inform our evaluation.
Our discussion will take around [15/20 – 30 minutes] is that ok with you?
I would like to record the conversation to allow analysis and the selection of anonymised
quotes for the evaluation report. The recording will not be shared beyond the College
wellbeing research team and will be destroyed once the evaluation report has been
published. The anonymised written transcript will remain in College of Policing records of this
project are you happy to be recorded for this purpose?
[If yes…] Thank you I’ll turn on the recorder now and I’ll briefly ask you to state your
agreement again, so that we have a record of your consent to take part.
[turn on recorder]
[Date/time]
Are you happy to provide feedback on your experience of participating in the mindfulness
online resource trial, for the purpose of the College of Policing’s evaluation of
mindfulness in Policing?
Are you happy for our discussion to be recorded for this purpose?
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Can we use anonymised quotes from the recording in our evaluation report and any
related academic papers?
You can withdraw from the trial at any time by emailing Helen Fitzhugh, whose details were
provided via email. Anonymised quotes cannot be withdrawn after the publication of the
evaluation report at the end of March 2019. If you have any questions, please do not
hesitate to ask.
Relevant for
group
Semi-structured interview framework
(please feel free to probe and prompt to gain high quality qualitative
feedback in the framework areas)
1 2 3 4 INDIVIDUAL CONTEXT
Before we start the main questions, please could you sum up for me your
role [eg, officer/staff in a particular team]?
1 2 3 4 INITIAL EXPECTATIONS
What were your expectations when you applied to learn more about
mindfulness in September 2018?
1 NON-USE – REASONS
To what extent did you use [Headspace/Mindfit Cop]?
[If not at all….]
Please tell me why this was…
[Please check for and note:
Technical issues (with registering, getting on to the site?)
Expected face to face not online course?
Workload/time issues
Working environment/colleague support issues
Anything else unanticipated?]
[If they say they did use it…]
Please could you tell me a little about how you used it?
[transfer to group 2 questions now if they used resource a little]
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1 NON-USE – SCOPE FOR IMPROVEMENT?
What would have to change for you to want to or feel able to use
[Headspace/Mindfit Cop]?
1 OTHER MEANS?
Are you still interested in learning about mindfulness?
(For instance if training was offered in a different way)?
2 3 4 ENVIRONMENT AND TIME MANAGEMENT
Where and when did you tend to access [Mindfit Cop/Headspace]?
[Please check for and note:
Workload/time issues
Working environment/colleague support issues
Anything else unanticipated?]
2 3 4 TECHNICAL ISSUES
How did you find accessing and using the app/website for [Mindfit Cop/
Headspace]?
Was it easy/difficult? Why?
2 3 4 IMPRESSION
What was your overall impression of [Mindfit Cop/Headspace]?
What did you like about it? What didn’t you like about it?
2 3 4 LEARNING
Do you feel you learnt anything from using [Headspace/Mindfit Cop]?
(2) 3 4 BEHAVIOURAL CHANGE
Have you made any changes to your everyday working life as a result of
the trial?
What about outside of work?
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(2) 3 4 IMPACT
Overall, what impact would you say learning about mindfulness has had
on you?
[Please check for and note:
Wellbeing/resilience
Performance at work
Other unanticipated?]
(2) 3 4 SUSTAINABILITY:
Do you have any plans to practise mindfulness after the trial?
Is there anything that could help you to continue practising? What might
stop you from practising?
2 3 4 RECOMMENDATION:
Would you recommend [Headspace/Mindfit Cop] to others in Policing?
Thank you.
Those were all of my questions. Did you have any additional comments or questions?
We will continue to discuss the mindfulness resources with colleagues across the
participating forces and prepare an interim report based on the feedback.
[If they have been using the resource] Please feel free to continue using [Headspace/Mindfit
Cop] until the end of February 2019.
We will send out a final survey as part of the trial at the start of March 2019. Please take part
in this as it will allow us to gain a longer-term picture of whether learning about mindfulness
is useful in Policing.
Thank you for your time.
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Appendix 7: Analysis details
Selected further details from the University of East Anglia
analysis report
To evaluate the effect of the mindfulness interventions, we used a series of regressions to
examine whether the allocation group influenced the primary (wellbeing, performance, life
satisfaction and resilience) and secondary (absenteeism, presenteeism, restricted duties (all
week 24) and mindfulness (week 10)) outcomes. For these tests, we used the raw scores
and controlled for the baseline measurement that was taken before the intervention.
Although mindfulness was not measured in the week 24 survey, so we could not test it as an
outcome, we did include the baseline mindfulness score as a control variable. This way we
account for any potential individual differences in mindfulness that may have existed
between participants at the beginning of the study.
For all the outcomes except absenteeism, we removed all cases with missing values. The
exact sample used in each model is reported in the tables.
To evaluate whether there are any differences between the participating forces and the
different generations in our sample, we tested their effects on each of the outcome variables
both as part of the overall models and on their own. For three generations (Baby Boomers,
Generation X and Generation Y), we used regressions with dummy variables specified as
fixed effects. There were no significant effects for any of the outcome variables.
For the five participating forces, we used a slightly different approach and tested regressions
with a random intercept in order to model variation between the five forces. This approach is
more effective when there are multiple groups as it requires fewer degrees of freedom, but
more importantly has the implication that the five forces are not a finite set of categories (as
gender or generation are) but rather a sample of forces out of a larger population of possible
forces. As such, this allows generalising beyond the five participating forces to the
population of possible forces that they represent. Using this approach, we calculated the
intraclass correlation coefficient of each of the outcome measures, which approximates the
variance explained by taking into account the forces. The results showed that only a very
small fraction of the total variance can be attributed to the participants working in one force
rather than another. These estimates ranged from almost 0 for life satisfaction to 0.79 per
cent for wellbeing.
Given these results, it was decided to exclude these two variables from any further analysis.
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Overall, for the primary outcomes the model’s predictors explained 30 per cent of the
variance of wellbeing, 22 per cent of job performance, 33 per cent for life satisfaction and 28
per cent for resilience (see Appendix 8 for the model). More importantly though, group
allocation had a significant effect on all the outcomes tested. Specifically, individuals
allocated to either Headspace or Mindfit Cop were significantly improved for all the
outcomes. Compared to the week 10 survey these results are consistent for Headspace and
show a further improvement for Mindfit Cop.
In terms of the secondary outcomes, we evaluated mindfulness (week 10 only), absence
days, absence spells, presenteeism, leaveism, and going on restricted duties.
The variables used explained 28 per cent of the variance of mindfulness.
Absence days and spells are count variables, and as such we used negative binomial
regressions. Presenteeism, leaveism and restricted duties are measured as binary variables
(the responses are either Yes or No) and therefore we used logistic regressions. Overall, we
found significant relationships between group allocation and presenteeism and did not find
any other evidence for similar relationships for the other secondary outcomes. It should be
noted that absence data are based on organisational records rather than self-report
measured, and as such we have a complete account of the number of absence days and
spells for each participant. However, not all participants who are allocated in the Headspace
or Mindfit Cop conditions engaged with the intervention. As such, for the absence models,
we excluded (out of the whole sample) participants who did not engage at all with the app
provided by Headspace or Mindfit Cop. This resulted in a final sample of 875 participants.
Direct, indirect and total effects
As an additional step, we evaluated if the effect of group allocation on each of the primary
outcomes was indeed through an indirect influence on mindfulness awareness. To do this
we refitted the week 24 models for wellbeing, life satisfaction, job performance and resilience
by using the week 10 post-intervention mindfulness awareness as an additional predictor.
We also fitted an additional model using the week 10 post-intervention mindfulness
awareness as an outcome. For all of these models we removed cases with missing values,
which reduced our sample to 450 participants who completed all three surveys.
Consequently, there are some small discrepancies between the results in this section and
the rest of the report. The detailed results of these additional regression analyses are not
included in this report but can be provided upon request.
We evaluated if the indirect paths are indeed significant by bootstrapping the regression
models for 10,000 simulation samples. Table 4 below shows the bootstrapped confidence
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intervals for the indirect, direct and total mediation effects. Overall, the results suggest that
there are significant indirect effects for the Headspace group through mindfulness. However,
the equivalent indirect effect for Mindfit Cop was not significant for any of the outcomes.
Considering that the residual direct effect is still significant for a number of relationships for
both Headspace and Mindfit Cop, the most likely explanation of this is that mindfulness
training has positive effects other than the intended increases in mindfulness awareness. For
instance, the training could have helped participants with sleep problems even if it did not
influence their mindfulness. A second possible explanation of these results is that the
measure used to operationalise mindfulness does not fully capture what has been achieved
through the mindfulness training.
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Table 4: Indirect effects of mindfulness training through mindful awareness
Indirect effect
Direct effect
Total effect
Effect
SD
2.5%
CI
97.5%
CI
Effect
SD
2.5%
CI
97.5%
CI
Effect
SD
2.5%
CI
97.5%
CI
Headspace ->
mindfulness -> wellbeing
1.94
0.53
0.99
3.05
4.16
1.6
1.06
7.36
6.1
1.73
2.73
9.53
Mindfit Cop ->
mindfulness -> wellbeing
0.72
0.57
-0.33
1.91
4.26
2.01
0.33
8.27
4.98
2.02
1.09
8.99
Headspace ->
mindfulness ->
job performance
0.57
0.18
0.26
0.95
1.16
0.54
0.08
2.24
1.73
0.58
0.59
2.83
Mindfit Cop ->
mindfulness ->
job performance
0.2
0.17
-0.11
0.56
1.48
0.7
0.07
2.84
1.68
0.69
0.31
3.04
Headspace ->
mindfulness ->
life satisfaction
0.79
0.22
0.4
1.25
1.25
0.64
-0.03
2.5
2.04
0.66
0.73
3.33
Mindfit Cop ->
mindfulness ->
life satisfaction
0.29
0.23
-0.14
0.77
1.45
0.81
-0.13
3.01
1.74
0.8
0.17
3.3
Headspace ->
mindfulness ->
resilience
0.3
0.08
0.15
0.46
0.73
0.27
0.21
1.27
1.03
0.28
0.48
1.59
Mindfit Cop ->
mindfulness ->
resilience
0.11
0.09
-0.05
0.29
0.5
0.33
-0.14
1.13
0.61
0.34
-0.04
1.27
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Appendix 8: Regression models
Table 5: Regression results for primary outcomes (week 24)
Wellbeing
Life satisfaction
Job performance
Resilience
B
SE
B
SE
B
SE
B
SE
Intercept
7.93
1.22
***
2.35
0.45
***
3.09
0.46
***
1.38
0.19
***
Gender (male)
0.08
0.34
-0.05
0.13
-0.15
0.13
-0.09
0.06
Role (other)
0.22
1.19
-0.33
0.47
-0.40
0.49
-0.10
0.19
Role (senior officer)
-0.39
0.75
0.18
0.30
0.36
0.29
0.05
0.12
Role (staff)
0.25
0.34
0.03
0.14
0.31
0.13
*
-0.04
0.06
Allocation (headspace)
6.36
1.45
***
2.16
0.57
***
1.57
0.56
**
0.99
0.24
***
Allocation (mindfit cop)
5.10
1.69
**
1.89
0.66
**
1.89
0.65
**
0.69
0.27
*
Job control (pre-intervention)
0.94
0.33
**
0.24
0.13
0.19
0.13
0.11
0.05
*
Job control * Headspace
-1.48
0.50
**
-0.49
0.20
*
-0.31
0.20
-0.25
0.08
**
Job control * Mindfit Cop
-1.33
0.57
*
-0.52
0.22
*
-0.49
0.22
*
-0.17
0.09
Mindfulness (pre-intervention)
0.11
0.28
0.04
0.10
0.10
0.11
-0.01
0.04
Wellbeing (pre-intervention)
0.51
0.04
***
Performance (pre-intervention)
0.39
0.04
***
Life satisfaction (pre-intervention)
0.51
0.03
***
Resilience (pre-intervention)
0.51
0.04
***
R
2
0.30
0.33
0.22
0.28
N
584
581
576
578
RMSE
3.64
1.42
1.41
0.59
*** p < 0.001, ** p < 0.01, * p < 0.05
Note: RMSE = root mean square error
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Table 6: Regression results for mindfulness (week 10 only)
Mindfulness
B
SE
Intercept
1.13
0.16
***
Gender (male)
0.05
0.05
Role (other)
-0.01
0.16
Role (senior officer)
0.08
0.10
Role (staff)
0.12
0.05
*
Allocation (Headspace)
0.96
0.20
***
Allocation (Mindfit Cop)
0.32
0.23
Job control (pre-intervention)
0.12
0.04
**
Job control * Headspace
-0.25
0.07
***
Job control * Mindfit Cop
-0.09
0.08
Mindfulness (pre-intervention)
0.49
0.04
***
Wellbeing (pre-intervention)
Performance (pre-intervention)
Life satisfaction (pre-intervention)
Resilience (pre-intervention)
R
2
0.28
N
688
RMSE
0.54
*** p < 0.001, ** p < 0.01, * p < 0.05
Note: RMSE = root mean square error
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Table 7: Regression results for secondary outcomes (week 24)
Absence days
Absence spells
Presenteeism
Leaveism
Restricted duties
Intercept
2.95
0.58
***
0.02
0.32
2.21
0.86
*
-0.67
0.94
0.01
0.94
Gender (male)
-0.34
0.18
-0.46
0.11
***
-0.26
0.23
0.07
0.29
-0.18
0.29
Role (other)
0.29
0.67
0.55
0.3
0.64
1.1
-0.74
0.95
-0.23
0.87
Role (senior officer)
-0.67
0.38
-0.36
0.26
-1.27
0.46
**
-0.57
0.67
-0.46
0.58
Role (staff)
-0.21
0.18
0.06
0.1
-0.61
0.23
**
-0.08
0.29
-1.08
0.29
***
Allocation (Headspace)
-0.11
0.79
0.17
0.41
-2.98
0.99
**
-2.52
1.22
*
-1.01
1.24
Allocation (Mindfit Cop)
-1.02
0.81
-0.67
0.44
-3.71
1.12
***
-2.98
1.54
-1.6
1.36
Job control (pre-intervention)
-0.15
0.17
-0.21
0.09
*
-0.64
0.23
**
-0.5
0.26
-0.62
0.29
*
Job control * Headspace
0.04
0.27
-0.08
0.15
0.86
0.33
**
0.72
0.42
0.35
0.46
Job control * Mindfit Cop
0.3
0.28
0.22
0.15
1.15
0.37
**
0.92
0.52
0.73
0.48
Mindfulness (pre-intervention)
-0.34
0.14
*
0.02
0.08
0.09
0.17
-0.07
0.23
0.03
0.22
Absence days
(pre-intervention)
0.03
0.01
***
Absence spells (pre-intervention)
0.31
0.04
***
Presenteeism (pre-intervention)
1.54
0.22
***
Leaveism (pre-intervention)
2.74
0.27
**
*
Restricted duties (pre-intervention)
1.78
0.29
***
AIC
3529.48
1788.65
643.1
422.09
427.99
BIC
3591.54
1850.72
695.41
474.34
480.18
Log likelihood
-1751.74
-881.33
-309.55
-199.05
-201.99
Deviance
721.75
872.81
619.1
398.09
403.99
N
875
875
578
575
572
*** p < 0.001, ** p < 0.01, * p < 0.05
Note: AIC = Akaike information criteria and BIC = Bayesian information criteria
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Appendix 9: Qualitative analysis
The interview data were analysed using the framework approach. This analysis was carried
out in Microsoft Excel over multiple spreadsheets.
The framework approach is a formalised type of thematic analysis that was developed
around 30 years ago at the National Centre for Social Research as a means of carrying out
social policy research, but it has since spread to other areas of qualitative research that
require sensitivity to both themes and case context (Gale et al, 2013; Bryman, 2012). The
key feature of this type of analysis is the production of grids or spreadsheets where each cell
both stores and indexes a short data description and/or verbatim quote by theme and
interviewee (Gale et al, 2013; Bryman, 2012). By building up sets of grids, the researcher is
able to ask direct and specific research questions of the data (eg, what were the barriers and
enablers to take-up?), keep an audit trail of the quotes they used to answer the questions
and also retain a sense of where each quote came from (eg, an interviewee who was
female, a police officer, had used Headspace and had spent over two hours on the app).
The grids employed for this framework analysis were as follows:
reasons for using the online resources
barriers and enablers
learning
behavioural change
impact
future intentions
other (miscellaneous themes arising multiple times but not coded for elsewhere
clarifications over methods and times of usage and aesthetic responses to the online
resources).
The inclusion of themes in the report was not based purely on the number of interview
responses that could be used to justify the theme, but also on importance and relevance for
policy in future. Themes were based on common points of response from between 4 and 19
respondents (average 9) out of the pool of 29 respondents overall.
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
Stress and stress‐related mental health problems are major causes of illness and disability. Mindfulness‐based stress reduction (‘MBSR’) is a group‐based health promotion intervention to improve health and the way people deal with stress and life?s challenges. The core ingredient is mindfulness training through physical and mental exercises practiced daily for eight weeks. The mindful non‐judgmental attitude of being present with what arises is practiced in the formal exercises and in everyday situations. This review assesses the effect of MBSR programs on outcome measures of mental and physical health, quality of life and social functioning in adults. MBSR has a moderately large effect on outcome measures of mental health, somatic health, and quality of life including social function at post‐intervention when compared to an inactive control. If 100 people go through the MBSR program, 21 more people will have a favourable mental health outcome compared to if they had been put on a wait‐list or gotten only the usual treatment. These results may be inflated by underreporting of negative trials and moderate heterogeneity (indicating differences between the trials). MBSR has a small but significant effect on improving mental health at post‐intervention compared to other active treatments. MBSR has the same effect as other active interventions on somatic health, and quality of life (including social function). There was no underreporting of negative trials, and heterogeneity (differences between trials) were small for mental health, moderate for quality of life and large for somatic health. The effects were similar across all target groups and were generally maintained at follow‐up (1?34 months). The effects were largely independent of gender and study sample. The effects seemed also largely independent of duration and compliance with the MBSR intervention. No studies report results regarding side‐effects or costs. Effects were strongly correlated to the effects on measures of mindfulness, indicating that the effects may be related to the increase in self‐reported mindfulness. Two thirds of the included studies showed a considerable risk of bias, which was higher among studies with inactive than active control groups. Studies of higher quality reported lower effects than studies with low quality. The overall quality of the evidence was moderate, indicating moderate confidence in the reported effect sizes. Further research may change the estimate of effect. Plain language summary Mindfulness training improves health and quality of life for adults Mindfulness‐based stress reduction (MBSR) is used to improve health, quality of life and social functioning. MBSR has a positive effect on mental health outcomes measured right after the intervention and at follow up. It also improves personal development, quality of life, and self‐reported mindfulness. What is this review about? Stress and stress‐related mental health problems are major causes of illness and disability. MBSR is a group‐based health promotion intervention to improve health and the way people deal with stress and life's challenges. The core ingredient is mindfulness training through physical and mental exercises practiced daily for eight weeks. The mindful non‐judgmental attitude of being present with what arises is practiced in the formal exercises and in everyday situations. This review assesses the effect of MBSR programs on outcome measures of mental and physical health, quality of life and social functioning in adults. What is the aim of this review? This review summarizes all studies that compare the effect of a MBSR program to a control group intervention, in which the participants had been randomly allocated to be in either the MBSR group or a control group. The review summarizes the results in two categories. First, where the effect of the MBSR program was compared to an inactive group (either a wait list group or one receiving ordinary care also received by the MBSR group). Second, where MBSR was compared with an alternative active group intervention. What studies are included? The review summarizes 101 randomized controlled trials with a total of 8,135 participants from USA, Europe, Asia and Australia. Twenty‐two trials included persons with mild or moderate psychological problems, 47 targeted people with various somatic conditions and 32 of the studies recruited people from the general population. Seventy‐two studies compared MBSR to an inactive control group, while 37 compared MBSR to an active control intervention. Seven studies compared MBSR to both. Ninety‐six studies contributed data to the meta‐analyses, with data from 7,647 participants. Is mindfulness effective? MBSR has a moderately large effect on outcome measures of mental health, somatic health, and quality of life including social function at post‐intervention when compared to an inactive control. If 100 people go through the MBSR program, 21 more people will have a favourable mental health outcome compared to if they had been put on a wait‐list or gotten only the usual treatment. These results may be inflated by underreporting of negative trials and moderate heterogeneity (indicating differences between the trials). MBSR has a small but significant effect on improving mental health at post‐intervention compared to other active treatments. MBSR has the same effect as other active interventions on somatic health, and quality of life (including social function). There was no underreporting of negative trials, and heterogeneity (differences between trials) were small for mental health, moderate for quality of life and large for somatic health. The effects were similar across all target groups and were generally maintained at follow‐up (1–34 months). The effects were largely independent of gender and study sample. The effects seemed also largely independent of duration and compliance with the MBSR intervention. No studies report results regarding side‐effects or costs. Effects were strongly correlated to the effects on measures of mindfulness, indicating that the effects may be related to the increase in self‐reported mindfulness. Two thirds of the included studies showed a considerable risk of bias, which was higher among studies with inactive than active control groups. Studies of higher quality reported lower effects than studies with low quality. The overall quality of the evidence was moderate, indicating moderate confidence in the reported effect sizes. Further research may change the estimate of effect. What do the findings of this review mean? Based on this review it is reasonable to consider MBSR a moderately well‐documented method for helping adults improve their health and cope better with the challenges and stress that life brings. New research should improve the way the trials are conducted addressing the pitfalls in research on mind‐body interventions. How up‐to‐date is this review? The review authors searched for studies up to November 2015. This Campbell Systematic Review was published in October 2017. Executive summary/Abstract Background There is an increasing focus on mind‐body interventions for relieving stress, and improving health and quality of life, accompanied by a growing body of research trying to evaluate such interventions. One of the most well‐known Programs is Mindfulness‐Based Stress Reduction (MBSR), which was developed by Kabat‐Zinn in 1979. Mindfulness is paying attention to the present moment in a non‐judgmental way. The Program is based on old contemplative traditions and involves regular meditation practice. A number of reviews and meta‐analyses have been carried out to evaluate the effects of meditation and mindfulness training, but few have adhered to the meta‐analytic protocol set out by the Cochrane Collaboration and Campbell Collaboration, or focused on MBSR only. The first edition of this review was published in 2012 with a literature search done in 2010, comprising 31 studies. As the field is rapidly developing, an update is called for. Objectives To evaluate the effect of Mindfulness‐Based Stress Reduction (MBSR) on health, quality of life and social functioning in adults. Search methods The following sources were searched, most recently in November 2015: PsycINFO (Ovid), MEDLINE (Ovid), EMBASE (Ovid), AMED (Allied and Complementary Medicine) (Ovid), CINAHL (Ebsco), Ovid Nursing Full Text Plus (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL), British Nursing Index, (ProQuest), Eric (ProQuest), ProQuest Medical Library, ProQuest Nursing & Allied Health Source, ProQuest Psychology Journals, Web of Science, SveMed+, Social Services Abstracts, Sociological Abstracts and International Bibliography of Social Sciences. Selection criteria The review included randomised controlled trials (RCTs) where the intervention followed the MBSR protocol developed by Kabat‐Zinn, allowing for variations in the length of the MBSR courses. All target groups were accepted, as were all types of control groups, and no language restrictions were imposed. Data collection and analysis Two reviewers read titles, retrieved studies, and extracted data from all included studies. Standardized mean differences (as Hedges’ g) from all study outcomes were calculated using the software Comprehensive Meta Analysis. The meta‐analyses were carried out using the Robumeta Package within the statistical program R, with a technique for handling clusters of internally correlated effect estimates. We performed separate meta‐analyses for MBSR compared to either waitlists or treatment as usual (WL/TAU – named inactive), and for MBSR compared to control groups that were offered another active intervention. Results The review identified 101 RCTs including the 31 from the first review, with a total of 8,135 participants. Twenty‐two trials included persons with mild or moderate psychological problems, 47 targeted people with various somatic conditions and 32 of the studies recruited people from the general population. Seventy‐two studies compared MBSR to a WL/TAU control group, while 37 compared MBSR to an active control intervention. Seven studies compared MBSR to both a WL/TAU condition and to an active control group. Ninety‐six studies contributed to the meta‐analyses (based on information from 7,647 participants). Two thirds of the included studies showed a considerable risk of bias, and risk of bias was higher among studies with inactive than active control groups. Post‐intervention Hedges’