Evaluation of the Implementation strategy and outcomes of a 5-week mindfulness-based self-leadership training (MBSL-Training) with physiotherapy students: A mixed-methods study

Background Mental health concerns are rising among university students, particularly those in health professions who experience exam stress, performance pressure, and difficulty balancing academic, work, and personal life demands. Evidence-based curricular programs for stress prevention and mental health promotion in this population barely exist. To address this, a 10-hour Mindfulness-Based Self-Leadership training (MBSL- Training), based on established mindfulness and self-leadership principles, was delivered over five weeks. After pilot refinement with physiotherapy students, this study evaluated the implementation outcomes, including feasibility, appropriateness, acceptability, fidelity, outcome expectancy, and implementation barriers and facilitators. Methods From February to June 2024, 44 sixth-semester physiotherapy students at a university of applied sciences participated in the voluntary MBSL-Training, which was integrated into the regular teaching schedule to facilitate access. The convergent mixed-methods design featured two measurement timepoints. Quantitative data included demographics and validated instruments for primary outcomes, while qualitative insights were obtained through responses to four open-ended questions regarding the integration of MBSL-Training into daily life. Descriptive statistics for the quantitative data were calculated while the qualitative data were analysed using content analysis. Results Implementation was positively evaluated, with average scores (on five-point scales) of 3.89 for acceptance, 4.09 for appropriateness, 4.08 for feasibility, and 4.13 for fidelity. Outcome expectancy (seven-point scale) for future stress management and well-being was rated at M = 5.00 for remaining study duration and M = 4.97 for anticipated career settings. Facilitators included reminders, intrinsic motivation, routine establishment, flexibility, and perceived effectiveness of MBSL-Training. Obstacles comprised time constraints, poor time management, forgetfulness, mental state, and lack of routine or discipline. All participants recommended the program, noting improvements in well-being, stress management, professional readiness, requesting earlier integration, more exercises, and additional support. Conclusions The five-week MBSL-Training showed strong implementation results, with students reporting significant perceived benefits for future stress management in academic and professional contexts. However, evaluation was limited by the study's specific setting and small sample size, restricting analysis of the program’s impact on stress and mental well-being. A forthcoming randomized controlled trial with an active control group is planned to address these limitations and provide more robust evidence for practical application.