Psychological Therapy for ICT Literate Older Adults in the Time of COVID-19: Perceptions on the Acceptability of Online Versus Face to Face Versions of a Mindfulness for Later Life Group

The current study assesses the acceptability of an online mindfulness group for older adults...

The evidence base for the acceptability and feasibility of online interventions for older adults is promising but limited. Elsegood and Powell [14] surveyed 60 adults using mental health services, aged over 65 with anxiety and/or depression and found that 45% were interested in online CBT. Dear et al. [15] find that online CBT is beneficial for those over 60 years of age with anxiety and/or depression and results in significant reductions in symptomatology.
As Xiang et al. [16] note in a recent meta-analysis, studies of this type tend to have reasonably small participant samples and reinforce the need for further investigation. populations (e.g. Future Learn [18]). The current study aimed to understand whether there is demand for an online mindfulness for later life group in older adults who use ICT, whether there is a preference for face to face mindfulness therapy, and whether age and gender impact on this. It also asks respondents to give the reasons why they find online mindfulness therapy acceptable or

Participants & Recruitment
The data were collected as part of a service development programme for the Gatehouse Charity in East Anglia in response to COVID-19. A database of local services, social and healthcare groups that typically cater for older adults was collated. These included local older adult charities, peer support groups e.g. stroke peer support groups; University of the third age; local commissioning group contacts. A newspaper article was also published in the local press, and notices added to local village newsletters. The link to the study was found on the Gatehouse charity's website. The recruitment information given to respondents was that the online for later life mindfulness group was for people aged 65 years and over, and that people could participate individually or as part of a couple. Respondents were told that the Mindfulness for Later Life groups were originally proposed as face to face groups, to run in late spring 2020. But given the current COVID-19 restrictions, we were gauging interest for delivering them online. It was explained that the content of the group is based on the Mindfulness Based Stress Reduction programme developed by John Kabat Zinn, and that the format would involve six weekly meetings via Zoom, audio recordings of the practices and handouts to download. Participants had a three-week window in which to respond to the questionnaire.

Data Collection
The questionnaire was programmed and delivered through Qualtrics XM. Participants were asked to provide their age and gender. Responses were formatted on a five point likert scale with response options ranging from: 'definitely yes' to 'definitely not'.
The responses were anonymous. The questions used and response options are available here: https://openss.qualtrics.com/jfe/form/ SV_2sm4eIqItwaHbOl

Results
In total, 36 people (15 Male, 21 female) responded to the survey, the average age of respondents was 70 years (std dev = 4.46, range 65-80 years).

Frequency data for acceptability of online, and preference for face to face mindfulness groups
As the survey was only offered online, respondents were necessarily people with computer access. Of these, the majority (73%) wanted to attend the online mindfulness for later life group, 13% did not and 14% were undecided. With regards to a face to face group, 39% prefer a face-to-face group, 34% said they would not, 23% were undecided and 4% did not respond.

Associations between age, gender and acceptability of online or preference for face to face mindfulness groups
Of the respondents, 17 were age 65 to 69; 10 were aged 70 to 74 and nine were 75 to 80+ years. There was no significant association between age group and the acceptability of online mindfulness therapy χ 2 (8) = 5.25, p = .73, ϕc = .27. There was a significant association with regards to the age group and preference for face to face interventions, χ 2 (8) = 17.76, p = .023, ϕc = .50. Further analysis showed that people in the 75-80 age group were more likely to use the 'probably yes' or 'probably not' options, whilst those in the 65-69 group were more likely to use 'definitely yes' or 'definitely not.' There was no significant association between gender and acceptability of online therapy χ 2 (4) = 4.33, p = 0.36, ϕc = =0.35; or preference of face to face groups χ 2 (4) = 8.34, p = 0.08, ϕc = 0.48.

Qualitative Data
Participants were asked 'What is your main reason for wanting to attend the online mindfulness for later life group?' and 'If you don't want to attend, please tell us why?" There were 27 responses to the first question, and nine to the second. Responses were analysed using thematic analysis [19]. Under participant's reasons for attending the group five themes were noted which accounted for all the responses. These related to mental health, wellbeing, COVID-19, reviving an existing mindfulness practice and personal interest.

Mental Health:
Either improving or maintaining mental health was a common reason for attending the group. The mental health difficulties identified by participants were anxiety, depression or stress: "I have had depression before, so it would be a strategy to learn to help overcome this" "I am affected by anxiety and stress".

Well-being:
Reasons relating to wellbeing typically spoke of wanting to attain, achieve or improve a positive mental state: "To achieve contentment in life" "To aid going forward in tranquility".

COVID-19:
Several participants gave responses which reflected the unique "I did go to the Buddhist centre for a term years ago and found it useful but would prefer to try it at home".

Personal Interest:
Here, participants tended to express an intellectual interest in mindfulness; in the ideas of it or learning more about it: "Interested in the idea" "I wish to learn more about mindfulness".
Of the participants who did not want to attend a face to face or online mindfulness group the following themes emerged: No benefit, no need, online format and already meditate.

No benefit:
For this theme participants were either sceptical of the benefits of mindfulness generally, or for themselves in particular: "Not sure I would benefit from it" "Not convinced about the effectiveness of mindfulness".

No need:
Two participants stated that they did not feel any need to try mindfulness, either in general, or at the current point in time: "I am comfortable with myself as I am" "I don't feel the need to at this point in time".

Online Format:
One participant stated that they did not want to attend due to concerns over the technology used: "On line meetings can be disrupted by the internet when it is busy".

Already Meditate:
Two participants were already meditating, and so did not feel that they needed to attend the group: "I have already undertaken a mindfulness course. But I think it's a brilliant idea, thank you!".

Discussion
In this study, an online mindfulness for later life group was acceptable to 73% respondents. There was a small difference between the number of people who stated that they would prefer a face-to face-group (39%) compared to 34% who would not.
There was no association between the acceptability of the online intervention, or preference for a face to face intervention with age or gender. These findings challenge the widespread assumption that older adults are both unable and unwilling to engage with online activities and health interventions [12]. It is not possible to ascertain the degree to which participant's responses were shaped by the context of COVID-19. However, qualitative analysis showed that participants typically gave personal reasons in terms of improvements in mental health, well-being or personal interest, for wanting to attend the group.
Whilst some participants gave COVID-19 and the circumstances surrounding it as their reason, they were not the majority. Indeed, one participant saw COVID-19 in a positive light in providing time to engage in a mindfulness group. Of the participants who did not want to attend the mindfulness group, only one participant stated that this was due to the online format of it. The majority of the reasons were related to mindfulness itself, either not seeing the benefit of it or not feeling a need for it.
The current data strongly speak to the idea that online interventions are acceptable to older adults who have access to online services and that there is not a strong preference for a face to face version of the same intervention. Given the potential negative effects of the extended periods of isolation on older adults during the COVID-19 pandemic [7], the fact that mindfulness was seen as an acceptable intervention by 73% of the participants of this study, favors its potential use.
As Weinberg [20] notes, the pressing issue may in fact be how to meaningfully translate the group therapy format to the screen during COVID-19. For older adults, this may raise unique barriers such as the perceived ease of use, navigation and terminology [21].
These barriers could be tackled by offering training and support to older adults. Physical barriers including diminishing eyesight and social factors such as financial restrictions, might be more difficult to overcome so future research should aim for research which examines these factors, and solutions for them, in order to more robustly bridge the gap between research and practice.
The limitation of the study is that all the respondents had access to a computer and access to online services. We do expect that, for this reason, the results are skewed in favor of the acceptability of the online intervention and future studies may address the barriers to accessing online interventions in the general population.