Mindfulness is the nonjudgmental awareness of one's present moment experience [1] and is a strategy capable of promoting individual and relationship health [2]. Higher levels of mindfulness are associated with greater relationship satisfaction [3,4], and higher relationship mindfulness (i.e., the propensity to be mindful in a romantic relationship) is associated with better relationship quality, as well as less stress and depression [5]. Mindfulness-based interventions have become increasingly common over the past three decades [6], and these interventions have demonstrated improvements in relationship and sexual satisfaction, acceptance, negative affect, and distress [[7], [8], [9]]. Mindfulness-based couple interventions have also been found to improve individual health through reductions in stress, depression, and anxiety [8,[10], [11], [12]]. Whereas these interventions are effective for improving individual and relationship health, these interventions have been tested with mostly White, higher-income, samples [13], which limits the generalizability of these findings to persons with low income and economic marginalization (LIEM), or persons whose economic position negatively impacts their health or well-being due to factors such as access to healthcare [14].

According to the 2020 United States census, 11.4% of the population lives below the poverty threshold and this rate is increasing in recent years (e.g., 2019: 10.5%). Further, families of color tend to be overrepresented among families living below the poverty threshold (White families: 8.2%; Black families: 17.5%; Hispanic families: 15.6%; Asian families: 6.2%). Individuals with LIEM are at greater risk for poorer individual and relationship outcomes relative to middle-class couples [15] and are also less likely to seek help for their relationship [16], which may be due to the multiple barriers they face in accessing treatment. Given the benefits mindfulness has for individual and relationship health, it may be a particularly useful skill for couples with LIEM. Teaching mindfulness to the couple, versus an individual, could equip the couple with skills that reduce individual stress and improve relationship health outcomes. Thus, the dyad could act as a vehicle to enhance individual and relationship health. Further, mindfulness can be taught and practiced flexibly through a variety of different mediums (e.g., virtually, in person) and formats (e.g., individuals, couples, groups) for little to no cost [6,17], which reduces the burden of some of the common help-seeking barriers experienced by couples with LIEM (e.g., cost, transportation) [18].

Despite the promise of mindfulness for communities with LIEM, research disseminating mindfulness to individuals or couples in this community is in its infancy. Qualitative research exploring perceptions of mindfulness has found that individuals with LIEM believe that mindfulness can improve their mental and physical health and has the potential to enhance their religious and spiritual practices [19]. Post-intervention interviews with individuals experiencing LIEM, who participated in a mindfulness-based stress reduction (MBSR) program, revealed that they applied the mindfulness principles to their daily lives and that these strategies helped reduce their stress [20]. Qualitative research has documented perceived changes in interpersonal relationships, including more assertive communication and increased relationship quality among women with a history of intimate partner violence (IPV) and trauma [21], as well as increased acceptance, awareness, and a deeper connection with their partner following mindfulness-based relationship education (MBRE) for expecting couples across income levels [22].

Qualitative research among underrepresented communities has identified barriers and clinical considerations for using mindfulness when working with specific populations, including prenatal women, victims of IPV, and communities of color [[20], [21], [22]]. Although these studies were not necessarily conducted with communities with LIEM, their findings emphasize the importance of understanding how to adapt mindfulness interventions to fit the needs of the community being served. For example, prenatal women reported that their “commute/traffic” and “competing schedules” were barriers to practicing yoga [23]. Another study conducted among women with IPV and trauma identified two potential barriers to disseminating mindfulness to this community: (1) the participants were skeptical that mindfulness could be helpful to them and (2) they had difficulty attending to their internal experiences; however, the authors noted that these barriers were less significant over time [21]. Another qualitative study that examined attitudes of African American women following a four-week mindfulness-based intervention for individual health emphasized necessary clinical adaptations, such as having African American facilitators, fostering self-empowerment, and utilizing storytelling [24]. Similarly, when using mindfulness among Latinx communities, researchers note the importance of adaptations like modifying language to be more culturally appropriate, using culturally relevant narratives and metaphors, and adapting concepts to incorporate other cultural aspects related to this community [25]. For Native American communities, Proulx and colleagues emphasized the importance of developing strong community networks grounded in trust before introducing interventions [26]. They argued that interventions should be introduced collaboratively and receive regular input from the community for guidance on language within the informed consent process and intervention. Despite these findings demonstrating the importance of cultural adaptation, considerations for using mindfulness with communities with LIEM have yet to be established.

While the accessibility and ostensible utility of mindfulness may make it an ideal intervention for communities with LIEM, mindfulness interventions adapted for these communities are limited, and specific adaptations for using mindfulness with this community are needed for optimal treatment outcomes. Most mindfulness-based interventions were developed among individuals with higher income, which lack the narrative, or lived experiences, of individuals with LIEM. Thus, understanding how individuals with LIEM experience mindfulness is essential for developing mindfulness-based interventions tailored for this community. In doing so, the challenges associated with using mindfulness and acceptance-based approaches with under-resourced communities should be considered [27]. For example, individuals with LIEM face a multitude of daily contextual stressors which may make it difficult to attend to, or accept, their experiences as they are, especially if these experiences are inherently negative or painful. Individuals with LIEM may also display some resistance to the construct of valued living, or living consistently with one's values, and exploring what it means to not act in accordance with one's values [28]. For individuals with LIEM, it may be more critical to focus their efforts on meeting their basic needs, even if this does not align with their values. Further, case examples have identified that individuals from under-resourced communities may have concerns about how mindfulness might contradict their religious values [27].

Although qualitative research has documented that individuals with LIEM believe mindfulness to be useful and can apply principles of mindfulness to their daily lives [19], other considerations for adapting mindfulness for individuals with LIEM remain [27]. There is a need for mindfulness interventions to be adapted for individuals with LIEM in order to improve treatment efficacy and reduce health inequities in this community [29]. Consulting and collaborating with individuals experiencing LIEM about their perceptions of mindfulness and how to best disseminate mindfulness would allow for richer adaptations of mindfulness-based interventions for this community.

We used a community-based participatory research (CBPR) approach [30,31] and a series of focus groups to understand how individuals with LIEM cope with stress, how they perceive mindfulness, and how to reduce barriers to their participation in a brief mindfulness-based intervention. CBPR methods consider community members as “partners” rather than “subjects” and use their experience to inform intervention development, recruitment, and delivery [32]. Using this approach, we collaborated with individuals with LIEM in the community to develop an intervention (i.e., centering the community and learning from them) rather than imposing specific protocols that have been validated among individuals with higher income who may have different life experiences than individuals with LIEM [29]. The present study conducted focus groups to understand this communities’ experiences of stress and perceptions of mindfulness. Then, we sought to apply what was learned from these focus groups to established models for working with couples with LIEM (e.g., brief intervention, flexible delivery) to develop a brief, couple-based, mindfulness intervention for individual stress that would be disseminated to couples with LIEM experiencing stress. That is, the dyad would act as a vehicle to enhance and maintain improvement in individual stress and well-being. The present focus groups addressed four research questions (RQ):

RQ1

How do individuals with LIEM cope with stress?

RQ2

How do individuals with LIEM perceive mindfulness?

RQ3

How do individuals with LIEM experience mindfulness upon the completion of a brief mindfulness practice?

RQ4

How can a mindfulness-based intervention address common barriers to care experienced by individuals with LIEM?