# Using an implementation science framework to enhance participation in mindfulness programs for patients with chronic low back pain

> **NIH NIH R21** · KAISER FOUNDATION RESEARCH INSTITUTE · 2020 · $214,718

## Abstract

Nonpharmacologic treatments for chronic low back pain are now recommended as the first line of therapy
according to several US-based clinical guidelines. One recommended treatment is mindfulness-based stress
reduction (MBSR) because its benefits are supported by evidence of moderate quality in a recent systematic
review. MBSR has received much public and media attention, but the potential for its widespread
implementation is unknown. Learning the classic MBSR program, which has three core practices of a body
scan, mindful yoga and mindfulness meditation, makes heavy demands on patients' time. To optimize the
reach of MBSR, we need to know if it can be packaged to be attractive and feasible to patients. In this project,
we directly evaluate MBSR optimization using the domain of Intervention Characteristics from the Consolidated
Framework for Implementation Research (CFIR) to create eight video vignettes. These vignettes will describe
versions of MBSR that differ according to characteristics such as relative advantage, adaptability and
complexity. We will conduct a 23 web-based factorial-design experiment. We will recruit 400 patients with
chronic low back pain as participants. All will view a video vignette about classic MBSR and then be
randomized to one of the eight versions of MBSR. They will view a corresponding video vignette of the new
version of MBSR (unless they have been assigned to classic MBSR). Participants will then be asked to
complete a survey developed using the Theory of Planned Behavior to collect information on the attractiveness
of the MBSR vignette(s) they observed and their own back pain history, current clinical status, and other
characteristics. We will conduct multiple regression analyses on the survey data to characterize the
subpopulation of patients who are likely to engage in classic MBSR and determine the core components that
are most important to them. Using structural equation analysis, we will also compare the differential influence
of attitudes, subjective norms, and perceived behavioral control (from the Theory of Planned Behavior) on the
likelihood of use of classic MBSR. Finally, we will use structural equation analysis to explore whether the
MBSR characteristics that we varied in the vignettes increase participants' behavioral intentions to engage in
MBSR and its core components. The product of this project will be actionable information regarding the
subpopulation for whom MBSR is a good fit and characteristics of the intervention that require repackaging or
reframing to optimize fit and increase its reach. Such information is foundational for optimizing the likelihood
that MBSR will be considered by patients as a viable treatment for chronic low back pain. Once these
dissemination questions are answered, we can compare classic MBSR with the modified version (based on the
results of this study) in an effectiveness-implementation hybrid study that attends to other critical domains of
the CFIR.

## Key facts

- **NIH application ID:** 9830584
- **Project number:** 5R21AT010170-02
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** KAREN J SHERMAN
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $214,718
- **Award type:** 5
- **Project period:** 2018-12-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9830584

## Citation

> US National Institutes of Health, RePORTER application 9830584, Using an implementation science framework to enhance participation in mindfulness programs for patients with chronic low back pain (5R21AT010170-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/9830584. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*