Mastering Mindfulness-Based Stress Reduction: A Science-Backed Guide for Health Professionals: Applying Research and Real-World Strategies for Mindfulness-Based Interventions

Chapter 1:

Introduction to the Study

Introduction

Breast cancer poses a significant health concern in Texas, emerging as the second leading cause of cancer-related deaths among women (Texas Health & Human Services Commission, 2024). From 2015 to 2019, the incidence rate of invasive or malignant breast cancer in Texas was reported at 116.9 cases per 100,000 women (Texas Department of State Health Services, 2022). The mortality rate among breast cancer patients was approximately 19.8 deaths per 100,000 women since 2015 (Texas Department of State Health Services, 2022). Projections for 2022 estimated 19,921 new cases, with 3,415 patients expected to die from it. These statistics raise concerns about a potential increase in fatalities (Texas Department of State Health Services, 2023).

The Gulf Coast region, particularly Houston, has experienced significant population growth, highlighting the need for targeted health interventions (Texas Comptroller, 2022). These statistics underscore the necessity of examining the intentions of female breast cancer patients in the Gulf Coast region to attend a mindfulness-based stress reduction (MBSR) program. Addressing the rising prevalence of breast cancer in this region is imperative, given its substantial contribution to cancer-related mortality among women. In this quantitative survey study, I used a convenience sampling method among female breast cancer patients living in the Gulf Coast region of Texas to predict their intentions to attend an MBSR program. Studies have shown the efficacy of MBSR therapy, delivered via video conferencing/in-person, in managing stress among various populations, including individuals affected by diseases like breast cancer (Bui et al., 2020).

I examined aspects of the theory of planned behavior (TPB) to provide evidence on whether there is a committed relationship between those variables (attitude, subjective norms, and perceived behavioral control). The study offers valuable insights on how health educators and health professionals can increase awareness to foster a positive and significant result among the patients’ subjective norms (among family, friends, and significant others) and their perceived behavioral control (offering help in making them feel that they will be successful in the program, such as providing practical support like free computer classes for telehealth options and incentives like gift cards, transportation assistance, and lunch coverage for in-person sessions). The benefits of MBSR techniques, such as hatha yoga and other mindfulness-based practices, establish the value of incorporating mindful activities into daily routines and promoting intentionality (Gilchrist et al., 2024; Moulton-Perkins et al., 2020;).

Prominent figures like Langer (2000), the developer of mindfulness, have emphasized the importance of mindfulness in overcoming self-imposed limitations and managing distress. When individuals learn to manage their stress effectively, they can prevent mortality and morbidity (Langer, 2000). Langer also suggested that individuals who are mindful are more open to learning new ways of addressing challenges and accepting them. Dempsey (2020) highlighted numerous mindfulness strategies to manage stress, noting the body’s ability to adapt and the significance of reducing the negative effects of stressors to enhance resilience. According to Werdani (2022), cancer is a serious stressor that can cause distress (p. 1).

Despite the proven benefits of MBSR interventions, there has been a lack of assessment regarding breast cancer patients’ intentions to attend such interventions through telehealth or in-person sessions. I aimed to address this gap by examining female breast cancer patients living in Texas and their intentions to attend or not attend an MBSR program. Fishbein and Ajzen (1985) stated that the TPB could be used to predict intentions by considering patients’ attitudes, subjective norms, and perceived behavioral control. I used the TPB as a framework to understand the patient’s intention to participate in MBSR interventions via telehealth or in-person classes. Furthermore, health education and promotion efforts using MBSR practices have shown effectiveness in helping breast cancer patients manage their stress effectively (Bui et al., 2020). However, the intentions of female breast cancer patients to attend an MBSR program for stress management in the state of Texas require further examination. In this chapter, I introduce the background, problem statement, and research gaps by establishing a clear connection between them. Additionally, the theoretical framework of the TPB is outlined, and the significance, assumptions, limitations, and definitions relevant to the study are discussed.

Background of the Study

There are proven benefits of using MBSR to help individuals manage their stress effectively (Langer,2000). MBSR includes techniques such as mindful eating, mindfulness Hatha yoga practices, and body scanning and relaxation techniques, which have been effective in preventing stress-related morbidity and mortality among breast cancer patients (Lai et al., 2021). The TPB is widely used to predict individuals’ intentions to attend intervention programs, which can lead to positive behavior change (Ajzen, 1985; Beyera et al.,2022). Previous research indicates that positive responses in attitude, subjective norms, and perceived behavioral control increase the likelihood of individuals following through with planned behavior changes (Ajzen, 1991).

Langer (2000) established the benefits of mindfulness, yet there is limited research using the TPB to predict breast cancer patients’ intentions to attend MBSR programs, whether in-person or via telehealth. While the literature acknowledges the importance of all three TPB constructs, I examined if there is a significant relationship between the TPB variables and the patient’s intentions to attend MBSR programs in Texas. Understanding these factors can inform the development of effective, targeted MBSR programs, which can enhance participation rates, improve psychological well-being, and reduce stress related diseases among breast cancer patients (Bui et al., 2020). Furthermore, the findings could assist health education professionals in creating evidence-based intervention strategies and foster collaboration with stakeholders to promote mindfulness-based stress reduction as a lifestyle among this population.

Problem Statement

MBSR interventions have demonstrated significant benefits in helping individuals manage stress effectively (Lai et al., 2021). Health education and promotion efforts have found MBSR practices to be effective in supporting female breast cancer patients in managing stress (Brown University, 2022), and in preventing stress-related diseases and improve wellbeing (Chu et al., 2021). However, there is limited literature where researchers have applied TPB to examine the intentions of breast cancer patients to attend in-person or telehealth MBSR programs in Texas. Breast cancer remains the most frequent cause of morbidity among all cancer occurrences (U.S. Department of Health and Human Services, 2022) and the second most common cause of cancer death among women in Texas (Texas Health & Human Services Commission, 2024). Between 2015 and 2019, Texas experienced an incidence rate of 116.9 cases of invasive or malignant breast cancer per 100,000 women (Texas Department of State Health Services, 2022). During this period, the mortality rate among breast cancer patients was approximately 19.8 deaths per 100,000 women (Texas Department of State Health Services, 2022). Projections for 2022 indicated 19,921 new cases, with an estimated 3,415 women expected to die from the disease, highlighting a concerning trend in potential fatalities (Texas Department of State Health Services, 2023).

Despite the proven benefits of MBSR and other mindfulness-based techniques (Bui et al., 2020; Moulton-Perkins et al., 2020), there is a lack of research using the TPB to understand the intentions of female breast cancer patients in Texas regarding attending an MBSR program. I aimed to address this gap by using the TPB framework to analyze survey data, providing insights that could help health educators and practitioners develop targeted interventions to improve the quality of life for breast cancer patients. Identifying factors influencing attitudes, subjective norms, and perceived behavioral control could help to inform the development of effective MBSR programs, raise awareness about the benefits of mindfulness-based stress reduction among the public, healthcare providers, and policymakers (Langer, 2023; Li et al., 2021). This increased awareness could lead to broader acceptance and use of MBSR programs in various settings (Wang et al., 2023).

Purpose of the Study

The purpose of this quantitative cross-sectional survey study was to apply the TPB framework to examine the intentions of female breast cancer patients living in Texas to attend a MBSR program and to better understand their attitudes towards the program. In addition, when individuals learn how to manage stress effectively, they become aware that their inner thoughts, self-talk, and ability to control their emotions help to prevent distress (Langer, 2000). Dempsey (2020) also stated that MBSR techniques could reduce the effects of negative stimuli that interrupt an individual’s daily thoughts by increasing their ability to resist distress. Specifically, I examined the relationship between an individual’s intention to attend a mindfulness-based stress reduction program and their attitude, subjective norms, and perceived behavioral control. When MBSR is coupled with a cheerful outlook that everything will work out for good, patients are more likely to reappraise their situation by doing what is necessary to become free from distress and to allow the body to heal itself (Huang et al., 2020). Figure 1. Below shows the theoretical framework for the study.

Research Questions and Hypotheses

RQ1: Is there a relationship between female breast cancer patients’ attitudes towards attending MBSR intervention and the patients’ intention to attend the MBSR intervention?

H01: There is no relationship between breast cancer patients’ attitudes towards attending MBSR interventions and the patients’ intention to attend an MBSR intervention.

Ha1: There is a relationship between breast cancer patients’ attitudes toward attending MBSR interventions and the patients’ intention to attend an MBSR intervention.

RQ2: Is there a relationship between female breast cancer patients’ subjective norms and the patients’ intention to attend MBSR intervention?

H02: There is no relationship between breast cancer patients’ subjective norms and the patients’ intention to attend an MBSR intervention.

Ha2: There is a relationship between breast cancer patients’ subjective norms and the patients’ intention to attend an MBSR intervention.

RQ3: Is there a relationship between female breast cancer patients perceived behavioral control and the patients’ intention to attend an MBSR intervention?

H03: There is no relationship between breast cancer patients perceived behavioral control and the patients’ intention to attend an MBSR intervention.

Ha3: There is a relationship between breast cancer patients perceived behavioral control and the patients’ intention to attend an MBSR intervention.

Theoretical Framework for the Study

Figure 1: Theoretical Framework for the Study

Note. Figure created by the author using terminology adapted from Ajzen’s (1985) From Intentions to Actions: A Theory of Planned Behavior. In J. Kuhl & J. Beckman (Eds.), Action Control: From Cognition to Behavior (pp. 11–39), Springer. https://doi.org/10.1007/978-3-642-69746-3_2

TPB is a well-validated social cognitive theory that serves as a behavioral prediction model, guiding a large majority of theory-based research (Shifter & Ajzen, 1985). The theory suggests that a patient’s behavior is determined by their intention to perform a given behavior, and this intention is influenced by three key factors: attitude, subjective norm, and perceived behavioral control (Shifter & Ajzen, 1985). Attitude refers to how positively or negatively behavior is evaluated. Subjective norms reflect the perceived social pressure individuals feel to perform or not perform a desired behavior. Perceived behavioral control refers to the perception of how easy or difficult it is to perform the behavior (Youn et al., 2021).

The TPB is an extension of the theory of reasoned action developed by Fishbein and Ajzen in 1975 (Fishbein & Ajzen, 1975). Perceived behavioral control was added to the theory in 1985 to account for factors outside the individual’s control that may affect the performance of the behavior (Ajzen, 1985; Chu et al., 2021). I aimed to examine the attitudes, subjective norms, and perceived behavioral control of female breast cancer patients regarding their intentions to attend a MBSR health education program, which teaches effective stress management strategies (see Fauer et al., 2022). I