Culturally Responsive Stress Reduction: A Mobile Mindfulness Application for African Americans (CRSR)

Emotion regulation will be assessed by the Difficulty in Emotion Regulation Scale Short Form (DERS-SF), a 18 item frequency scale ranging from 1 (almost never; 0-10%) to 5 (almost always; 91-100%) with higher scores indicating less emotional regulation (negative change scores indicate better outcomes). Single score and 6 subscales (strategies, non-acceptance, impulse, goals, awareness, and clarity) can be analyzed as either total score or average scores. Total scores on the full scale range from 18 to 90. Subscales have three items each, thus total scores on the subscales range from 3 to 15.

Mindfulness will be assessed by the Five Facet Mindfulness Questionnaire (FFMQ), a 24-item frequency scale with scores ranging from 1 (never) to 5 (very often). This scale provides subscales with four having five items each (describe, act with awareness, nonjudgmental, and non-reactance) and on having four items (observe). Total scores range from 5 to 25 on the five-item subscales and 4 to 20 on the four-item subscale, with higher scores indicating indicating more mindfulness. Thus positive changes at posttest indicate better outcomes.

Attitudes toward general use of mindfulness techniques as well as program specific recommendations, affective responses towards the items, and outcome expectancies will be measured using the Attitudes Towards Mindfulness Scale (MTMS), a 10-item scale developed in Phase I. The MTMS is a 10-item Likert-like scale, on a 5 point scale ranging from 1 "strongly disagree" to 5 "strongly agree" which measured positive attitudes towards mindfulness strategies (higher change scores indicate a better outcome). Example items included "Practicing mindfulness can help me reduce my stress" and "Knowing what I am thinking in the moment is important". The MTMS demonstrated strong internal reliability during Phase I (alpha = .91 at pretest and .94 at posttest). The average score of the scale is used in analysis.

Perceived Behavioral Control (self-efficacy) will be measured using the Mindfulness Self-Efficacy Scale (MSES) a 12-item Likert-like scale developed in Phase I based on the content about ability and competence in stress reduction through mindfulness. The MSES evaluated self-efficacy, by asking how confident on a 5 point scale ranging from 1 "not at all confident" to 5 "very confident" participants were in their ability to use the skills taught in the course, for example "Take time to breathe" and "Pay attention to tasks in the moment". Higher scores indicated greater self-efficacy (better outcome). The MSES demonstrated strong internal reliability in Phase I (alpha = .90 at pretest and .91 at posttest). The average score of the scale is used in analysis.

Mindfulness Behaviors i.e., actual behavioral change, will be assessed through the Mindfulness Behavior Usage Scale (MBUS) a self-report of 12 mindfulness activities as well as usage data provided through the app. The MBUS is a 12-item frequency scale, asking how often in the last week participants engaged in mindfulness strategies, ranging from 1 "never' to 4 "daily" (higher change scores indicate better outcomes). For example, "How often did you take time to breathe" and "Pay attention to tasks in the moment". The MBUS demonstrated good internal reliability (alpha = .94 at pretest and .90 at posttest).

Knowledge about mindfulness techniques will be assessed pre- and post- to determine the extent to which participants understand basic knowledge delivered during the intervention. Knowledge items will be derived from the conceptual and practical content. In Phase I we used a 10-item multiple-choice assessment of participants' knowledge about mindfulness. For Phase II additional items will be added to reflect the new information presented in the program.