# Developing a mindfulness program for pre-clinical medical students in Indonesia: a mixed-methods study on suitability and appropriateness

## TL;DR

This study developed and evaluated a mindfulness program for Indonesian pre-clinical medical students to address their mental health challenges and found it to be culturally appropriate and feasible.

## Contribution

The study introduces a culturally adapted mindfulness program tailored for Indonesian pre-clinical medical students using a user-centered design approach.

## Key findings

- Interest in the program increased with iterative refinements, with moderate to high engagement reported.
- The program was seen as highly relevant to students' academic and personal challenges, especially stress and communication.
- Participants were likely to apply mindfulness practices like S.T.O.P. meditation and journaling in their daily lives.

## Abstract

Medical students experience high rates of psychological distress, including depression, anxiety, burnout, and suicidality, due to rigorous academic demands. Mindfulness-Based Interventions (MBI) have demonstrated small-to-moderate effectiveness in reducing stress and improving well-being, yet culturally adapted and developmentally appropriate programs for Indonesian medical students remain limited. This study aims to develop and evaluate the Mindfulness Program for Pre-Clinical Medical Students in Indonesia (MPPMS-I) to determine its feasibility, acceptability, and suitability in addressing the mental health needs of pre-clinical medical students.

This study employed a convergent mixed methods approach guided by the User-Centered Design (UCD) framework which emphasized iterative development based on user feedback. First-, second-, and third-year pre-clinical medical students were recruited between May and July 2024. The study was conducted in three iterative phases, each involving different participant groups to refine MPPMS-I: Phase 1 assessed initial impressions and interest, Phase 2 evaluated program relevance and clarity, and Phase 3 gathered detailed feedback on individual sessions to finalize the module. Quantitative analysis examined participant characteristics, interest levels, program relevance, applicability of learned concepts, and instructional clarity. Qualitative analysis were analyzed using framework analysis to explore themes such as participants’ first impressions, key lessons learned, beneficial aspects, daily integration of mindfulness practices, and barriers and facilitators to participation. Dual coding was used to enhance trustworthiness.

Findings revealed three key insights: (1) a moderate and rising level of interest (mean range: 5.75 to 6.6), supported by qualitative feedback indicating increased engagement following iterative refinement; (2) The program was perceived as highly relevant to students’ academic and personal challenges, particularly around stress, perfectionism, and communication; and (3) Participants reported a high likelihood of applying what they learned, such as mindfulness practices like S.T.O.P. meditation and journaling, into their daily routines.in their daily lives. Themes of relevance, practical benefit, and cultural fit emerged prominently in qualitative feedback.

This study suggests that MPPMS-I is a feasible, culturally appropriate, and suitable intervention for pre-clinical medical students in Indonesia. Participants found it helpful for stress management, personal growth, and improving communication. As the program remains in an early evaluative phase, future research should include a longitudinal pilot study involving clinical students and assess long-term outcomes. Integrating MPPMS-I into medical curricula could offer a sustainable and context-sensitive approach to enhancing student well-being and resilience.

Not applicable.

The online version contains supplementary material available at 10.1186/s12909-025-07642-5.