Designing a culturally responsive mindfulness-based blood pressure program: the IndigenousMIND/MB-BP protocol

Indigenous cultures across Turtle Island have long promoted wellness through language, ceremony, storytelling, movement, community connection, and relationships with the natural world. These cultural practices may serve as important pathways for healing and health promotion. At the same time, Indigenous communities experience disproportionate rates of cardiovascular disease (CVD), with hypertension representing a major modifiable risk factor. Although Mindfulness-Based Blood Pressure Reduction (MB-BP) has demonstrated clinically meaningful reductions in blood pressure, standard mindfulness interventions often lack the cultural grounding necessary for sustained engagement in Indigenous communities. This study describes the development and pilot implementation of an Indigenous-focused mindfulness program (IndigenousMIND) with the MB-BP class, a culturally grounded adaptation that integrates MB-BP with Indigenous language, cultural teachings, ceremony, and community-defined contemplative practices.

Thirteen Indigenous adults participated in an eight-week IndigenousMIND/MB-BP program. Using a rapid-cycle adaptation process, we approached MB-BP with culturally adapted programming in conjunction with tribal cultural leaders, and delivered in a tribally specific format. Adaptations incorporated tribal language, storytelling, ceremonial elements, ecological relationships, and relational learning practices while preserving MB-BP's core mechanisms. Qualitative reflections collected at the final community gathering were analyzed thematically to assess feasibility, acceptability, and perceived impact. The adaptation process also produced a structured IndigenousMIND/MB-BP protocol and facilitator guide.

Participants reported high engagement and strong acceptability. Five primary themes emerged: (1) connection and community, (2) cultural identity and preservation, (3) mindfulness and personal transformation, (4) intergenerational healing and responsibility, and (5) challenges and resilience. Participants described mindfulness as consistent with Indigenous ways of knowing and identified language, storytelling, ceremony, and connection to land as meaningful pathways into practice. Reflections emphasized cultural reconnection, community belonging, and ecological awareness as important components of healing and well-being.

IndigenousMIND/MB-BP demonstrates the feasibility of integrating evidence-based hypertension prevention with Indigenous cultural strengths and community leadership. The resulting protocol provides a model for community-led adaptation of mindfulness-based health interventions and offers a framework for future studies addressing cardiovascular health equity in Indigenous communities.