Background: Homeless women are at high risk for trauma-exposure (particularly violence), posttraumatic stress disorder (PTSD), and associated physical health problems. Such health disparities are often exacerbated as PTSD can be costly and difficult to treat. Low-cost mindfulness-based interventions (MBI), such as Mindfulness-based Stress Reduction (MBSR) have demonstrated effectiveness in improving health outcomes and can be implemented in community-based, group settings. Yet few studies have evaluated the acceptability and feasibility of MBIs with trauma-exposed homeless women or adapted them for cultural appropriateness and sensitivity.

Methods: Between 9/29/19-10/16/19, using a community-participatory approach, we conducted a mixed-methods acceptability and feasibility study with 28 trauma-exposed, homeless women, currently residing at one of two residential drug treatment facilities in Southern California. A Community Advisory Board consisting of residents and site staff helped design a Semi Structured Interview Guide for use in subsequent focus groups. The goal of the focus groups was to identify potential challenges to program MBSR program implementation and increase program acceptability and feasibility. Women participated in focus groups (N=4) and completed a survey. Key components of MBSR (e.g., body scans, gentle yoga, meditation), were demonstrated using a theater-style approach.

Results: Participants were, on average 30.3 years old (SD=8.6). All 28 had been diagnosed with a substance use disorder, 22 (78%) had an additional doctor diagnosed mental health condition. Trauma-exposure in the sample was exceedingly high. Common trauma exposures included physical assault (n=27; 96%), sexual assault (n=24, 86%), assault with a weapon (n=23, 82%), and sudden violent death (n=13, 46%). Almost 90% of women (n=25) met criteria for probable-PTSD. Quantitative data revealed great enthusiasm for the MBSR program: 89% of participants endorsed that MBSR would be “a great deal” useful for them and 10% “somewhat” useful. Participants endorsed that using gentle yoga (86%), meditation (86%), body scans (71%), worksheets (89%), and discussion with trainers (82%) would help them a “great deal”. Focus group recordings were transcribed and analyzed using open coding techniques. Key themes that emerged included adopting language so that it was culturally appropriate and non-triggering; a focus on explaining mechanisms of action; incorporation of art; accountability groups to help with home practice fidelity; scaffolding of practices (e.g., starting with shorter meditations); compassion from the trainer; and non-monetary incentives (e.g., certificate of completion).

Discussion: Results informed the design of a modified-MBSR program for trauma-exposed, homeless women. Strengths of the study include the focus on an underrepresented population experiencing high health disparities and a community-participatory approach. Limitations include the relatively small sample size, common in qualitative assessment and feasibility studies. Findings suggest implementing low-cost MBIs as an adjunct to ongoing care in samples experiencing high health disparities could improve public health. Implications for reducing health disparities and addressing violent trauma exposure will be discussed.