A Community Health Coach–Delivered Mental Wellness Intervention: Using Mind–Body Bridging to Reduce Health Disparities in Diverse Communities

Abstract

Research has shown that members of racial and ethnic minority groups experience greater cumulative stress burden. Because a high cumulative stress burden increases the likelihood of mental health disorders, community health coaches trained in techniques to help community members manage stress more effectively could be an important step toward improving mental health in minority populations. As a pilot project, we invited individuals from organizations representing five minority populations to receive training in Mind–Body Bridging (MBB), a mindfulness approach that teaches skills to calm the mind and relax the body. Participants included community health coaches, organizational leaders, and community members. Surveys of quality of life and self-efficacy were conducted at the beginning and completion of training, and at 9 months following completion. A focus group was also held at training completion to solicit perceptions of the usefulness of MBB among the participants’ respective communities. Eleven participants completed the training. Overall, participants reported regular use of MBB techniques to manage their own stress and showed some moderate improvements in both quality of life and self-efficacy. MBB was generally perceived to be a useful tool for community health coaches, with perceived strengths including the ease of teaching it to others and increased ability to empower community members to handle their own problems more efficiently. Next steps include longitudinal tracking of the coaches’ use of MBB as a coaching tool and monitoring outcomes among the community members receiving the coaching.

Keywords

mindfulness stress management train the trainer community-based intervention

In a 2006 report by the Global Burden of Disease study, mental health disorders were estimated to account for 13.5% of the total global disease burden as measured by disability-adjusted life-years (Mathers & Loncar, 2006). According to this study, mental disorders contribute more to the global disease burden than any other noncommunicable disease, including cardiovascular disease and cancer (Prince et al., 2007). Some researchers, however, have argued that this is an underestimate, as the report does not account for the bidirectional relationship between mental health disorders and other diseases (Prince et al., 2007). Recent studies have found that mental health disorders play a significant role in both the onset and severity of a wide variety of communicable and noncommunicable diseases (Hert, Correll, et al., 2011; Prince et al., 2007; Scott & Happell, 2011; Tosh, Clifton, Mala, & Bachner, 2010). Researchers have also consistently reported that severe mental health disorders limit an individual’s ability to manage existing illness and impair their capacity for making necessary health-related behavioral changes (Hert, Cohen, et al., 2011; Lorig, Ritter, Pifer, & Werner, 2014; Prince et al., 2007; Siantz & Aranda, 2014). These studies are part of a larger trend in public health research that seeks not only to mitigate disease and illness directly but also recognizes poor mental health as a primary underlying cause of poor physical health that often is not adequately addressed (Patel, Flisher, & Cohen, 2006) and as detrimental to overall well-being (Perry, Presley-Cantrell, & Dhingra, 2010).

One element of mental health that has received substantial attention in public health research in recent decades is stress. One review of the literature on stress and health concluded that stressors do have a substantial impact on an individual’s health and significantly increase the likelihood of mental health disorders, especially depressive disorders and anxiety (Thoits, 2010). Interestingly, while it is commonly known and expected that the experience of trauma or acute changes (e.g., job loss, death of a relative, etc.) may lead to psychological distress and/or mental health disorders, some researchers have found that “chronic strains,” the daily stressors of life (e.g., monthly bills, child care, etc.), may have a much stronger influence on an individual’s mental health status (Thoits, 2010; Turner, 2003; Turner & Avison, 2003). Research also suggests that minority populations experience a higher cumulative stress burden, much of which is associated with social determinants of health, such as low socioeconomic status and low education level, as well as experiences of racial/ethnic discrimination (Thoits, 2010). Other factors that have been reported to negatively affect the mental health of minority populations are the following: (a) historical trauma, in which the mental health of an individual is affected by the “cross-generational transmission of trauma from historical losses” experienced by a community (Brown-Rice, 2013) and (b) the inability to discuss and treat poor mental health within and across communities that can result from not having common terminology, dissimilar beliefs about causation, and/or cultural stigma associated with a mental health diagnosis (Brown-Rice, 2013; Paniagua & Yamada, 2013).

Researchers have also reported that in addition to pervasive and unique stressors, minority populations also face significant disparities in accessing mental health care (Alegría et al., 2008; Fiscella, Franks, Doescher, & Saver, 2002; Lee, Xue, Spira, & Lee, 2014). According to a report published by the Surgeon General of the United States, minority populations are less likely to have access to mental health care and are more likely to have unmet mental health care needs (U.S. Department of Health and Human Services, 2001). Mistrust of treatment practices, cultural differences in the conception of illness and help-seeking behavior, and uninsured status were identified as significant barriers preventing access to mental health care services among racial and ethnic minorities. This same report cited evidence of the relative lack of cultural competency among mental health care workers. Consequently, when they do access care, many racial and ethnic minorities do not receive culturally sensitive care. Research on stress and mental health among minority populations, combined with the documented pervasive lack of access to appropriate care, suggests that an intervention designed to help individuals manage stress more effectively could be a powerful tool in improving the overall well-being of racial and ethnic minority populations.

The use of mindfulness methods as a tool for managing stress and improving overall quality of life has increased rapidly in popularity within recent decades (Bishop, 2002). As the popularity has risen, researchers have increasingly sought to examine the efficacy of these methods for improving mental health. One review of studies of mindfulness meditation concluded that mindfulness meditation improved symptoms of anxiety, depression, and pain (Goyal et al., 2014). Other studies looking specifically at mindfulness-based stress reduction methods have found positive improvements in both psychological and physiological outcomes related to stress, suggesting these approaches are a promising intervention for reducing stress and improving quality of life (Grossman, Niemann, Schmidt, & Walach, 2004; Khoury, Sharma, Rush, & Fournier, 2015; Sharma & Rush, 2014).

Purpose of Study

The pilot program discussed here seeks to evaluate the usefulness of one such mindfulness-based stress reduction approach called Mind–Body Bridging (MBB; Block & Block, 2007; Block, Block, & Peters, 2012). The underlying premise of MBB is that we all have expectations for how we should be and how the world around us should work; however, there are times when our expectations are not met. As we wrestle with these unmet expectations, we often encounter self-talk that is not helpful, for example, “I will never be good enough, so why should I try?” The consequence of having unmet expectations and negative self-talk is manifested as stress, for example, a restless mind, fear or anxiety, depression, physical tension, and distress (Block & Block, 2007; Block et al., 2012). The MBB techniques help individuals recognize and manage these symptoms and unmet expectations, thus decreasing both physical and mental manifestations of stress. The techniques central to the use of MBB include noticing sensory details, creating mind–body maps (concept maps that tie one’s stressors to the stress felt in the body), recognizing thoughts as “just thoughts” and not actualities, and identifying “storylines” (ongoing thought streams that cloud reality and prevent the individual from being present in the moment).

In recent studies, MBB has been found to have promise for improving symptoms of posttraumatic stress disorder, reducing sleep disturbances, and reducing self-reported symptoms of depression (Nakamura, Lipschitz, Kuhn, Kinney, & Donaldson, 2013; Nakamura, Lipschitz, Landward, Kuhn, & West, 2011). Because both chronic strain and poor mental health can affect the ability to manage existing health conditions and make health-related behavioral change (Hert, Cohen, et al., 2011; Lorig et al., 2014; Prince et al., 2007; Siantz & Aranda, 2014), addressing underlying stressors with an MBB intervention may improve both mental and physical health in racial and ethnic minority populations.

Because MBB is easily learned and adapted, it lends itself well to use by community health workers (CHWs). In a 2007 report on the CHW workforce, the U.S. Department of Health and Human Services defines CHWS as

lay members of communities who work either for pay or as volunteers in association with the local health care system [ . . . ] and usually share ethnicity, language, socioeconomic status and life experiences with the community members they serve. [ . . . ]. CHWs offer interpretation and translation services, provide culturally appropriate health education and information, assist people in receiving the care they need, give informal counseling and guidance on health behaviors, [and] advocate for individual and community health needs. (U.S. Department of Health and Human Services, 2007, pp. 2-3)

For underserved communities, CHWs serve both as an important source of health information and support and as an important liaison to health care resources (Goldman, Ghorob, Eyre, & Bodenheimer, 2013; Richardson, Willig, Agne, & Cherrington, 2015; Rosenthal et al., 2010). Because they possess valuable understanding of the needs and barriers of their respective communities, and are trusted allies from within the community, CHWs play a critical role in the development and implementation of effective community health interventions (Simonsen et al., 2015). There is increasing evidence that CHWs can effect moderate changes in health behaviors among racial and ethnic minority communities and are a valuable resource for health promotion efforts in these populations (Anderson, Adeney, Shinn, Krause, & Safranek, 2012; Rosenthal et al., 2010).

When considered within the framework of the social ecological model (Sallis, Owen, & Fisher, 2002), CHWs serve as an important two-way link among individuals, communities, and systems. By serving as an important link between individuals and their communities, between individuals and health systems, and between communities and health systems, CHWs may be uniquely able to help members of their communities achieve improved mental health.

This study was conducted to evaluate the usefulness of MBB as a resource for use by CHWs to support others in their community as well as to enhance their own coping skills. Participants were already active in their communities, and many were performing the responsibilities of CHWs, including providing social support, educating on health topics, and serving as advocates for their communities (Rosenthal et al., 2010). Although they perform the responsibilities of traditional CHWs, the participants of this study prefer to view their role not as a worker, but as a coach, providing support and guidance for members of their community seeking to achieve healthier lives; for this reason, they will be referred to as community health coaches (CHCs), with our understanding that health coaching is a developing area of health professions.

Method

Participants

Participants came from communities with leaders who are members of the Community Faces of Utah (CFU), an organizational partnership among the University of Utah, the Utah Department of Health, and five racial and ethnic minority communities in Salt Lake County, Utah, which were defined as African Americans, Africans, Hispanics, Native Americans, and Pacific Islanders. CFU engages with researchers via community-based participatory research processes. The community leaders had identified mental health as one of the top health needs in their communities and were seeking culturally appropriate ways to address this issue. The CFU–researcher partnership was formed to provide insight into the value of MBB from the perspective of the CHCs, the community members who will be receiving services from them, and the organizational leaders who supervise the CHCs.

The MBB training opportunity was presented at one of the monthly CHC meetings. The CHCs subsequently invited other members of their communities to participate. Sixteen individuals expressed interest in participating in the training—four CHCs, seven community members, five community leaders (one leader is also a CHC), and the University of Utah Community Liaison who is a member of CFU.

Data Collection

Study procedures were approved by the University of Utah Institutional Review Board. The MBB training consisted of four 2-hour training sessions conducted over a 1-month period. Each training session was conducted by a licensed social worker who is also a board-certified instructor of MBB. Each MBB session was designed to teach the participants to utilize MBB techniques for themselves and evaluate whether the techniques would be useful among other members of their respective communities. Short homework assignments were given to encourage participants to utilize MBB tools between training sessions. Participants were also trained in recognizing when a member of their community might need professional mental health care and were given information and resources on how to connect community members to professional care.

Surveys were administered at three time points: at the beginning of the first training session (“baseline”), following completion of the last training session (“posttraining”), and 9 months after completion of the training (“9-month follow-up”). At baseline, participants were asked to complete a basic quality of life survey (as contained within MBB practice materials) and the General Self-Efficacy Scale survey (Block & Block, 2007; Schwarzer & Jerusalem, 1995). At the posttraining and 9-month follow-ups, participants again completed these surveys and also reported on their frequency of use of MBB techniques. Change over time on the quality of life and self-efficacy surveys and self-reported frequency of use of MBB were analyzed using Wilcoxon signed-rank tests.

At the conclusion of the final training session, participants were invited to participate in a focus group to evaluate their satisfaction with the training and with the MBB techniques. In order to understand how our participants used MBB in their lives as the training unfolded, we took a phenomenological research approach to ensure that participants were able to describe their experience with the MBB process and its usefulness for them (Creswell, 2013). The process of phenomenological research allows us to “describe the lived experiences” (Creswell, 2013) of our participants around the training and use of the MBB intervention.

We audiotaped the focus group (n = 9), which lasted 40 minutes, using an iPad mini through Voice Recorder Pro and took written notes. We did not transcribe the focus group discussion for analysis. Instead, we listened to the recording and referred to the data notes taken at the time of the focus group. We used focused coding for the data collected in the focus group. Coding is structured through “three basic procedures.” First, the researcher recognizes the “relevant phenomena” from the data. Second, the researcher collects “examples of those phenomena.” Third, the researcher analyzes “those phenomena in order to find commonalities, differences, patterns, and structures” (Esterberg, 2002; Schwandt, 2007). Thus, the overall purpose of coding qualitative data is to identify patterns and examples of these patterns, and then to link them to the quantitative data we collected. Through this mechanism of coding, we were able to immerse ourselves in our data and identify themes and categories discussed by the MBB focus group participants.

Results

Of the 16 individuals who agreed to participate, 11 attended the training sessions and completed all three surveys (baseline, posttraining, and 9-month follow-up). Nine participants also chose to participate in the focus group to share their perceptions of the training.

Utilization of MBB Tools

The survey of MBB practices asked how regularly individuals used the techniques presented in the training, using a scale of “never,” “hardly ever,” “occasionally,” and “regularly.” At the time of the posttraining survey, participants reported their frequency of use of specific MBB techniques and overall use of MBB to manage stress (see Figure 1). Each specific technique of MBB was used regularly by over half the participants, with nearly all of the remaining participants reporting occasional use. When asked how often they used MBB to manage stress, nine reported regular use and the remaining two reported occasional use. This information suggests that individuals participating in the training found the tools suitable to use in daily life and useful for managing stress.

Figure 1.

Frequency of use of Mind–Body Bridging techniques.

At the 9-month follow-up, while use of specific techniques and overall use of MBB to manage stress declined slightly from the posttraining survey, these differences were not statistically significant, suggesting that MBB is a practice that can be sustained over a long period of time (see Table 1). Each MBB technique was used regularly or occasionally by at least 9 of the 11 respondents. Similarly, in evaluating their use of MBB to manage stress most broadly, eight reported regular use and the remaining three reported occasional use (see Figure 1). It is important to note that study participants received no ongoing support or reminders outside of the initial month of training. Even without any ongoing support, all continued to use MBB to manage stress at least occasionally, suggesting that MBB can be sustained independently over time, but likely would be utilized more frequently with some additional support from MBB trainers or researchers.

Table 1.

Change in Use of Mind–Body Bridging.

“How frequently do you . . .”	9-Month follow-up compared with posttraining follow-up
“How frequently do you . . .”		N	Z	p
Listen to background sounds	Less frequent use	2	−0.634	.5264
	More frequent use	1
	No change	8
Make daily mind–body maps	Less frequent use	4	−0.378	.7055
	More frequent use	3
	No change	4
Label your thoughts	Less frequent use	3	−1.000	.3173
	More frequent use	1
	No change	7
Recognize storylines	Less frequent use	3	−1.732	.0833
	More frequent use	0
	No change	8
Use bridging to help you relax and stay focused	Less frequent use	1	0.577	.5637
	More frequent use	2
	No change	8
Use bridging practices to manage stress	Less frequent use	2	−0.577	.5637
	More frequent use	1
	No change	8

Quality of Life and Self-Efficacy Outcomes

At the time of the posttraining surveys, respondents reported improvement on several survey items. On the quality of life survey, respondents significantly improved in their evaluation of “being satisfied with what you accomplished at home, work or school” (p = .026) and in “satisfactory management of diet, health, exercise and recreation” (p = .038; see Table 2). Similarly, items on the self-efficacy survey that showed significant improvement included “finding it easy to stick to personal aims and accomplish goals” (p = .014) and “remaining calm when facing difficulties because of reliance on coping skills” (p = .015; see Table 3). Additionally, several quality of life and self-efficacy items were suggestive of improvement (p < .10) but were not statistically significant at α = .05 in our small study; further investigation with a larger sample would be needed to more fully assess the impact on these items.

Table 2.

Changes in Quality of Life.

“Over the past 10 days, how have you been doing?”	Posttraining follow-up compared with baseline				9-Month follow-up compared with posttraining follow-up
“Over the past 10 days, how have you been doing?”		N	Z	p		N	Z	p
1. Positive interest in doing things	Fewer days	1	0.577	.5637	Fewer days	1	0.839	.4017
	More days	2			More days	3
	No change	8			No change	7
2. Optimistic, enthusiastic, and hopeful	Fewer days	2	0.105	.9165	Fewer days	2	−0.105	.9165
	More days	2			More days	2
	No change	7			No change	7
3. Sleeping well and waking rested	Fewer days	2	1.214	.2247	Fewer days	3	−0.284	.7763
	More days	5			More days	3
	No change	4			No change	5
4. Having lots of energy	Fewer days	1	1.667	.0956	Fewer days	6	−1.731	.0835
	More days	5			More days	2
	No change	5			No change	3
5. Able to focus on tasks and having self-discipline	Fewer days	2	0.641	.5212	Fewer days	5	−0.157	.8755
	More days	4			More days	4
	No change	4			No change	1
6. Satisfactory management of diet, health, exercise, and recreation	Fewer days	3	1.894	.0582	Fewer days	6	−2.066	.0388
	More days	8			More days	1
	No change	0			No change	4
7. Feeling good about relationships with family and friends	Fewer days	0	1.414	.1573	Fewer days	2	−0.640	.5225
	More days	2			More days	1
	No change	9			No change	7
8. Satisfied with what you accomplished at home, at work, or at school	Fewer days	0	2.222	.0263	Fewer days	4	−0.905	.3656
	More days	5			More days	2
	No change	6			No change	5
9. Comfortable with your financial situation	Fewer days	0	1.728	.0840	Fewer days	5	−1.705	.0883
	More days	3			More days	1
	No change	8			No change	5
10. Feeling good about the spiritual base of your life	Fewer days	0	1.414	.1573	Fewer days	4	−1.427	.1536
	More days	2			More days	1
	No change	9			No change	6
11. Satisfied with the direction of your life	Fewer days	0	1.413	.1578	Fewer days	3	−1.048	.2945
	More days	2			More days	1
	No change	9			No change	7
12. Self-fulfilled with a sense of well-being and peace of mind	Fewer days	0	1.000	.3173	Fewer days	3	−1.048	.2945
	More days	1			More days	1
	No change	10			No change	7

Note. Bold formatting indicates a statistically significant difference with a p value less than 0.05.

Table 3.

Changes in Self-Efficacy Capability.

	Posttraining follow-up compared with baseline				9-Month follow-up compared with posttraining follow-up
Self-efficacy statement		N	Z	p		N	Z	p
1. I can always manage to solve difficult problems if I try hard enough	Less capable	2	0.905	.3656	Less capable	4	−2.000	.0455
	More capable	4			More capable	0
	No change	5			No change	7
2. If someone opposes me, I can find the means and ways to get what I want	Less capable	1	0.577	.5637	Less capable	2	−1.414	.1573
	More capable	2			More capable	0
	No change	8			No change	9
3. It is easy for me to stick to my aims and accomplish my goals	Less capable	0	2.449	.0143	Less capable	5	−2.236	.0253
	More capable	6			More capable	0
	No change	5			No change	6
4. I am confident that I could deal efficiently with unexpected events	Less capable	1	0.577	.5637	Less capable	2	−0.577	.5637
	More capable	2			More capable	1
	No change	8			No change	8
5. Thanks to my resourcefulness, I know how to handle unforeseen situations	Less capable	2	1.134	.2568	Less capable	3	−1.732	.0833
	More capable	5			More capable	0
	No change	4			No change	8
6. I can solve most problems if I invest the necessary effort	Less capable	0	1.414	.1573	Less capable	3	−1.732	.0833
	More capable	2			More capable	0
	No change	9			No change	8
7. I can remain calm when facing difficulties because I can rely on my coping abilities	Less capable	0	2.429	.0152	Less capable	3	−1.000	.3173
	More capable	6			More capable	1
	No change	5			No change	7
8. When I am confronted with a problem, I can usually find several solutions	Less capable	1	1.633	.1025	Less capable	5	−1.633	.1025
	More capable	5			More capable	1
	No change	5			No change	5
9. If I am in trouble, I can usually think of a solution	Less capable	1	1.890	.0588	Less capable	1	0.000	1.0000
	More capable	6			More capable	1
	No change	4			No change	9
10. I can usually handle whatever comes my way	Less capable	2	0.619	.5359	Less capable	1	0.634	.5264
	More capable	4			More capable	2
	No change	5			No change	8
11. I am confident that I can teach coping strategies to members of my community	Less capable	1	1.000	.3173	Less capable	3	−1.000	.3173
	More capable	3			More capable	1
	No change	7			No change	7

Note. Bold formatting indicates a statistically significant difference with a p value less than 0.05.

At the 9-month follow-up, there was a general decline in the measures of quality of life and self-efficacy when compared with the posttraining surveys, though most did not reach statistical significance. On the quality of life survey, the improvements in feeling satisfied with accomplishments at home, work or school were found to be sustained. However, the improvements in satisfactory management of diet and exercise at the posttraining follow-up were not sustained at 9 months (see Table 2). On measures of self-efficacy, participants maintained the improvements in remaining calm by relying on coping abilities, but did not maintain improvements in sticking to aims and accomplishing goals. Affirmative responses to the statement “I can always manage to solve difficult problems if I try hard enough” also were found to be significantly lower at the 9-month follow-up (see Table 3). While the quality of life and self-efficacy survey findings are mixed, there was some sustainability without any reinforcement over a 9-month period, again suggesting that a more effective intervention would require some initial support to sustain both use and benefits of the MBB program.

Focus Group Results

In analyzing the results of the focus group conducted on completion of the training, three main benefits of MBB emerged. First, participants agreed that MBB techniques were easy to learn and apply in daily situations. Participants generally agreed that use of MBB was an easy way to reestablish an individual’s sense of control and choice in stressful situations. For example, one participant stated that instead of “shutting down” when confronted with a stressful situation, she was now “in control of [her] thoughts.” One participant stated that MBB helped her to recognize when tension is building in the moment, helping her to handle situations “smarter.”

Second, participants repeatedly discussed the role MBB can play in improving problem-solving abilities. One participant stated that MBB allowed her to clear “the fog in [her] brain.” Another participant stated that he felt able to breathe, relax, and then think clearly. Subsequently, he experienced better focus and less stress when faced with a difficult situation. Another participant similarly expressed her view that MBB prevented situations of “woulda, coulda, shoulda,” and instead allowed her to catch herself and make a conscious decision about how to handle stress and emotions. Many focus group participants expressed similar improvements in problem-solving ability.

Finally, the “ripple effect” of MBB was perceived to be a particularly positive outcome. Participants expressed expectations that the empowerment resulting from MBB would be seen by other members of the community and encourage them to also utilize the techniques. One participant described how she had already begun using MBB techniques to help members of her family handle stressful situations and looked forward to sharing it with others in the community. One participant explained that MBB helped her feel more empowered and confident in her role as a health coach in her community. She reported that MBB enabled her to feel less pressure to “fix” the person she is helping. Instead, she felt she could share techniques from her MBB “toolbox,” enabling the person to find his/her own solutions. Overall, perception of the usefulness of MBB as a tool CHCs can use to address the high rates of stress experienced by members of their communities was aptly summarized by one participant who stated, “As an [MBB] coach, I can give power back to [my trainee] and they find the solution for themselves.”

The themes that emerged from the focus groups also add support to the tentative findings from the analysis of the survey. The frequency of use of MBB techniques revealed by the survey, coupled with the ease of use identified by participants in the focus group, suggests MBB is generally perceived among these CHCs to be an acceptable and useful approach to managing stress. The statements made during the focus group regarding an increased sense of empowerment in their role as a coach or community leader add strength to the tentative findings of improved self-efficacy and quality of life identified by the survey. Overall, the focus group and survey data suggest that MBB was generally perceived to be useful and could be a valuable resource for increasing CHCs’ own coping skills, as well as a tool they could teach members of their communities to use to better manage stress.

Discussion

The results from our surveys and focus group suggest that MBB can effect meaningful improvements in quality of life and self-efficacy over a relatively short period of time. Regular use of MBB techniques to manage stress was reflected in both survey and focus group data in our small pilot study with five underserved communities. These data suggest MBB may be an effective tool for achieving improved health among racial and ethnic minority populations. As discussed above, mental illness often prevents individuals from making health-related behavior change. While this study did not include those with severe mental illness, it does suggest that MBB can lead to better management of stress. Through improving stress management, MBB could serve as an early intervention to buffer against the emergence of more serious mental health disorders. Therefore, although this study cannot speak directly to the effect of MBB on improvements in ability to make needed health behavior change among those with severe mental illness, the pilot data suggest that MBB may be a useful tool for maintaining mental health and potentially preventing the development of more severe mental health problems.

A particularly important outcome of this MBB training is the empowerment of the community health coaches. As Goldman et al. (2013) found, peer health coaches reported feeling empowered to serve as role models for their community. As role models, they strove to exemplify the healthy behaviors, and in doing so, felt better able to improve their own health while also supporting members of their community (Goldman et al., 2013). In this study, we found similar elements of CHC participants expressing increased ability to manage their own stress and to serve as a role model, expressed by our participants as a “ripple effect.” During the focus group, many participants discussed that being trained in MBB contributes to their sense of empowerment to not only change their own behavior but also strengthens their sense of empowerment (in their role as leaders and CHCs) to help members of their community. As Richardson et al. (2015) found, community members prefer to have a CHW (or, in our vernacular, a CHC) who is not only knowledgeable but also has shared experiences and who can serve as a partner in making health behavior change. Because the MBB training first teaches CHCs to use the tools themselves, this MBB intervention equips them with the knowledge and shared experiences needed to successfully partner with and coach members of their communities to achieve health behavior change.

The use of MBB by the CHCs could also begin to address more serious mental health disorders among racial and ethnic minority populations by serving a referral function. It is important to note that while previous research has found that MBB has promise for treating some aspects of clinical PTSD and depression, MBB coaches are not intended to replace mental health care professionals in cases of clinical disorders. However, CHCs were trained to identify phrases and situations that suggest referral to a clinical mental health specialist is warranted. The CHCs were also provided with resources to connect community members to a variety of professional mental health providers, establishing a pipeline from underserved communities to mental health services to address the issue of lack of access to culturally appropriate care (U.S. Department of Health and Human Services, 2001). In this manner, MBB training could improve the mental health of minority communities by identifying those members of the community who need professional care and connecting them to appropriate resources.

This study also provides initial support for the acceptability of MBB among diverse communities. The regular use of MBB techniques by the study participants (including CHCs and community members) suggests that MBB may be an appropriate approach to managing stress among these racial and ethnic minority communities. Prior to this study, MBB had only been studied in clinical populations, with unknown racial and ethnic make-up. This study was designed to be a pilot study to gauge the initial acceptability of MBB among racial and ethnic minorities. Because of the small sample size, this study cannot speak to the potential generalizability of MBB as a tool to improve mental health in minority communities. However, the improvements in self-efficacy and quality of life do suggest that the MBB intervention may be effective in helping members of these racially and ethnically diverse communities manage their daily stressors in a healthier manner. While this pilot study provides support for the conclusion that MBB is generally well received and utilized by the minority community leaders and coaches in this study, more research is needed to identify how the intervention is perceived differently across individual cultural communities; culturally specific modifications to the content and delivery of the MBB techniques can then be developed. In particular, as MBB was developed as an individualistic approach to managing stress, more research is needed to identify how MBB can be modified to align more closely with the values held by collectivist communities and cultures, such as group interdependence and use of oral storytelling to transmit knowledge, and so on (Leake & Black, 2005).

The implications of this study are limited by the small number of participants and communities represented. One of the purposes of this pilot study was to test the feasibility of training CHCs, which produced encouraging results. It suggests that MBB may be effective in improving management of stress for individuals who are members of several racial- and ethnic-minority communities. In addition, MBB was generally perceived by participants to be a useful tool in providing assistance to community members. However, additional research is needed to identify how MBB can be tailored to be effective for specific communities and to establish what form of ongoing support CHCs may need as they use MBB in their respective communities. This pilot study also did not address the system-level factors that contribute to stress and mental health concerns among minority communities. Future studies will need to explore how MBB can be used to address these system factors. Next steps for future studies include incorporation of a control group, longitudinal tracking of the coaches’ use of MBB as a coaching tool, evaluating referral patterns for clinically delivered mental health services, and monitoring outcomes among the community members receiving the coaching.

Since mental health disorders often make desired health-related behavioral change difficult to actualize, more research is needed to explore what resources individuals with mental health concerns need in order to self-manage the other aspects of their overall health (Siantz & Aranda, 2014). MBB may allow individuals to manage their stress and emotional responses more effectively (Block et al., 2012). It thus has the potential to not only improve the mental health status of minority populations but could also provide underserved racial and ethnic minority populations with effective, simple, and inexpensive tools to manage and improve their overall health.

Footnotes

Acknowledgements

The authors wish to thank Sophie Archibald for conducting the Mind–Body Bridging (MBB) training sessions. The authors also thank the Community Faces of Utah (CFU) for their collaboration in planning and holding the MBB training, for participation by several members in the training, and for valuable feedback and input on this article. We particularly thank the CFU community leaders for inviting the Community Wellness Coaches to participate and for recruiting community member participants. Ms. Heather Coulter, the Community Liaison with the Utah Center for Clinical and Translational Science, facilitated organization of the training and followed up weekly with participants to remind them about sessions. CFU members who contributed to this work include Pastor France A. Davis and Doriena Lee, Calvary Baptist Church; Ana Sanchez Birkhead and Jeannette Villalta, Hispanic Health Care Task Force; Valentine Mukundente, Best of Africa; Edwin Napia, Urban Indian Center of Salt Lake; Fahina Tavake-Pasi, National Tongan American Society; and Stephen C. Alder, Heather Coulter, Louisa A. Stark, and Grant Sunada, University of Utah.

Authors’ Note

The contents of the article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the funding agency.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for Ms. Coulter’s participation was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number 1ULTR001067.

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