Mindfulness (2022) 13:1544–1554 https://doi.org/10.1007/s12671-022-01899-3 ORIGINAL PAPER Meditators’ Non‑academic Definition of Mindfulness David Alvear1 · Joaquim Soler2,3 · Ausiàs Cebolla4 Accepted: 20 April 2022 / Published online: 24 May 2022 © The Author(s) 2022, corrected publication 2022 Abstract Objectives Mindfulness has been defined differently in academic scientific contexts and in Buddhist academic contexts. An under-studied area is that of lay (non-academic) theories of mindfulness. The goal of this article is to identify, organize, analyze in detail, and provide themes from the meditators’ definitions of mindfulness. Possible differences and similarities of the collected definitions of mindfulness with the scientific-academic definitions and with the academic-Buddhist defini- tions are also checked. Methods A qualitative and inductive thematic analysis on the definitions of mindfulness offered by the participants was carried out. Results The sample consisted of 326 meditators who offered a definition of mindfulness through an open question. Seven themes were identified: (1) mindfulness defined as attention/awareness; (2) mindfulness defined as a non-evaluative attitude; (3) mindfulness defined as strategy; (4) mindfulness defined from a theoretical analysis; (5) mindfulness defined as a psycho- affective-spiritual state; (6) mindfulness defined as personal development; and (7) lack of understanding of mindfulness. From these themes, it can be deduced that the definitions collected share more patterns of meaning with the scientific-academic definition of mindfulness than with the academic-Buddhist one. Conclusions The findings of this study provide new insights into the complexity and heterogeneity of the definition of mind- fulness. What has been discovered may indicate the complexity of the mindfulness construct itself. Keywords Mindfulness · Lay theories · Qualitative research · Thematic analysis · Meditation In recent decades, mindfulness has been defined in multiple non-judgmentally” (Kabat-Zinn, 1994). Other definitions ways in academic contexts, from a theoretical construct that suggested defining it as a trait. In that case, mindfulness can be measured (Baer et al., 2008; Brown & Ryan, 2003) can be understood as a relatively stable but trainable ability. to a type of meditation practice (Kabat-Zinn, 1994). One of Therefore, a fairly consensual model of trait mindfulness the most accepted definitions in the academic field is the one would have two components (Bishop et al., 2004): (a) self- that understands mindfulness as the ability to “pay attention regulation of attention so that it remains in the experience in a particular way: on purpose, in the present moment, and of the present moment and (b) the deliberate guidance of attention toward one’s own experience while approaching it with curiosity, openness, and an acceptance of bodily sensa- * David Alvear tions, thoughts, and emotions. david.alvear@ehu.eus The role of learning in mindfulness-based intervention 1 (MBI) programs is the acquisition of mindfulness skills Department of Developmental and Educational Psychology, HEFA I, University of the Basque Country UPV/EHU, with the aim of achieving clinical, educational, social, or Office 3B3.3. Avenida de Tolosa, 70. 20018, San Sebastian, emotional outcomes (Crane et al., 2017). Different meas- Spain uring instruments are used to understand the level of trait 2 Servei1Servei de Psiquiatria, Hospital de La Santa Creu I mindfulness and to evaluate the mindfulness competences Sant Pau, Barcelona, Spain acquired by participants (Baer, 2016; Soler et al., 2014). 3 Department of Psychiatry and Forensic Medicine, Universitat Although there are many advantages in using a psychomet- Autònoma de Barcelona (UAB), Barcelona, Spain ric approach to measure mindfulness (e.g., rapid applica- 4 Department of Personality, Assessment and Psychological tion, known methodology, and statistical support) (Sauer Treatments, University of Valencia, Valencia, Spain 13 Vol:.(1234567890) Mindfulness (2022) 13:1544–1554 1545 et al., 2013), numerous criticisms have been associated and dimensions of mindfulness, which would mean refining with how problematic it can be to even define a construct and integrating the complexity of the theoretical definition as complex and with such a particular historical-spiritual itself (Dorjee, 2010). journey as mindfulness, let alone try to measure it using In the case of the Buddhist tradition, the purpose of cul- self-evaluation instruments (Grossman, 2011; Grossman & tivating mindfulness, different from what is proposed by the Van Dam, 2011), or how the verbal nature of the question- mindfulness known in the scientific field, is related to the naires limits their capacity to assess non-conceptual aspects search for liberation or awakening that can annihilate dissat- included in the construct (Tortella-Feliu et al., 2020). One of isfaction (dukkha) (Sayadaw, 2016). Each Buddhist school, the most problematic issues is that the definition of mindful- and even each author within each school, contributes cer- ness is different for each measuring instrument, due to the tain nuances to the definition of mindfulness in numerous different theoretical models underlying each of them. As geographical locations and at different historical moments Grossman (2011) pointed out, one of the possible reasons (Dreyfus, 2011; Dunne, 2015). In fact, the very translation of is that even though an accepted definition, out of the doz- the term sati as mindfulness in the second half of the nine- ens of existing scales, exists by consensus (Bishop et al., teenth century by T. W. Rhys Davis has never been clarified 2004), only the Philadelphia Mindfulness Scale (PHLMS) or justified at a philological level (Gethin, 2011). (Cardaciotto et al., 2008) is inspired by Bishop’s definition. Bhikkhu Bodhi (1993) defines mindfulness (the term sati What happens then is that studies that aim to analyze the in Pali) as “the mental ability to pay attention to physical or correlations between mindfulness scales find that the mean mental events that occur in the present moment.” Anālayo correlation can range anywhere between 0.21 and 0.67 with (2016) proposed a more complex and richer conceptualiza- an average value of 0.43 (Bergomi et al., 2013). One study tion of mindfulness, starting from an analysis based on Pali even reported a total absence of correlations between the discourses from early Buddhism. Anālayo (2016) distin- measurement scales (Thompson & Waltz, 2007). This could guished between different types of mindfulness (e.g., right account for the fact that half of the MBIs failed to detect mindfulness and wrong mindfulness; established mindful- changes in self-reported mindfulness after ending the treat- ness and lost mindfulness) and took a standard definition ment (Visted et al., 2015). of mindfulness as “someone who is aware (mindful) and This abundance of different mindfulness measurement has the ability to remember what has been done or said a scales does not seem to have reduced the problems of valid- long time ago,” although he emphasized that this element ity and reliability of the construct (Grossman, 2019; Tom- of remembering would have to do with episodic memory. linson et al., 2018). In addition, quantitative approaches Levman (2017) gave the memory and recall factor implicit have been criticized and reported to be limited and biased in the term sati a key importance, while Anālayo (2019a) in terms of the significant responses offered when analyzing indicated that in early Buddhism sati is not always under- multidimensional, complex terms with an experiential value stood as memory in terms of thought; in fact, he pointed out (first-person experiences) such as mindfulness (Grossman, that in the context of satipaṭṭhāna meditation, the mean- 2008, 2019). All of this has led to a gradual increase and ing “conscious attention to what is present” offers a bet- a trend toward qualitative research that seeks to enrich the ter fit. Anālayo (2020) himself also differentiated between field of study of mindfulness (Frank et al., 2019). Thus, it is mindfulness and attention and considered them two different possible to offer a greater prominence to the subjectivity of mental qualities, attention being a constantly present mental the meditators or to the complex set of conditions determin- quality, while the mental quality of mindfulness would be ing whether and how the mindfulness training influences intermittent, given that it would have to be activated and the attendees. (Frank et al., 2019; Garland & Gaylord, 2009; cultivated with practice. Based on the Visuddhimagga writ- Tomlinson et al., 2018). ten by Buddhaghosa in the fifth century AC, Wallace (2008) Regarding the problem of defining the construct, Gross- pointed out that sati is characterized by properties such as man (2011) proposed another added difficulty, in which he “not floating,” “not getting lost,” “vigilant,” “being face to pointed out that some authors are not sufficiently familiar face with the object,” or “noticing strongly.” In reference to with the theoretical and practical bases of the concept of “not floating” (apilāpana), Anālayo (2019b) qualifies the mindfulness as presented in the Buddhist tradition. Yet term and provides a historical perspective on the change in another difficulty could be found when trying to unlink a meaning to which it was subjected. The debate surround- single concept (mindfulness) from related concepts belong- ing the definition of mindfulness (sati) in Buddhist tradition ing to a conceptual framework of Buddhist origin at a theo- remains open and with relatively clear socio-cultural influ- retical level (Christopher et al., 2009) and, at the same time, ences (Dunne, 2015). carrying out this terminological decontextualization with At present, the term mindfulness is popular in psychol- different objectives. For this reason, some authors already ogy, psychiatry, neuroscience, and education, and from recommended designing MBIs considering different types there, it has spread first to other scientific fields and, later, 13 1546 Mindfulness (2022) 13:1544–1554 to the rest of society via mass media, internet, non-fiction mindfulness meditation. Each practitioner experiences dif- literature of an informative nature, and social networks (Van ferent variables from aspects that are ineffable or difficult to Dam et al., 2018). We could therefore justify that a large part label through language. For example, the practice of mind- of the Euro-American population has their own definition, fulness can modify factors such as the subjective experience a lay definition, of what they understand by mindfulness of time (Droit-Volet et al., 2018). The meditating subject (Choi et al., 2021). is immersed in a meditative tradition and in a culture that Lay theories are the informal theories that people (not sustains and contextualizes the subjectivity of the experience academically specialized in a certain subject) use in their itself (Reddy & Roy, 2019). Since Varela & Shear (1999) daily lives to explain different phenomena and their causes promoted first-person approaches in the contemplative sci- and consequences (Furnham, 1988; Levy et al., 2006). These ences, several authors have stressed the need to integrate lay theories serve as frames of reference that influence the first-person and third-person research in this type of science processes of perception, interpretation of information, and (Hadash & Bernstein, 2019). prediction of events and, consequently, also people’s choices This interest in first-person experiences has led to quali- and behaviors (Furnham, 1988; Levy et al., 2005). Normally, tative methodology studies that prioritize the narrative- lay theories are not based on scientific research, not even experiential basis and the phenomenological aspects of the on a systematic study of the phenomenon in question, but meditator. Therefore, this study can be considered an initial are rather nourished by stereotypes and everyday beliefs qualitative approach with the aim of understanding and ana- (“everyone knows that ...”) (Ritter & Rietzschel, 2017). lyzing, in a thematic way, the experimental, semantic, and Lay theories can be found everywhere, implicit in every- phenomenological richness of the definitions of mindfulness day conversations between people, in non-scientific written in Spanish-speaking meditators. publications (books, newspapers, web pages), in the media, on social networks, etc. When comparing lay theories with scientific theories, lay theories are not explicit, lack coher- Method ence and consistency, give more importance to content than to process, and tend to confuse correlation with causality Participants (Furnham, 1988). For this reason, it is difficult to use the term lay “theory” as we understand it in science, as they are A total of 326 participants completed the questionnaire, of rather a dynamic group of implicit beliefs used systemati- which 325 (99.7%) responded to the open-ended question cally to explain and predict certain phenomena. There are to be analyzed. Responses that did not adhere to the open- several similar psychological terms such as implicit theories, ended question were not detected, so all 325 definitions were lay theories, folk psychology, common-sense psychology, analyzed. The mean age of the sample was 50.2 years (SD = or mindset. In this article, they will all be represented by 10.6, range = 25 to 74) and 72.7% were women. All partici- the term lay theory, lay in the sense of contrary to expert or pants had meditated or practiced mindfulness; 23.6% cur- scientific, every day, non-specialist beliefs of most people on rently did not meditate regularly, 13.8% had been meditating a subject, in this case mindfulness. By theory, we understand regularly for less than a year, 20.2% had been meditating that there is a certain interconnection between these ideas between 1 and 3 years, 26.1% had been meditating regularly about mindfulness. for 4 to 10 years, and 15.6% had been meditating regularly There is a wide body of literature that refers to lay theo- for more than 10 years. A total of 63.7% of the sample that ries, as opposed to academic ones, on various psychologi- meditated regularly indicated that mindfulness was the type cal phenomena (Furnham, 1988). Regarding mindfulness, of meditation that best suited their practice. Regarding the lay beliefs of attention and awareness have been previously type of meditative practice, 63.7% practiced mindfulness, addressed to understand their implication in the workplace 4.6% practiced Zen, 4.3% practiced Vipassana, 2.8% prac- (Kong & Jolly, 2019). However, the debate on the suitabil- ticed a combination of mindfulness with another type of ity of the dichotomy between lay and scientific expertise is meditation, 2.5% practiced Yoga, 1.8% practiced Christian open. There are authors who, in the case of mindfulness, meditation or prayer, 1.5% practiced Buddhist meditation classify it as problematic; they consider it highly question- (generic), and 12.9% practiced another type of meditation. able that expertise (in contrast to lay perspectives) evolves only through academic engagement (Grossman, 2019). Procedure The definition that each person has of mindfulness can have a direct impact on their own mindfulness practice, on An online questionnaire was developed on a commer- the level of adherence to the practice, and on the results from cial platform (https://​docs.​google.​com/) and distributed the practice itself. Subjectivity and the preponderance of through various websites and social networks in Spanish first-person experiences have been a prominent element in on mindfulness and meditation. The participants were 13 Mindfulness (2022) 13:1544–1554 1547 informed about the research and invited to participate in or qualitative methods. The six phases of analysis that were the study to “understand your opinion regarding mind- carried out are the following (Braun & Clarke, 2006): fulness and meditation.” The date was processed anony- mously and in accordance with the Spanish Data Protec- (1) Data familiarization: reading and rereading all the tion Law. The link was available for 3 weeks (from April answers to the open-ended question and taking notes 15, 2020, to May 6, 2020). of the general ideas (2) Initial code creation: all relevant words, phrases, or paragraphs (units of meaning) that were related to the Measures research question were extracted and coded. This code was a brief labeling that captured the essence of the The questionnaire in its extended version contained con- unit of meaning. The codes were then organized in a textual data related to meditation practice and sociodemo- specific code table graphic variables, as well as other types of open-ended ques- (3) Theme search: codes compilation on possible themes tions on contemplative sciences. To achieve the objectives and gathering of all relevant data for each theme proposed in this study, we analyzed the following open- (4) Theme review: The themes were reviewed and organ- ended question: “Using your own words: How would you ized in a coherent pattern. A consistent pattern includes define mindfulness?” The answer did not have any character internal homogeneity (e.g., codes are conceptually inte- limitation and each participant could develop the answer grated in each theme) and external homogeneity (e.g., freely. We have assumed that the responses to this open- there is a clear distinction between themes). The team ended question reflect the most important definition, con- subsequently re-examined all definitions as a whole to cepts, and narratives regarding what participants understand ensure that all relevant units of meaning were captured by mindfulness. by one of the themes (5) Theme definition and naming: constant analysis to adjust the details of each theme and creation of clear Data Analyses definitions and names for each theme (6) Report: Finally, an academic report on the analysis was This research was carried out following the interpretive written with detailed information on each theme. paradigm, focused on the study of the meanings of human actions and social life, that is, the interpretation that social Reliability was obtained with two evaluations. The first actors make of their “reality,” and emphasizes the research- was based on expert judgment, following reflection, discus- er’s process of understanding to try to interpret the meaning sion, and criticism (Ahuvia, 2001) with an international spe- of their actions (Daly, 2007). According to Willis (2007), cialist. The second was obtained through agreement between the interpretive paradigm is in favor of qualitative methods, the coders and was the product of systematic reflections to given that they can offer a more profound approach when define and establish the codes (subcodes) and categories it comes to understanding how human beings interpret the (subcategories). Validity was obtained during this agreement world around them. between the coders, in which an external coder assigned the In the present work, a qualitative analysis with a par- same analysis codes in the same categories according to the ticularly inductive character was chosen to search for the coding carried out by the research team (Vaismoradi et al., data’s underlying categories. A bottom-up approach to the 2013). data analysis was used, with the authors primarily using the data obtained from the participants’ responses. To ana- lyze the answers to the open-ended question, we used the Results method employed in thematic analysis. This method makes it possible to identify, organize, analyze in detail, and pro- The thematic analysis carried out based on the 325 defini- vide patterns or themes from a careful reading and reread- tions of mindfulness derived from the open-ended question ing of the collected information, and thus infer results that “Using your own words: How would you define mindful- promote the adequate understanding/interpretation of the ness?” offered seven main themes: attention/awareness, non- study’s phenomenon (Braun & Clarke, 2006). In this way, evaluative attitude, strategy, theoretical analysis, psycho- we followed a systematic process to find response patterns affective-spiritual state, personal development, and lack of or themes embedded in the narrative of the responses. The understanding (see Table 1). Each theme is described below. data analysis was carried out by two members of the team, scientific psychologists who are experts in mindfulness and/ 13 1548 Mindfulness (2022) 13:1544–1554 Table 1  Summary of themes Themes Subthemes and subthemes obtained regarding the lay definition of Mindfulness defined as attention/awareness Attention to the present mindfulness Full awareness “Atención plena” (synony- mous definition) Presence Attention when doing Attention with intention Being aware/noticing Attention to different phenomena (breath, body, thoughts, or emotions) Observing Remembering Concentration Mindfulness defined as a non-evaluative attitude Non-judgmental attitude Acceptance and equanimity attitude Curious attitude Kind and/or compassionate attitude Mindfulness defined as strategy Strategy to regulate emotions or the mind Strategy to regulate attention Mindfulness defined from a theoretical analysis General theoretical analysis Technical theoretical analysis Mindfulness defined as a psycho-affective-spiritual state A state of well-being A psychological state A spiritual state Mindfulness defined as personal development Lifestyle Self-knowledge Connection with oneself Connection with the environment Lack of understanding of mindfulness Total or partial ignorance Mindfulness defined as attention/awareness numerous nuances in the more than 300 definitions covered by this theme itself lead to a distinction in a large number of In this theme, the main and transversal element is that of subthemes. Thus, there were definitions that highlighted the attention. A large majority of the sample defined mindful- aspect of a spatio-temporal setting (n = 43) with expressions ness as attention, especially as “paying attention to the pre- such as “here and now,” and others that gave it a different sent moment” (n = 191). Understanding that the subthemes nuance by using “presence” (n = 12). Quite a few people are essentially themes within a theme, ten subthemes were chose to define mindfulness with a synonym such as the identified in the theme mindfulness defined as attention/ term “atención plena [Spanish for mindfulness or full aware- awareness: attention to the present, full attention, pres- ness]” (n = 41). Some participants were more specific and ence, attention when doing, attention with intention, being spoke of being focused and aware when doing (something) aware/noticing, attention to different phenomena, observing, (n = 17), and one participant pointed it out as “being in what remembering, and concentration. you do.” Other members of the sample went a little further Some of the participants expressed their attention to the into detail and defined mindfulness directly as “concentra- present moment in a terminologically close way but with tion” (n = 10), “concentrating on the present.” qualitative nuances that we consider important to highlight. Definitions were also detected that, without explic- In this theme, we wanted to highlight that what may appear itly using the term attention, indicated verbs with a visual to be concepts that are linguistically close (e.g., “attention sensory basis such as observe, see, or look (n = 10) (e.g., to the present” vs. “full attention”), at a semantic and even “observe what is there”). Some indicated an attention with axiological level, have differential characteristics that justify an intention (n = 13), an attention that implies a certain will. that we have created numerous subthemes. We are aware In this regard, one person wrote, “paying attention delib- that when doing thematic analysis, the subthemes generally erately,” and another indicated, “paying attention with the should be used sparingly, only when there is one particular intention to do so.” element of a theme that has a particular focus, is notable, Multiple definitions were found that referred to attention and/or is particularly important for the research question. paid to different phenomena such as “attention to breathing” However, we believe that the idiosyncrasy, breadth, and (n = 9), “attention to thoughts or mind” (n = 14), “attention 13 Mindfulness (2022) 13:1544–1554 1549 to emotions or feelings” (n = 14), or “attention to the body” control, although the approach to what type of regulation (n = 21). One person defined it as “becoming aware of the strategy involves mindfulness is diverse. Some did propose sensations of your body when you notice them.” a clear definition of mindfulness as an element of emotional It is important to highlight that part of the sample, instead regulation (n = 7), “it is a set of skills for managing the of (or in addition to) defining mindfulness as attention, pre- mind and emotions,” while other definitions suggested that ferred to use the term “being aware” (ser consciente in Span- mindfulness regulated emotions by being a thought-avoid- ish) (n = 63) or “noticing” (darse cuenta in Spanish) (n = 9), ance strategy or a “not thinking” strategy (n = 6), “it serves which, as we understand it, offers a phenomenologically and to stop automatic thoughts” or “it seeks to stop the mental epistemologically differential nuance of how one relates to chatter.” Something terminologically close came from the one’s experience. One person spoke of “simply being aware one that understood it as a calm or, even, an “emptying the of what arises,” and another pointed it out as “becoming mind” (n = 6); one person defined it as “a way of quieting aware of everything that is happening at all times.” the mind.” Other proposals in these lines of emotional/men- Finally, there was a way to define mindfulness from an tal regulation would be those that understood mindfulness attentional aspect but with an evident memory weight; it is as “stopping” or “a way to stop” (n = 6), and as a strategy what we have called “remembering” (n = 2), and one subject to let go and/or release (n = 6). One participant expressed it defined it as “remembering to pay attention.” as “free your mind,” and another suggested that it involved “constantly letting go from attention the objects that appear Mindfulness defined as a non‑evaluative attitude in one’s consciousness.” Some participants understood mindfulness as a strategy based on disidentification (n = Part of the definitions of mindfulness implied an attitude, a 6). One said that mindfulness was “(paying attention to the way of coping, a concrete way of relating to what is expe- mind) without identifying with the contents.” And others rienced. We called this theme non-evaluative attitude. Four understood it as an aid to act (n = 4), “a state that predis- subthemes were detected within this theme: non-judg- poses one to action,” or even for “mind control” (n = 2). mental attitude, acceptance and equanimity attitude, curi- The second subtheme detected within this theme was ous attitude, and kind and/or compassionate attitude. The mindfulness understood as a strategy to regulate attention (n “non-judgmental” attitude stands out (n = 47) within this = 10). Here, the participants highlighted the capacity offered non-evaluative attitude theme. This type of attitude implies by the practice of mindfulness to not direct attention to the approaching what is experienced without judgment, or, at past or to the future and to focus attention on the present, least, with as little evaluation as possible. offering special emphasis on the process itself, “being really The acceptance or equanimity attitude (n = 34) implies in what I am and, when I’m leaving, becoming aware that another way, perhaps more passive and receptive, of carry- I have gone.” Another one added importance to the ability ing out this non-evaluative attitude, as one person pointed to direct attention at will, “the ability to direct attention to out “accepting what comes.” On the other hand, the curious what is wanted.” attitude (n = 10) could indicate a more active and inquiring approach to what is experienced, as one participant reported Mindfulness defined from a theoretical analysis “paying attention with curious interest.” Finally, the atti- tude of kindness and/or compassion was also indicated with There were participants who chose to define mindfulness a more affective basis (n = 22). One participant said that by carrying out a theoretical analysis, reflecting and pro- mindfulness meant “bringing attention to the present in a viding a conceptual description of the term. In this theme, gentle way.” we detected two subthemes: a general theoretical analysis that each person offers from their meditation and contextual Mindfulness defined as strategy experience, and a more defined theoretical analysis in which mindfulness is analyzed from a more technical and concrete Another different way that the participants chose to define perspective. mindfulness was to understand it as a strategy. In this case, In the subtheme of the general theoretical analysis (n = the meaning of mindfulness was no longer considered a 11), the diversity in the approach to what mindfulness is direct conceptual definition such as attention, but rather can be highlighted. There are participants who defined it as defined as something instrumental, as a means to an end. a way to simplify or make the practice of meditation more Two subthemes were detected: strategy to regulate, manage, pragmatic, one pointed out that “it is a good simplification,” or control emotions or the mind, and strategy to regulate and another said that “it is a pragmatic turn to traditional attention. meditation.” Others were more critical and spoke of mind- We observed how part of the sample defined mindfulness fulness as “a trend,” as “a more superficial way than the as a regulation strategy or as a tool for emotional or mental original forms of meditation (yoga, Zen).” One participant 13 1550 Mindfulness (2022) 13:1544–1554 even defined it as “decaffeinated Buddhism for western Other people related mindfulness to “self-knowledge” (n = companies.” 7), with one participant pointing out that it is “a way of self- Regarding the other subtheme, referring to the theoretical exploration,” and another writing that “it is an indispensable analysis in which mindfulness is defined from a more techni- practice for self-knowledge.” cal and concrete perspective (n = 44), participants came to Some participants identified mindfulness as an important catalog it into five different categories. Some thought that element of “connection with oneself” (n = 24), and illus- mindfulness “is a type of meditation,” others reported that trated it in different ways, “it is an encounter with myself,” it is a training or a practice, with one saying that it is “the or “it is the ability to go within yourself,” or even “it is the training of attention,” whereas others saw it more as a pro- ability to pay attention to what is happening in your inner cess or path, “it seems like a path.” There were people who world.” However, others gave weight not only to the connec- related it to “the wisdom that is implied” in the mere fact of tion with oneself, but also to the potential of mindfulness practicing mindfulness, and others indicated that it was more for the “connection with the environment” (n = 4), with of a type of yoga, “it is a yoga of the mind.” one participant pointing out that mindfulness implied “the awareness of your whole being and what surrounds you.” Mindfulness defined as a psycho‑affective‑spiritual Lack of understanding of mindfulness state A group of people showed total or partial ignorance (n = Some participants indicated that they understood mindful- 10) regarding the meaning of mindfulness and, obviously, ness as a state. Among the people who defined mindfulness did not offer a definition. Some were brief in their response, as a state, the answers were grouped into three subthemes: pointing out that “I don’t know what mindfulness is, I don’t those who understood it as a state of well-being, as a psy- understand it,” and others did not dare to define it because chological state, and as a spiritual state. Among those who they did not have the necessary knowledge, “I am still too referred to mindfulness as a state of well-being (n = 39), the new to define it properly.” answers were diverse when it came to specifying that state, some spoke of “general well-being,” while others reported positive emotional states related to activation such as “posi- Discussion tivity,” “energy,” or “strength”, and others indicated positive states more related to deactivation such as “calm,” “seren- The present study collected seven descriptive themes that ity,” “relaxation,” or “a state of tranquility.” Other people revealed the different types of definitions surrounding connected mindfulness with a more generic and affectively the concept of mindfulness. These themes were identi- neutral psychological state (n = 3), with one participant fied through a systematized analysis of the qualitative data pointing out that it is “a state of mind.” In the third sub- obtained from the definition of mindfulness reported by each theme, some participants explained mindfulness as a state of the participants. The results of this study revealed the of spiritual nature (n = 11), some spoke of “return to peace” complexity of the mindfulness construct (Grossman & Van or only “peace,” while others referred to it as “Being” or Dam, 2011), and the even greater linguistic and semantic “Stillness.” dispersion and diversity that is found in non-academic defi- nitions, compared to academic ones. At the same time, the Mindfulness defined as personal development strong socio-cultural influence on the definition itself was verified and we can speculate that there are many reasons Definitions were detected in which the participants under- why these definitions may vary (i.e., personality or learning stood mindfulness as an integrated element in their lives history) (Dunne, 2015). and that it implied support in their personal development. In As presented in the results, seven themes were concep- this broad theme, we identified four subthemes: mindfulness tualized that represent the definitions obtained from the as a lifestyle, as self-knowledge, as an element of connec- data. As expected, the subject of mindfulness as attention/ tion with oneself, or as an element of connection with the awareness stood out at a quantitative and qualitative level; environment. most of the participants used some unit of meaning that was There were participants who understood mindfulness not articulated from attention or awareness to define mindful- only as a practice or a state, but also as a “lifestyle” or a ness, in such a way that conceptual similarities were found “life philosophy” (n = 14), something that involved every- with the scientific-academic definition of mindfulness, day life and a vision for the future. In this regard, answers where the importance offered to attention and awareness is were found to express that “more than a meditation it is a decisive (Bishop et al., 2004; Kabat-Zinn, 1994). Another way of life” or that mindfulness “is a way of being in life.” similarity observed was the importance that the theme of 13 Mindfulness (2022) 13:1544–1554 1551 mindfulness as a non-evaluative attitude took in the col- synonym (“atención plena [Spanish translation for mind- lected definitions, coinciding with the psychometric weight fulness or full awareness]”). An explanation could be that of factors such as acceptance or non-judgment in scientific- having carried out the study in Spanish, and having used academic definitions (Baer et al., 2008; Bishop et al., 2004). an Anglicism (mindfulness) when asking the open-ended However, participants’ definitions that resembled those pro- question, made it possible for some participants to be satis- posed by Buddhist academics were limited. In this regard, fied with the mere translation of the term from English to mindfulness (sati) understood as remembering, important in Spanish. tradition, was reported only by two people, and mindfulness The data also highlights the wealth of perspectives integrated in an ethical-moral aspect was not pointed out by with which mindfulness was understood in the population; anyone. This may indicate that, at a pedagogical level, the although most opt for a definition related to attention/aware- dissemination of scientific mindfulness has permeated the ness, some referred to mindfulness as a strategy to achieve public in a more evident way than the dissemination of Bud- an end, such as a psychological or spiritual state, or as a path dhist mindfulness. On the other hand, the aspects debated at to self-knowledge, of connection with oneself, or, even, as a scientific-academic level, such as the differences between a life philosophy. Some of these issues were not covered in paying attention and awareness (Travis et al., 2017) or the scientific-academic definitions or in Buddhist ones. In the differences between awareness and concentration (Miku- case of collected definitions, the influence of popular or self- las, 2015), were also included in the collected definitions, help literature on mindfulness, or on meditation in general, although with varied terminological connotations and not may be a causal factor to consider. Criticism surrounding always coinciding with the academic ones. In non-academic mindfulness meditation was also collected, several of them definitions, the linguistic complexity and the variety of terms implying that scientific mindfulness was a trend, indicating were greater than in the academic definitions, detecting up its superficial and utilitarian character, compared to what the to ten subthemes referring to the subject of attention/aware- Buddhist contemplative tradition proposed through the inte- ness. In general, we can say that, in conceptual terms, the gration of ethical and spiritual aspects. This line of criticism lay or common-sense definitions were quite aligned with the has already appeared in the scientific literature (Grossman scientific-academic definitions and the construct of mindful- & Van Dam, 2011). ness itself, although they differed in the importance they Derived from the thematic analysis of the definitions, it gave to each dimension (attention to the present moment could be hypothesized that the concept of attention was the vs. acceptance/non-judgment), with the importance given linguistic reference that stood out. Furthermore, due to its to attention/awareness to the present being greater in the difference in meaning with respect to the rest of the themes, collected definitions. This study can also confirm that the the theme referring to people who do not know mindfulness definitions that come from the Buddhist school have little stood out. In this study (with a sample that spoke Spanish), conceptual weight in the definitions collected. less than 5% (4.7%) of the participants did not understand The theme that includes mindfulness as a strategy coin- mindfulness. Thus, it could be hypothesized that the vast cides with the mechanisms of action proposed by the litera- majority of meditators, no matter what meditation they prac- ture to explain how mindfulness meditation works (Hölzel ticed, were able to offer a definition of mindfulness. et al., 2011), especially the mechanisms that refer to the regulation of attention and the regulation of emotion. Along Limitations and Future Research with this, some definitions were found that were not very compatible with scientific-academic definitions. Some par- What has been discovered with this study must be considered ticipants defined mindfulness as flowing or being completely under the prism of the different existing limitations. Given concentrated, which seems to be referring to the construct of that the answers to the open-ended question were anony- flow (Csikszentmihalyi, 1990), rather than to that of mind- mous and in writing, we were not able to do any follow-up to fulness. Specifically, two categories detected within the sub- clarify ambiguous questions or to validate conclusions with ject of mindfulness understood as a strategy of emotional the participants. In this line, there is a potential coverage and and/or mental regulation, such as thought-avoidance or “not self-selection bias related to the online questionnaire and its thinking” strategies and objective activity, seemed highly distribution on web pages and social networks related to the incompatible with the scientific definition of mindfulness. field of mindfulness and meditation. Also, the data collec- However, while these characteristics of mindfulness were tion of the questionnaire was carried out in the midst of the not necessarily reflected in the scientific literature, they were global Covid-19 pandemic, and this very special contextual sometimes described as such by leading mindfulness practi- situation could have modified the responses. tioners and trainers (Knuf, 2019). The sample that responded to the questionnaire is cul- Some definitions were inconclusive or not very explicit, turally and linguistically limited, since it was only possible and limited themselves to defining mindfulness with a to answer the questionnaire in Spanish. Furthermore, the 13 1552 Mindfulness (2022) 13:1544–1554 digital divide and limited ability with new technologies gen- Declarations erate a cut-off point when accessing the questionnaire, so the possible answers have been limited only to the population Ethics Statement All procedures performed in studies involving human with access and sufficient capacity to use new technologies participants were in accordance with the ethical standards of the insti- tutional and/or national research committee and with the 1964 Helsinki and the Internet. Also, the sample of the study consists of Declaration and its later amendments or comparable ethical standards. 76.4% regular meditation practitioners, out of which almost The data were processed anonymously and in accordance with the 15.6% have been practicing mindfulness regularly for more Spanish Data Protection Law. than 10 years. From this perspective, it can be difficult to Informed Consent Informed consent was obtained from all individual understand such a cohort as “lay people,” as probably many participants included in this study. of them have more extensive mindfulness experience than many academics. Therefore, it may be risky to call the Conflict of Interest The authors declare no competing interests. results obtained a “lay definition.” The data collection regarding the lay definition of mind- Open Access This article is licensed under a Creative Commons Attri- fulness was carried out only through an open question in a bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long questionnaire; this contribution may be limited if we want as you give appropriate credit to the original author(s) and the source, to understand the phenomenon in all its complexity. The provide a link to the Creative Commons licence, and indicate if changes data obtained in focus groups or in a semi-structured inter- were made. The images or other third party material in this article are view with each participant would provide a broader and included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in deeper vision of the studied phenomenon. Finally, in the the article’s Creative Commons licence and your intended use is not early phases of the study, no steps were taken to discriminate permitted by statutory regulation or exceeds the permitted use, you will between academic and non-academic meditators. Thus, it is need to obtain permission directly from the copyright holder. To view a not possible to reliably know if the sample is offering non- copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. academic definitions. Looking ahead to future research, it seems convenient to continue studying the non-academic definition of mindful- References ness with the aim of better understanding both the lexicon and the educational methods in the teaching-learning pro- Ahuvia, A. (2001). Traditional, interpretive, and reception based con- cesses of mindfulness in the different interventions. tent analyses: Improving the ability of content analysis to address The present study provides new information on the com- issues of pragmatic and theoretical concern. Social Indicators Research, 54(2), 139–172. https://d​ oi.o​ rg/1​ 0.1​ 023/A:1​ 01108​ 7813​ plexity and heterogeneity of the non-academic definition of 505 mindfulness, and the differences and similarities between Anālayo, B. (2016). Early Buddhist mindfulness and memory, the body, non-academic definitions compared to academic scientific and pain. Mindfulness, 7(6), 1271–1280. https://​doi.​org/​10.​1007/​ definitions and Buddhist academic ones. This study points s12671-​016-​0573-1 Anālayo, B. (2019a). Adding historical depth to definitions of mindful- to the diversity of mindsets when it comes to understanding ness. Current Opinion in Psychology, 28, 11–14. https://​doi.​org/​ mindfulness and highlights the need for additional research 10.​1016/j.​copsyc.​2018.​09.​013 to better comprehend what the population understands by Anālayo, B. (2019b). How mindfulness came to plunge into its mindfulness. objects. Mindfulness, 10(6), 1181–1185. https://​doi.​org/​10.​1007/​ s12671-​019-​01152-4 Anālayo, B. (2020). Attention and mindfulness. Mindfulness, 11(5), Supplementary Information The online version contains supplemen- 1131–1138. https://​doi.​org/​10.​1007/​s12671-​019-​01286-5 tary material available at https://d​ oi.o​ rg/1​ 0.1​ 007/s​ 12671-0​ 22-0​ 1899-3. Baer, R. (2016). Assessment of mindfulness and closely related con- structs: Introduction to the special issue. Psychological Assess- Acknowledgements This work was partially supported by CIBEROBN ment, 28(7), 787–790. https://​doi.​org/​10.​1037/​pas00​00309 as an initiate of the ISCIII and AMABLE-VR (RTI2018-097835-A-I00) Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, founded by MCIN/ AEI/https://​doi.​org/​10.​13039/​50110​00110​33/ and S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct FEDER Una manera de hacer Europa. validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15(3), 329–342. https://​ Author Contribution All authors made substantial contributions to the doi.​org/​10.​1177/​10731​91107​313003 conception and design of the study, data analysis, and data interpreta- Bergomi, C., Tschacher, W., & Kupper, Z. (2013). The assessment tion. DA contributed to data acquisition and the drafting of the article. of mindfulness with self-report measures: Existing scales and AC and JS revised the manuscript critically for important intellectual open issues. Mindfulness, 4(3), 191–202. https://​doi.​org/​10.​1007/​ content. All authors read and approved the final manuscript and agreed s12671-​012-​0110-9 to be accountable for all aspects of the work. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Funding Open Access funding provided thanks to the CRUE-CSIC Devins, G. (2004). Mindfulness: A proposed operational defini- agreement with Springer Nature. Open Access funding provided by tion. Clinical Psychology: Science and Practice, 11(3), 230–241. EHU/UPV agreement with Springer Nature. https://​doi.​org/​10.​1093/​clipsy.​bph077 13 Mindfulness (2022) 13:1544–1554 1553 Bodhi, B. (1993). A comprehensive manual of abhidhamma: The Grossman, P. (2011). Defining mindfulness by how poorly I think I pay abhidhammattha sangaha of âcariya anuruddha. Pariyatti. attention during everyday awareness and other intractable prob- Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. lems for psychology’s (re)invention of mindfulness: comment on Qualitative Research in Psychology, 3(2), 77–101. https://d​ oi.o​ rg/​ Brown et al. (2011). Psychological Assessment, 23(4), 1034–1040. 10.​1191/​14780​88706​qp063​oa https://​doi.​org/​10.​1037/​a0022​713 Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Grossman, P. (2019). On the porosity of subject and object in ‘mind- Mindfulness and its role in psychological well-being. Journal of fulness’ scientific study: Challenges to ‘scientific’ construction, Personality and Social Psychology, 84(4), 822–848. https://​doi.​ operationalization and measurement of mindfulness. Current org/​10.​1037/​0022-​3514.​84.4.​822 Opinion in Psychology, 28, 102–107. https://​doi.​org/​10.​1016/j.​ Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. copsyc.​2018.​11.​008 (2008). The assessment of present-moment awareness and accept- Grossman, P., & Van Dam, N. T. (2011). Mindfulness, by any other ance: The Philadelphia Mindfulness Scale. Assessment, 15(2), name…: Trials and tribulations of sati in western psychology and 204–223. https://​doi.​org/​10.​1177/​10731​91107​311467 science. Contemporary Buddhism, 12(1), 219–239. https://d​ oi.o​ rg/​ Choi, E., Farb, N., Pogrebtsova, E., Gruman, J., & Grossmann, I. 10.​1080/​14639​947.​2011.​564841 (2021). What do people mean when they talk about mindfulness? Hadash, Y., & Bernstein, A. (2019). Behavioral assessment of mind- Clinical Psychology Review, 89, 102085. https://d​ oi.o​ rg/1​ 0.1​ 016/j.​ fulness: Defining features, organizing framework, and review of cpr.​2021.​102085 emerging methods. Current Opinion in Psychology, 28, 229–237. Christopher, M. S., Charoensuk, S., Gilbert, B. D., Neary, T. J., & https://​doi.​org/​10.​1016/j.​copsyc.​2019.​01.​008 Pearce, K. L. (2009). Mindfulness in Thailand and the United Hölzel, B. K., Lazar, S. W., Gard, T., Schuman-Olivier, Z., Vago, D. R., States: A case of apples versus oranges? Journal of Clinical Psy- & Ott, U. (2011). How does mindfulness meditation work? Pro- chology, 65(6), 590–612. https://​doi.​org/​10.​1002/​jclp.​20580 posing mechanisms of action from a conceptual and neural per- Crane, R. S., Brewer, J., Feldman, C., Kabat-Zinn, J., Santorelli, S., spective. Perspectives on Psychological Science, 6(6), 537–559. Williams, J. M. G., & Kuyken, W. (2017). What defines mind- https://​doi.​org/​10.​1177/​17456​91611​419671 fulness-based programs? The warp and the weft. Psychological Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness Medicine, 47(6), 990–999. https://​doi.​org/​10.​1017/​S0033​29171​ meditation in everyday life. Hyperion. 60033​17 Knuf, A. (2019). Quiet up there! Independently published. Csikszentmihalyi, M. (1990). Flow: The psychology of optimal expe- Kong, D. T., & Jolly, P. M. (2019). Lay beliefs about attention to and rience. Harper & Row. awareness of the present: Implicit mindfulness theory (IMT) and Daly, K. J. (2007). Qualitative methods for family studies & human its workplace implications. Journal of Business and Psychology, development. Sage Publications. 34(5), 685–707. https://​doi.​org/​10.​1007/​s10869-​018-​9606-1 Dorjee, D. (2010). Kinds and dimensions of mindfulness: Why it Levit-Binnun, N., Arbel, K., & Dorjee, D. (2021). The mindfulness is important to distinguish them. Mindfulness, 1(3), 152–160. map: A practical classification framework of mindfulness prac- https://​doi.​org/​10.​1007/​s12671-​010-​0016-3 tices, associated intentions, and experiential understandings. Fron- Dreyfus, G. (2011). Is mindfulness present-centred and non-judg- tiers in Psychology, 12, 727857. https://​doi.​org/​10.​3389/​fpsyg.​ mental? A discussion of the cognitive dimensions of mindful- 2021.​727857 PMID: 34712178. ness. Contemporary Buddhism, 12(1), 41–54. https://​doi.​org/​ Levman, B. (2017). Putting smṛti back into sati (putting remembrance 10.​1080/​14639​947.​2011.​564815 back into mindfulness). Journal of the Oxford Centre for Bud- Droit-Volet, S., Chaulet, M., & Dambrun, M. (2018). Time and medi- dhist studies, 13, 121–149. http://​jocbs.​org/​index.​php/​jocbs/​artic​ tation: When does the perception of time change with mindful- le/​view/​167 ness exercise? Mindfulness, 9(5), 1557–1570. https://​doi.​org/​ Levy, S. R., West, T. L., & Ramirez, L. (2005). Lay theories and inter- 10.​1007/​s12671-​018-​0903-6 group relations: A social-developmental perspective. European Dunne, J. D. (2015). Buddhist styles of mindfulness: A heuristic Review of Social Psychology, 16(1), 189–220. https://​doi.​org/​10.​ approach. In B. F. Ostafin, M. D. Robinson, & B. P. Meier 1080/​10463​28050​03972​34 (Eds.), Handbook of mindfulness and self-regulation (pp. 251– Levy, S. R., Chiu, C., & Hong, Y. (2006). Lay theories and intergroup 270). Springer. relations. Group Processes & Intergroup Relations, 9(1), 5–24. Ekici, Ç., Garip, G., & Van Gordon, W. (2020). The lived experi- https://​doi.​org/​10.​1177/​13684​30206​059855 ences of experienced vipassana Mahasi meditators: An inter- Mikulas, W. L. (2015). Cultivating Mindfulness: A Comprehensive pretative phenomenological analysis. Mindfulness, 11, 140–152. Approach. Mindfulness, 6(2), 398–401. https://​doi.​org/​10.​1007/​ https://​doi.​org/​10.​1007/​s12671-​018-​1063-4 s12671-​014-​0339-6 Frank, P., Stanszus, L., Fischer, D., Kehnel, K., & Grossman, P. Reddy, J., & Roy, S. (2019). Understanding meditation based on the (2019). Cross-fertilizing qualitative perspectives on effects of subjective experience and traditional goal: Implications for cur- a mindfulness-based intervention: An empirical comparison of rent meditation research. Frontiers in Psychology, 10, 1827. four methodical approaches. Mindfulness, 10(11), 2452–2467. https://​doi.​org/​10.​3389/​fpsyg.​2019.​01827 https://​doi.​org/​10.​1007/​s12671-​019-​01227-2 Ritter, S. M., & Rietzschel, E. F. (2017). Lay theories of creativity. In Furnham, A. (1988). Lay theories. Pergamon Press. C. M. Zedelius, B. C. N. Müller, & J. W. Schooler (Eds.), The sci- Garland, E., & Gaylord, S. (2009). Envisioning a future contempla- ence of lay theories: How beliefs shape our cognition, behavior, tive science of mindfulness: Fruitful methods and new content and health (pp. 95–126). Springer International Publishing. for the next wave of research. Complementary Health Practice Sauer, S., Walach, H., Schmidt, S., Hinterberger, T., Lynch, S., Büss- Review, 14(1), 3–9. https://​doi.​org/​10.​1177/​15332​10109​333718 ing, A., & Kohls, N. (2013). Assessment of mindfulness: Review Gethin, R. (2011). On some definitions of mindfulness. Contempo- on state of the art. Mindfulness, 4(1), 3–17. https://​doi.​org/​10.​ rary Buddhism, 12(1), 263–279. https://​doi.​org/​10.​1080/​14639​ 1007/​s12671-​012-​0122-5 947.​2011.​564843 Sayadaw, M. (2016). Manual of insight. Simon and Schuster. Grossman, P. (2008). On measuring mindfulness in psychoso- Soler, J., Cebolla, A., Feliu-Soler, A., Demarzo, M. M. P., Pascual, matic and psychological research. Journal of Psychosomatic J. C., Baños, R., & García-Campayo, J. (2014). Relationship Research, 64(4), 405–408. https://​doi.​org/​10.​1016/j.​jpsyc​hores.​ between meditative practice and self-reported mindfulness: The 2008.​02.​001 13 1554 Mindfulness (2022) 13:1544–1554 MINDSENS composite index. PLoS ONE, 9(1), e86622. https://​ J., Fox, K. C. R., Field, B. A., Britton, W. B., Brefczynski-Lewis, doi.​org/​10.​1371/​journ​al.​pone.​00866​22 J. A., & Meyer, D. E. (2018). Mind the hype: A critical evaluation Thompson, B. L., & Waltz, J. (2007). Everyday mindfulness and mind- and prescriptive agenda for research on mindfulness and medita- fulness meditation: Overlapping constructs or not? Personality tion. Perspectives on Psychological Science, 13(1), 36–61. https://​ and Individual Differences, 43(7), 1875–1885. https://​doi.​org/​10.​ doi.​org/​10.​1177/​17456​91617​709589 1016/j.​paid.​2007.​06.​017 Varela, F., & Shear, J. (1999). First-person methodologies: What, why, Tomlinson, E. R., Yousaf, O., Vittersø, A. D., & Jones, L. (2018). how? Journal Consciousness Studies, 6, 1–14. Dispositional mindfulness and psychological health: A system- Visted, E., Vøllestad, J., Nielsen, M. B., & Nielsen, G. H. (2015). The atic review. Mindfulness, 9(1), 23–43. https://​doi.​org/​10.​1007/​ impact of group-based mindfulness training on self-reported s12671-​017-​0762-6 mindfulness: A systematic review and meta-analysis. Mindful- Tortella-Feliu, M., Luís-Reig, J., Gea, J., Cebolla, A., & Soler, J. ness, 6(3), 501–522. https://​doi.​org/​10.​1007/​s12671-​014-​0283-5 (2020). An exploratory study on the relations between mindful- Wallace, A. (2008). A mindful balance: Interview with B. Alan Wal- ness and mindfulness-based intervention outcomes. Mindfulness, lace. Tricycle: The Buddhist Review. https://t​ ricyc​ le.o​ rg/m ​ agazi​ ne/​ 11(11), 2561–2572. https://​doi.​org/​10.​1007/​s12671-​020-​01471-x mindf​ulness-​alan-​walla​ce/ Travis, S. L., Dux, P., & Mattingley, J. (2017). Re-examining the influ- Willis, J. W. (2007). Foundations of qualitative research: interpretive ence of attention and consciousness on visual afterimage duration. and critical approaches. Sage Publications. Journal of Experimental Psychology, 43(12), 1944–1949. https://​ doi.​org/​10.​1037/​xhp00​00458 Publisher’s Note Springer Nature remains neutral with regard to Vaismoradi, M., Turunen, H., & Bondas, T. (2013). Content analysis jurisdictional claims in published maps and institutional affiliations. and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15(3), 398–405. https://​doi.​org/​10.​1111/​nhs.​12048 Van Dam, N. T., van Vugt, M. K., Vago, D. R., Schmalzl, L., Saron, C. D., Olendzki, A., Meissner, T., Lazar, S. W., Kerr, C. E., Gorchov, 13