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Gen Hosp Psychiatry. 2015 Mar-Apr;37(2):166-71. doi: 10.1016/j.genhosppsych.2014.11.013. Epub 2014 Dec 10.

The implementation of mindfulness in healthcare systems: a theoretical analysis.

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Department of Preventive Medicine, "Mente Aberta" - Brazilian Center for Mindfulness and Health Promotion, Universidade Federal de São Paulo, São Paulo, Brazil.
Department of Basic and Clinical Psychology and Psycholobiology, Universitat Jaume I, Castellón, Spain; CIBEROBN Fisiopathology of Obesity and Nutrition, ISCIII, Santiago de Compostela, Spain.
Department of Psychiatry, Miguel Servet University Hospital and University of Zaragoza, REDIAPP, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. Electronic address:



Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare.


This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models.


We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care.


In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way.


Healthcare systems; Implementation; Mindfulness; Primary Care; Stepped-care model

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