Barriers and Facilitators to Implementing a Collaborative Mindfulness-Based Stress Reduction Pilot Program with Firefighters

Background and Purpose: Firefighters are at risk of experiencing adverse mental health outcomes related to occupational stressors and exposure to potentially traumatic events. Mindfulness-based practices may be effective at reducing distress and trauma symptomology among firefighters. However, little is known about the process of engaging firefighters in mindfulness interventions. Our aim was to qualitatively assess the barriers and facilitators of a mindfulness-based stress reduction (MBSR) pilot program conducted in collaboration with the City of Columbus Division of Fire (CFD) in Ohio to reduce distress and trauma symptoms among firefighters.

Methods: The MBSR program was developed and implemented in collaboration with members of the CFD peer support team from March – May 2023. The nine-week MBSR program consisted of daily stress monitoring and at-home breathing exercises for stress reduction using Garmin vívosmart 4 watches and weekly in-person group mindfulness sessions led by three CFD peer support facilitators. A convenience sample of CFD firefighters (N = 9) was recruited through email, flyer distribution, and station visits. The sample was mostly white (88.9%), non-Hispanic (88.9%) men (66.7%) who were 45 years of age or older (66.7%) and had served in the fire service for over 10 years (77.7%). The CFD peer support facilitators (n = 2) completed an online Qualtrics survey and answered open-ended questions about perceived barriers, facilitators, strengths, areas for improvement, and complications related to the MBSR program implementation. Thematic analysis was done to code the facilitators’ written responses using ATLAS.ti 24.0.1. Direct observation and feedback communicated by participants and CFD peer support facilitators were used to supplementarily understand barriers and facilitators to implementing the MBSR program.

Results: Themes related to barriers included 1) recruitment strategies (e.g., flyers were unsuccessful) 2) administrative preparedness, 3) firefighter preparedness, and 4) perceived value. The CFD peer facilitators shared that a lack of “education distributed to policy makers/leaders on the value of [MBSR]” and “ willingness to be open minded and accept change” are barriers to implementation at CFD. Themes related to facilitators included 1) workplace communication, 2) administrative support, 3) participant camaraderie, and 4) participant accommodations (e.g., flexible session scheduling). The CFD peer facilitators shared that “members sharing positive experience with [MBSR]” and administrative support of “trying different modalities” are facilitators to implementation at CFD. Having group discussions and actively supporting well-being were two themes related to the MBSR program’s strengths, whereas expanding the availability of the MBSR program was a theme related to areas for improvement. Themes related to complications included 1) technology issues (e.g., Garmin vívosmart 4 watch complications) and 2) participant session absences.

Conclusion and Implications: This pilot MBSR program was well-accepted by participating CFD firefighters, and collaboration with members of the CFD peer support team supported the program’s implementation. Of importance is better engaging CFD administration to support future adaptations of MBSR programming. Aligning with the identified barriers and facilitators to implementation, we will consider adapting future recruitment strategies to engage more firefighters and developing MBSR session materials to be accessed remotely (e.g., recorded meditations and educational content).