Acceptability is an important element to consider when assessing the implementation of a new treatment; without establishing strong acceptability, new interventions can be costly to patients, providers and institutions,  and result in low adherence and participation . Adolescent mental health treatment adherence is often challenging, [34–36] which makes it even more important to identify engaging interventions. Results from our study suggest that MBSGs may be an acceptable treatment for adolescents coping with depression. In light of positive improvements in depression,  adolescents in our study also reported positive perceptions of the MBSGs. These groups provided useful strategies to help combat depressive symptoms and also generated a sense of belonging and connectedness with others. After the intervention, adolescents reported several positive outcomes related to the group. For example, many adolescents reported feeling more positive, hopeful, and valued as an individual, while also feeling less isolated, depressed, and suicidal. Positive emotions, such as hope and connectedness have shown to be inversely related to depression, [37–39] and also predictive of life satisfaction, high self-esteem and optimism [40,41]. Results from our study reinforce the significance of eliciting trust, hope, and social connection when establishing acceptability of behavioral health treatments for youth.
Our results also found that a small number of adolescents reported disliking the groups, primarily because of specific activities practiced in the group. Yet others identified some of the same activities as beneficial. This reinforces the idea that offering different techniques – rather than focusing on one modality – can be beneficial. Offering a diverse array of practices in one comprehensive package ensures that every individual can explore and determine which techniques are most useful and appropriate for their personal needs. A packaged approach, with several types of mind-body practices may be particularly beneficial for youth, given that adolescence is a period characterized by autonomy seeking behaviors and exploration of different identities, values and secular interests [14,42].
Indeed, the nature of adolescent development and the heightened sensitivity for social influence during this time, is complex. Therefore, it is imperative to provide treatments that complement the developmental challenges experienced during this transitional period . MBSGs help facilitate developmental needs by providing adolescents the autonomy to choose which self-care techniques they prefer, and ultimately allow them to learn more about themselves and their treatment preferences. Additionally, a strength of the MBSGs is its ability to elicit a therapeutic partnership between group members and facilitators. Group facilitators provide didactic instruction to educate and support adolescents; yet, also refrain from threating an adolescents’ authority. Support for this can be found in our study results, in which several adolescents reported that the MBSGs were important and interesting because it provided a safe space to develop individualistic ideas and friendships. Therefore, the blend of didactic and interactive instruction, along with the strong emphasis on treatment preference autonomy, may help explain why adolescents found this treatment acceptable. Moreover, the program’s ability to foster social support and positive relationships appeared to be a reoccurring and important theme during interviews. Cultivating strong social support in healthcare settings has been linked to increased treatment adherence,  and research finds that social support can also positively impact health outcomes related to depression [45,46]. Thus, another plausible explanation to the treatment’s acceptability could be related to the social connections with others in the MBSGs - which may have also helped improve symptoms related to their depression .
Although the majority of adolescents in our study had positive things to say about the program, some participants did suggest areas of improvement for future development. Feedback frequently included discussions about the timing of the groups, when the groups occurred, and how long the groups lasted. Some adolescents reported concerns about the groups taking place after school, mainly because of transportation and interference with after school activities, which are common barriers to adolescent treatment adherence . Efforts should be made to help accommodate family needs by ensuring programs are highly accessible in a variety of locations, times, and formats. It was also suggested that the length of the groups be extended, as a few participants disclosed that they felt rushed for time. Feedback for ways to improve this area included having groups meet longer than 10 weeks, meet longer than 1.5 hours, or meet twice a week. This finding is encouraging given that adolescents may be challenging to engage in treatments,  and suggests that at least for some participants, extended time would be helpful for learning the mind-body practice.
Lastly, given the large proportion of Hispanic/Latinx youth in our sample, MBSGs may be particularly promising for engaging the Hispanic/Latinx community. Hispanic/Latinx youth are more likely to experience depression, compared to other races or ethnicities, [49,50] yet are less likely to engage in mental health treatments . Research on culturally sensitive, tailored interventions for this population is still in its infancy, although preliminary evidence has shown the clear benefit of interventions that resonate with core values held by Hispanic/Latinx groups [51,52]. For example, group-based therapy like MBSGs may resonate with Hispanic/Latinx populations due to this culture’s embrace of collectivist ideologies and togetherness, called familismo [53,54]. Considering that participants in our study were largely Hispanic/Latinx and female - and that engagement and acceptability within our study was strong - our results may provide preliminary evidence that MBSGs are acceptable for this vulnerable population.
This pilot study begins to establish acceptability of MBSGs as an intervention in primary care for adolescents with depression. However, results should be interpreted with caution. Given the relatively small and uniform sample - primarily female (79%) and Hispanic/Latinx (67%) - who were recruited from three clinics in one centralized hospital system, our findings may not generalize to all adolescents seeking mental health treatment in primary care. Larger scale studies, with more diverse samples and settings are needed. Future studies should also consider acceptability of MBSGs from other stakeholders, such as clinicians who deliver the treatment or from parents/guardians of adolescents receiving the treatment. Adolescents are embedded within a larger system, and other stakeholder views will be important for future implementation efforts. Finally, our investigation was limited by measurement concerns. Data came from four open-ended questions that covered basic domains of acceptability and did not include more in-depth questioning about their experience. Although interviewers were independent of treatment providers, participants may have wanted to please the interviewers given these were the same people who recruited and initially interviewed them.