A Qualitative Multicenter Study of Participant Experiences With an App-Based Mindfulness Intervention (Lift 2) for Critical Illness Survivors

IMPORTANCE: Persistent physical and mental health symptoms are common among ICU survivors and pose barriers to recovery. A randomized clinical trial of an app-based mindfulness intervention (Lift) for ICU survivors suggested improvement in mental health symptoms; however, participants' perceptions of the intervention and its influence on their recovery is unknown. OBJECTIVES: We sought to understand ICU survivors' perspectives on how the app-based mindfulness intervention influenced their recovery and identify potential mechanisms by which it influenced their physical/mental health symptoms. DESIGN, SETTING, AND PARTICIPANTS: This is a preplanned qualitative study of participants in the Lift 2 clinical trial at three academic medical centers between 2019 and 2023. We performed semi-structured interviews (from March 2024 to June 2024) of adults who survived an ICU stay for acute cardiorespiratory failure and completed the 1-month mindfulness program (n = 85), purposively sampling the twice-daily meditation group. ANALYSIS: We used a combined deductive/inductive approach to identify factors influencing the perceived effectiveness of the mindfulness intervention and general facilitators of recovery. RESULTS: Nineteen participants were enrolled, including six women (32%). Median age was 60 years (interquartile range, 43-66 yr). We identified themes related to participants' perceptions of the intervention and its influence on their recovery, leveraging the Who-What-When-Where-Why-How framework to organize results. Themes included: a) participants' receptiveness to mindfulness influenced their perceptions of its benefit ("who"); b) breathing exercises and mindfulness videos were considered the most useful content ("what") given their positive impact on mind/body connection; c) participants described perceived reductions in dyspnea and hypertension ("why") after using the app; d) the app-based intervention was feasible and easy to use ("how"); and e) integration of mindfulness with other rehabilitation techniques was synergistic and facilitated recovery ("where/when"). CONCLUSIONS: This qualitative study identifies potential mechanisms by which an app-based mindfulness intervention improved mental health and reduced physical symptom burden as perceived by ICU survivors. It also informs the development and implementation of future interventions to improve recovery from critical illness.