RESEARCH ARTICLE Open Access
Mind ulness in p ima y ca e heal hca e and
eaching p o essionals and i s ela ionship
wi h s ess a wo k: a mul icen ic c oss-
sec ional s udy
Rosa Magallón-Bo aya
1
, Luis Angel Pé ula-de To es
2,3*
, Juan Ca los Ve des-Mon eneg o A alaya
4
,
Celia Pé ula-Jiménez
2
, No be o Lie o -Villajos
5
, C uz Ba olomé-Mo eno
1
, Ja ie Ga cia-Campayo
6
,
He minia Mo eno-Ma os
7
and he Minduudd Collabo a i e S udy G oup
Abs ac
Backg ound: Wo k s ess is a common p oblem among he heal h pe sonnel o he Spanish Na ional Heal h
Sys em. The objec i e o his pape is o assess he s a e o mind ulness among Spanish p ima y ca e p o ide s and
o e alua e i s po en ial ela ionship wi h wo k s ess and basic labo and sociodemog aphic cha ac e is ics.
Me hods: C oss-sec ional, mul i-cen ic s udy. P ima y ca e nu ses, eache s, eaching collabo a o s and esiden s
assigned o six Spanish Family Medicine/Family and Communi y Ca e Depa men s we e in i ed o pa icipa e (n=
475). A empla e was designed in Google Fo ms, including sociodemog aphic and wo k- ela ed a iables. The s a e
o mind ulness was measu ed wi h he Fi e Face Mind ulness Ques ionnai e (FFMQ), while wo k- ela ed s ess was
measu ed using an o dinal scale anging om 0 o 10 poin s. Desc ip i e and in e en ial s a is ical analyses we e
ca ied ou , as well as bi a ia e and mul i a ia e s a is ics.
Resul s: The mean age o pa icipan s was 40,14 ± 13.12 ( ange:23–65 yea s); 66.9% we e women, 42.5% in e nal
medicine esiden s, 29.3% amily physicians, and 20.2% nu ses. Mo e han hal (54.5%) knew abou mind ulness,
wi h 24.0% ha e ecei ed aining on i , and 22.5% we e usual p ac i ione s. The a e age le el o mind ulness was
127.18 ± 15.45 ( ange: 89–177). The a e age sco e o s ess a wo k was 6.00 ± 2.44; 49.9% ( ange: 0–10). 49.9% o
pa icipan s sco ed 7 o mo e on he s ess a wo k scale. The e was an in e se co ela ion be ween he le els o
mind ulness (FFMQ o al sco e) and wo k- ela ed s ess (Spea man’s =−0.155, p= 0.003). Signi ican ela ionships
be ween he mind ulness p ac ice and he le el o mind ulness (F = 29.80, p< 0.001), as well as be ween he
mind ulness p ac ice and he le el o wo k- ela ed s ess (F = 9.68, p= 0.042), we e also ound.
(Con inued on nex page)
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* Co espondence: langel.pe ula.sspa@jun adeandalucia.es
2
Mul i-p o essional Teaching Uni o Family and Communi y Ca e o
Có doba, Heal hca e Dis ic o Có doba and Guadalqui i , Ins i u e
Maimónides o Resea ch Có doba (IMIBIC)/Hospi al Reina So ía/Uni e si y o
Có doba, Isla de Lanza o e, 3, 14011 Có doba, Spain
3
Ins i u e o Heal h Ca los III ( edIAPP 06/18), IIS-A agon, G oup B. Uni e si y
o Za agoza, Za agoza, Spain
Full lis o au ho in o ma ion is a ailable a he end o he a icle
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29
h ps://doi.o g/10.1186/s12875-021-01375-2
(Con inued om p e ious page)
Conclusions: Le els o mind ulness in p ima y ca e heal h p o ide s we e in line wi h hose le els obse ed in
o he g oups o heal h p o essionals. Hal o all o he p ima y ca e p o ide s su e ed om a high deg ee o s ess.
Al hough weak, in e se ela ionships we e obse ed be ween le els o mind ulness and s ess a wo k, wi h lowe
alues o s ess a wo k among hose who p ac iced mind ulness.
T ial egis a ion: NCT03629457.
Keywo ds: Mind ulness, Wo k s ess, Subjec i e well-being, P ima y heal h ca e p o essionals, Heal h se ices
esea ch
Backg ound
A g ea numbe o heal hca e p o essionals complain
abou hei wo k condi ions: excess o heal h ca e p es-
su e, inc easingly demanding use s seeking ea men o
hei heal h p oblems and needs, a lack o su icien ime
o aining and e- aining, as well as he pe cei ed lack
o suppo by manage s and hei supe io s [1–3]. P o-
essionals who also ake on aining asks, su e si ua-
ions o e en mo e o e load. Many s udies ha e
sugges ed he need o sol e his wi h an in eg al o m o
ackling he physical and psychological consequences o
wo k s ess in heal hca e p o essionals. No me ely
adop ing measu es a a wo k o ganiza ion le el and hei
wo k condi ions, bu also p o iding indi idual ools o
handle s ess, based on accep ance o eali y and emo-
ional sel - egula ion [4,5].
In he speci ic a ea o pos -g adua e eaching, Spain
boas s a high-quali y model o specialized aining [6].
The T aining P og am o Residen In e n Specialis s
(RIS) om he Family and Communi y Medicine spe-
cial y is 4 yea s long and he p og am o Family and
Communi y Nu sing is 2 yea s. Al hough he goal is o
he young aining doc o o nu se, o ake on esponsi-
bili ies in di e en a eas o compe ence, bo h heal hca e,
eaching and esea ch, in a p og essi e manne , s ess is
ine i able, especially in he eme gency depa men [7].
An impo an igu e in he aining p ocess o he RIS is
he pe sonal u o . Ca ying ou his ask o eaching im-
plies a majo wo k load in addi ion o he egula e e y-
day wo k ac i i y.
The e m “mind ulness”o igina es in Buddhis eachings
and implies a s a e, in which he indi idual ocuses hei
p esen on he ask a hand, wi hou he mind dig essing o
he u u e o pas , and wi hou he sensa ion o a achmen
o ejec ion. Mind ulness is a quali y ha can be de eloped
h ough app op ia e aining [8] and ha gene a es signi i-
can bene i s in he physical and men al heal h o hose
engaging in i . The le el o mind ulness appea s o be an
in luen ial ac o in he de e mina ion o he deg ee o
wo k- ela ed s ess expe ienced by heal hca e p o essionals.
In ac , di e se in e en ion s udies and me a-analyses
ca ied ou on heal hca e p o essionals, ha e demon-
s a ed ha medi a ion echniques inc ease he le els
o mind ulness and imp o e coping skills o wo k-
ela ed s ess [9,10].
We ha e ba ely ound s udies conduc ed in ou
ield ha examine he s a e o mind ulness in p ima y
ca e heal hca e p o essionals, on he one hand, wi h
he po en ial ela ionship be ween he knowledge,
aining and he p ac ice o mind ulness; and on he
o he , wi h he le el o wo k- ela ed s ess pe cei ed
[9,11]. Fu he mo e, we a e unawa e o i s ela ion-
ship wi h he eaching and lea ning condi ion o he
p o essional. The e o e, his s udy aims o de e mine
he s a e o mind ulness be ween Spanish p ima y
ca e p o essionals, as well as o assess po en ial asso-
cia ions be ween he le els o mind ulness, he p ac-
ice o mind ulness exe cises and he deg ee o wo k-
ela ed s ess. All his ocused, especially, o he
eaching a eas, compa ing he esul s acco ding o he
p ima y ca e p o essional p o ile.
Me hods
Design
A c oss-sec ional s udy was conduc ed, using a sel -
adminis e ed online ques ionnai e, by heal hca e p o es-
sionals in he p ima y ca e eaching and ca e en i onmen .
Pa icipan s and p ocedu e
The inclusion c i e ia we e: 1) To be a amily doc o , a
amily medicine esiden , o a p ima y ca e nu se; and 2)
To p o ide in o med consen o pa icipa ion in he s udy.
The s udy popula ion consis ed o p ima y ca e p o es-
sionals om six Teaching Depa men s o he Spanish
Na ional Heal h Sys em o di e en dimensions, acco ding
o he popula ion densi y o each e i o y, dis ibu ed
ac oss he Spanish geog aphy, (N o al = 802; Có doba N=
256; Alme ía, N= 147; Jaén, N= 185; Bu gos, N= 64; Pon-
e ada, N= 63; and Za agoza, N= 87). O he su eyed
pa icipan s p o essionals, 297 we e eache s and 595 we e
Residen In e n Specialis s in Family and Communi y
Medicine/Nu sing. Fo compa ison pu poses, a subsample
o 267 nu ses wo king in non- eaching ca e se ings, in he
Có doba p o ince, we e also su eyed. The esul s om
his sample ha e al eady been published [12]. Based on he
esul s o p e ious esea ch [12], i was necessa y o ec ui
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 2 o 9
a leas 433 pa icipan s in he p esen s udy. The sample
size was calcula ed assuming a p ecision o ±3.5%, a con i-
dence o 95%, and an expec ed knowledge abou mind ul-
ness o 36.5%. The calcula ions ha e been made wi h he
GRANMO p og am (h p://www.imim.ca /o e adese eis/
so wa e-public/g anmo/). Fo he ec ui men o he
subjec s, he s udy was dissemina ed by sending an email o
all hose esponsible o he pa icipa ing cen e s.
Measu emen s
The pa icipa ion p ocedu e was ca ied ou elec onic-
ally, h ough an online ques ionnai e c ea ed by ou e-
sea ch g oup in Google Fo ms. The ques ionnai e was
o iginally es ed on a subsample o ou subjec s, in
o de o check i s comp ehensibili y. The ques ionnai es
we e anonymous and he app op ia e mechanisms we e
es ablished o sa egua d he con iden iali y o he in o -
ma ion collec ed.
Mind ulness was he main a iable and i was mea-
su ed using he Fi e Face Mind ulness Ques ion-
nai e (FFMQ), alida ed o he Spanish popula ion
[13]. The FFMQ consis s o 39 i ems and i e
dimensions: obse a ion, desc ip ion, ac ing con-
scien iously, lack o judgmen and lack o eac i i y.
The pa icipan s answe ed o each i em on a Like
scale, wi h esponse i ems anging om 1 (ne e o
a ely ue) o 5 ( e y o en o almos ue). The
FFMQ pe mi s he compu a ion o a o al mind ul-
ness sco e, om he o al o all o i s dimensions,
such ha highe sco es mean g ea e le els o mind-
ulness. The psychome ic cha ac e is ics o he
FFMQ in he Spanish popula ion a e app op ia e,
wi h a esponse ange om be ween 89 and 177.
Compu a ion o in e nal consis ency o he p esen
da a showed an alpha coe icien o 0.88 o he
FFMQ o al sco e. In he co ela ions wi h o he
scales, he FFMQ alida ed o he Spanish popula ion
showed an expec ed and signi ican ela ionship wi h
almos e e y scale, excep he obse a ion dimension
[13]. In addi ion o he s a e o mind ulness, which
was measu ed by he FFQM, o he a iables we e also
included, such as age, gende , p o essional p o ile,
wo k si e, labo senio i y, deg ee o awa eness o he
mind ulness concep , p io aining, le el o p ac ice
and equency. The le el o wo k-based s ess was
also assessed o he p io 2 weeks, using a isual
analogue o dinal scale. Pa icipan s we e asked o a e
hei wo k-based s ess using he ollowing ques ion:
On a scale om 0 (none) o 10 (maximum), wha
deg ee o wo k s ess ha e you had in he las 2
weeks a you usual job?. In p e ious s udies, his
ype o scale has been ound o be sui able o he
assessmen o pe cei ed s ess [14].
E hical conside a ions
The s udy p o ocol was app o ed by he E hics and
Clinical Resea ch Commi ee o Có doba, (numbe 275;
e e encie 3845). In o ma ion on he s udy’s objec i e
was p o ided online o he p o essionals who ag eed o
pa icipa e ia in o med consen p io o comple ing he
ques ionnai e. In acco dance wi h pe sonal da a p o ec-
ion and con iden iali y egula ions (Eu opean Regula-
ion on da a p o ec ion and in acco dance wi h O ganic
Law 3/2018 on Pe sonal Da a P o ec ion and Digi al
Righ s Gua an ee).
S a is ical analysis
Da a cen aliza ion, dispe sion and posi ion a iables we e
used, as well as absolu e and ela i e equencies o
desc ibe he a iables ha we e he subjec o he s udy,
based on hei dis ibu ion. Con idence in e als we e cal-
cula ed a 95% (95% CI) o he main es ima o s. In o de
o examine he ela ionship be ween he sociodemo-
g aphic and labo a iables, and he deg ee o mind ulness
o he le el o wo k- ela ed s ess, bi a ia e analyses we e
conduc ed, applying he Spea man’s co ela ion coe icien
( ), he S uden ’s es and he ANOVA es (upon e i y-
ing he no mali y o he a iables h ough he
Kolmogo o -Smi no es ; in he con a y case, ei he he
Spea man’s co ela ion coe icien , Mann-Whi ney U es
o he K uskal-Wallis es was used). Mul i a ia e analyses
we e also applied, h ough applica ion o mul iple linea
eg ession models, using he dependen a iables o mind-
ulness and le el o wo k- ela ed s ess and he independ-
en a iables o age, gende , p o ession, amoun o ime
wo ked and knowledge, aining and p ac ice o mind ul-
ness, in model 1 and o hese only hose whose p alue
was less han 0.05 we e conside ed in model 2. The s a is-
ical signi icance le el was es ablished a alpha e o ≤
0.05. The SPSS (S a is ical Package o he Social Sciences)
.22 was used o da a analysis. SPSS is a s a is ical com-
pu e p og am widely used in he social and applied
sciences (h ps://www.ibm.com/p oduc s/spss-s a is ics).
Resul s
The su ey was comple ed by 475 p ima y ca e heal h
wo ke s, wi h an o e all esponse a e o 44.5%. The
esponse a e a ied be ween 47.2% o he membe s o
he eaching uni s and 35.9% o he non- eaching nu ses.
The mean age was 40.14 ± 13.12 –SD- ( ange: 23–65
yea s). 66.9% o he esponden s we e women. 42.5%
we e esiden in e n physicians; 29.3% we e amily doc-
o s and 20.2% we e nu ses. O he physicians, 61.0%
had wo ked o o e 20 yea s, as was he case wi h 42.7%
o he nu ses, whe eas 91.2% o he esiden in e n phy-
sicians had been wo king o less han 4 yea s.
The mean sco e o wo k- ela ed s ess was 6.00 ± 2.44
( ange: 0–10, 95% CI: 5.78–6.22), wi h 49.9% o he
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 3 o 9
pa icipan s sco ing 7 o highe on he wo k- ela ed
s ess scale.
Rega ding mind ulness, 54.5% s a ed ha hey knew
he meaning o his concep ; 24.0% o hem, had
ecei ed p io aining on i s p ac ice, while 22.5%
cu en ly engaged in mind ulness exe cises. O his 22.5,
4% o he su eyed pa icipan s p ac iced mind ulness
daily, while 4.2% p ac iced i om wo o h ee imes a
week and 14.3% did so occasionally.
The mean le el o mind ulness, assessed wi h he
FFMQ ques ionnai e, was 127.18 ± 15.45 ( ange: 89–177;
95% CI: 125.79–128.57).
As seen in Table 1, using bi a ia e analysis, i was
possible o obse e s a is ically signi ican di e ences
be ween he le els o mind ulness and age (p< 0.001;
highes mean sco e on he FFMQ o he oldes p o es-
sionals), p o essional ca ego y (p< 0.001; lowes sco e
o he esiden in e n physicians), amoun o ime
wo ked (p< 0.001; highe mean sco e o p o essionals
ha ing wo ked o he longes amoun o ime), and
aining o p io p ac icing o mind ulness (p< 0.001).
No signi ican di e ences we e ound based on gende
(p= 0.910) o p io knowledge o he concep o mind-
ulness (p= 0.145).
Table 2shows a s a is ically signi ican associa ion
be ween he s ess- ela ed wo k si ua ion o he p o es-
sional and his/he age (p< 0.001), p o essional p o ile
(p< 0.001), amoun o ime wo ked (p< 0.001), and he
p ac ice o mind ulness (p< 0.001). In he bi a ia e ana-
lysis shown in his able, no signi ican di e ences we e
ound, wi h ega ds o gende (p= 0.714), knowledge
(p= 0.727) o p io aining in mind ulness (p= 0.251).
A di ec , s a is ically signi ican ela ionship was ound
be ween he deg ee o exe cise p ac ice and le el o
Table 1 Rela ionship be ween he s udy a iables and he s a e o mind ulness h ough a bi a ia e analysis
Va iables Mean ± SD (95% CI o he mean) P alue
Age (yea s): < 0.001*
-Unde 30 121.94 ± 13.49 (119.95–123.90)
-F om 30 o 45 129.75 ± 14.93 (126.81–132.70)
-46 o o e 130.81 ± 16.14 (128.51–133.10)
Gende : 0.910**
-Male 127.29 ± 14.68 (124.98–129.61)
-Female 127.12 ± 15.84 (125.37–128.87)
P o essional ca ego y: < 0.001*
-Family physician 130.62 ± 15.29 (128.31–132.92)
-Nu se 131.19 ± 16.39 (127.88–134.49)
- In e nal medicine esiden s 122.42 ± 13.83 (120.52–124.32)
Amoun o ime wo ked: < 0.001*
-Less han 4 yea s 122.59 ± 13.75 (120.70–124.48)
-F om 5 o 10 yea s 130.59 ± 16.76 (125.78–135.40)
-F om 11 o 20 yea s 127.35 ± 15.83 (123.63–131.07)
-O e 20 yea s 132.36 ± 15.45 (129.88–134.84)
Awa e o mind ulness: 0.145**
-Yes 128.12 ± 15.87 (126.18–130.07)
-No 126.05 ± 15.45 (124.05–128.04)
Has ecei ed aining on mind ulness: < 0.001**
-Si 130.73 ± 18.01 (127.39–134.07)
-No 126.06 ± 14.40 (124.57–127.55)
P ac ices mind ulness: < 0.001*
-E e y day 145.53 ± 17.85 (136.92–154.13)
-F om 2 o 3 imes/week 136.00 ± 15.82 (128.59–143.41)
-Occasionally 129.35 ± 15.82 (123.87–126.83)
-Ne e 125.35 ± 14.43 (123.87–126.83)
SD S anda d de ia ion, 95% CI 95% con idence in e al
* ANOVA es ; ** S uden ’s es
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 4 o 9
mind ulness, assessed in he FFMQ ques ionnai e
(F = 14.389, p< 0.001). A sligh , bu signi ican nega-
i e co ela ion was also ound be ween he le el o
mind ulness (FFMQ o e all sco e) and he le el o
wo k- ela ed s ess ( =−0.155, p= 0.003).
In he mul i a ia e analysis (Table 3), a iables associ-
a ed wi h he le el o mind ulness we e: age (B = 0.313;
p< 0.001), p ac ice o mind ulness (B = 4.614; p< 0.001),
and wo k- ela ed s ess (B = −1.044; p< 0.001). On he
o he hand, as seen in Table 4, le els o wo k- ela ed
s ess a e associa ed wi h age (B = 0.036; p< 0.001) and
le el o p ac icing o mind ulness (B = -0.334; p< 0.001).
In con as wi h he indings om he bi a ia e analysis,
as seen in Tables 3and 4, he mul i a ia e analysis did
no e eal signi ican ela ionships, be ween p o essional
p o ile and le els o mind ulness, o pe cei ed wo k-
ela ed s ess.
Discussion
Hal o he heal hca e p o essionals appea o su e
om a high deg ee o wo k- ela ed s ess. The e is a
posi i e, hough weak, co ela ion be ween he deg ee o
mind ulness and wo k s ess, wi h less s ess among
hose who p ac ice mind ulness. In his sense, he s a e
o mind ulness in p ima y ca e heal hca e p o ide s
appea s o be in line wi h ha obse ed in o he p o es-
sional heal hca e g oups [15], wi h a le el o knowledge
mo e han accep able, al hough much lowe in e ms o
p ac ice.
This inding suppo s he po en ial p o ec i e ole o
mind ulness in he educ ion o wo k- ela ed s ess.
Medi a i e p ac ice migh be associa ed wi h g ea e
le els o mind ulness, and his, in u n, o he educ ion
o pe cei ed wo k - ela ed s ess. Some p io s udies a e
in line wi h his explana o y model [16,17].
Table 2 Rela ionship be ween he s udy a iables and he le el o wo k- ela ed s ess h ough a bi a ia e analysis
Va iables Mean ± SD (95% CI o he mean) P alue
Age (yea s): < 0.001*
-Unde 30 5.38 ± 2.61 (5.00–5.77)
-F om 30 o 45 6.36 ± 2.40 (5.88–6.83)
-46 o o e 6.39 ± 2.18 (6.08–6.70)
Gende : 0.714**
-Male 6.10 ± 2.31 (5.76–6.46)
-Female 5.95 ± 2.50 (5.67–6.22)
P o essional ca ego y: < 0.001*
-Family physician 6.34 ± 2.03 (6.04–6.65)
-Nu se 6.51 ± 2.39 (6.02–6.99)
- In e nal medicine esiden s 5.47 ± 2.68 (5.10–5.83)
Amoun o ime wo ked: < 0.001*
-Less han 4 yea s 5.40 ± 2.66 (5.03–5.76)
-F om 5 o 10 yea s 6.22 ± 2.08 (5.63–6.82)
-F om 11 o 20 yea s 6.72 ± 2.13 (6.22–7.22)
-Mo e han 20 yea s 6.40 ± 2.20 (6.04–6.76)
Awa e o mind ulness: 0.727**
-Yes 6.02 ± 2.67 (5.75–6.30)
-No 5.96 ± 2.64 (5.61–6.32)
Has ecei ed aining on mind ulness: 0.251**
-Yes 5.85 ± 2.37 (5.41–6.29)
-No 6.04 ± 2.47 (5.79–6.30)
P ac ices mind ulness: 0.040*
-E e y day 4.58 ± 2.34 (3.45–5.71)
-F om 2 o 3 imes/week 6.70 ± 1.84 (5.84–7.56)
-Occasionally 5.96 ± 2.39 (5.38–6.53)
-Ne e 6.04 ± 2.47 (5.79–6.29)
SD S anda d de ia ion, 95% CI 95% con idence in e al
* K uskal-Wallis Tes ; ** Mann-Whi ney U
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 5 o 9

The mul i a ia e analysis demons a es ha he e a e
no di e ences be ween he di e en p o essional p o iles
ha we e analyzed: physicians, nu ses and esiden s in
aining, bo h wi h espec o he le el o mind ulness as
well as he le el o wo k- ela ed s ess. These a iables
ha e been s udied sepa a ely o he dis inc ypes o
p o essionals [18]. This s udy b ings he no el y o com-
pa ing a he same ime he le el o mind ulness and
s ess be ween di e en p o essional g oups. The e
appea s o be a disc epancy in his esul , since a p io i
i appea s ha s ess may be mo e closely ela ed o he
le el o p o essional esponsibili y.
I has been su icien ly acc edi ed ha emo ional
in elligence p e en s bu nou and wo k- ela ed s ess,
no only in physicians bu also in nu ses [19,20]. And
he p ac ice o mind ulness is ano he s a egy used o
emo ional ein o cemen . I is a echnique which, when
pu in o p ac ice, elimina es (in heo y) he an icipa o y
anxie y, which is a igge o wo k- ela ed s ess. Some
s udies ca ied ou in p ima y heal h ca e p o essionals,
show ha medi a ion echniques se e o imp o e cop-
ing wi h s ess and empa hy [16]. I is likely ha he
e ec i eness o hese p og ams, in p e en ing wo k-
ela ed s ess is closely ela ed o he capaci y o sel -
compassion [21]. An a i ude o sel -compassion owa ds
onesel , is one o he key elemen s o mind ulness, since
i pe mi s us, o be e manage di icul emo ions, such
as ea , ange , sadness o doub .
Ou mul idisciplina y esea ch g oup has also exam-
ined he speci ic e ec o mind ulness on nu sing [12]
and o he p ima y ca e p o essionals, as we ha e de ailed
p e iously [21].
In he s udy ca ied ou among he nu sing s a [12]i
was ound ha hose nu ses who p ac iced mind ulness
had lowe le els o wo k s ess han hose who did no .
Wi hin he dimensions o he FFMQ, hey showed a
g ea e capaci y o obse a ion, in addi ion o a highe
le el o global mind ulness, compa ed o o he p ima y
Table 4 Va iables associa ed wi h he s a e o wo k- ela ed s ess h ough a mul i a ia e analysis
Va iables Model 1 Model 2
B 95.0% CI o B p B 95.0% CI o B
Lowe Bound Uppe Bound Lowe Bound Uppe Bound p
Age 0.000 −0.037 0.036 0.976 0.036 0.019 0.052 < 0.001
Gende 0.036 −0.436 0.507 0.882 –– – –
P o ession −0.035 −0.464 0.394 0.871 –– – –
Time wo king in cu en posi ion 0.186 0.024 0.347 0.024 –– – –
Awa eness o mind ulness −0.318 −0.822 0.187 0.216 –– – –
T aining in mind ulness 0.241 −0.360 0.843 0.431 –– – –
Mind ulness p ac ice −0.378 −0.714 −0.043 0.027 −0.334 −0.631 −0.037 < 0.001
In e cep 5.771 –––5.015 –––
Maximum model (model 1). Pa simonious model (model 2). Dependen a iable: pe cei ed wo k-based s ess; Coe icien o de e mina ion o model 1: R
2
= 0.054
(F = 8.86; p= 0.002); Coe icien o de e mina ion o model 2: R
2
= 0.039 (F = 9.68; p< 0.001). n= 474; 95% CI 95% con idence in e al
Table 3 Va iables associa ed wi h he s a e o mind ulness h ough a mul i a ia e analysis
Va iables Model 1 Model 2
B 95.0% CI o B p B 95.0% CI o B
Lowe Bound Uppe Bound Lowe Bound Uppe Bound p
Age 0.202 −0.015 0.419 0.068 0.313 0.211 0.414 < 0.001
Gende 0.533 −2.276 3.343 0.709 –– – –
P o ession −1.071 −3.626 1.485 0.411 –– – –
Time wo king in cu en posi ion 0.286 −0.681 1.254 0.561 –– – –
Awa eness o mind ulness 1.039 −1.970 4.048 0.498 –– – –
T aining in mind ulness −0.463 −4.047 3.122 0.,800 –– – –
Mind ulness p ac ice 4.727 2.720 6.734 < 0.001 4.614 2.845 6.383 < 0.001
Wo k- ela ed s ess −1.062 −1.603 −0.520 < 0.001 −1.044 −1.579 −0.508 < 0.001
In e cep 118.461 –––114.675 –––
Maximum model (model 1). Pa simonious model (model 2). Dependen a iable: mind ulness (FFMQ); Coe icien o de e mina ion o model 1: R
2
= 0.163 (F = 11.35; p< 0.001);
Coe icien o de e mina ion o model 2: R
2
= 0.161 (F = 29.80; p< 0.001). n=474;95% CI 95% con idence in e al
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 6 o 9
ca e heal h p o essionals, e en highe han in hose who
ecei ed a aining p og am in mind ulness [21].
Recen ly, A anda e al. [22] e alua ed he e ec i eness
o an eigh -week aining p og am on mind ulness and
sel -compassion, o educe s ess le els and bu nou in
p ima y ca e p o essionals. Despi e he limi ed esponse
o he p og am, i sugges s he po en ial bene i s o p o-
mo ing mind ulness and p ac ices o sel -compassion in
he heal hca e en i onmen .
O he in e es ing expe iences a e a ailable, such as he
p og am p oposed app oxima ely one decade ago, by
K asne , Eps ein e al. [23], wi h p ima y ca e physicians.
The esul s we e conclusi e: he pa icipa ion in a com-
munica ion p og am, was associa ed wi h sho and
long- e m imp o emen s, in well-being and a i udes
associa ed wi h pa ien -cen e ed ca e.
Del ing in o he educa ion ield, i is especially in e -
es ing he ac obse ed by Beddoe e al. [24] ha «being
a en i e» no only dec eases pe sonal s ess in s uden s
o a aining in e en ion, bu also imp o ed hei
empa he ic a i ude and dec eased he endency o be
loaded down wi h nega i e emo ions o o he s.
Also, in he eaching en i onmen , ce ain expe iences
in he a ea o e ec i eness o mind ulness in educa ion
ha e had posi i e esul s, no only o eache s [25].bu
also o s uden s [26], wi h subs an ial imp o emen ak-
ing place in academic pe o mance.
The e is a peculia i y o ou s udy ha makes i di e en
om o he s. We a e in a special eaching and lea ning en i -
onmen : heal hca e. Teache s and esiden s sha e expec a-
ions and esponsibili ies o eaching and lea ning wi h he
ca e ac i i y and he s ess ha may be caused by his si u-
a ion. The wo k o he eache u o s o he Family Medicine
Depa men s, does no di e subs an ially om ha o he
pu ely educa ional en i onmen . Bu pe haps he comple-
men a i y o hei eaching compe encies, wi h he clinical
p ac ice, makes he la e conside ed a p io i y unde mining
he eaching ac i i y.
The e ec i eness o mind ulness echniques on he
p o essionals (such as physicians and nu sing esi-
den s) in he lea ning p ocess, has been demons a ed
in he pas [27] as well as ecen ly [28]. Howe e , i
does no appea ha hese e idences had been
accompanied by i s se ious and ongoing implemen a-
ion o educe s ess in he a eas ha ha e been
s udied.
In ou s udy, we analyze he p io le el o mind ulness and
i s po en ial ela ionship wi h some a iables. We ha e no
ound di e ences in mind ulness no in he le el o wo k-
ela ed s ess, by p o essional g oups: in nu ses, physicians
and esiden s, sugges ing ha in e en ion p og ams may be
use ul o all o he p o essional g oups.
The e a e no di e ences de ec ed in e ms o gende ,
bu he e we e, wi h ega ds o age. In his sense, one o
he pending a eas o be add essed, also sugges ed in
o he s udies, is he lack o assessmen o he long- e m
e ec i eness o he in e en ion p og ams.
An in e se ela ionship was obse ed be ween he le el
o p ac icing o mind ulness exe cises and he le el o
wo k- ela ed s ess, such ha , wi h g ea e p ac ice
le els, he e we e lowe wo k- ela ed s ess le els. This
coincides wi h he esul s om pas s udies and suppo s
he need o he p ac icing o mind ulness in he ca e
and aining en i onmen s.
Limi a ions include he sample composi ion (unless
i can be demons a ed ha i main ains he same
pe cen agesbyoccupa ionas hegene alSpanish
popula ion). I should be men ioned ha a leas he
sample size is high, aking in o accoun he ype o
s a is ical analysis ca ied ou , he e o e he s a is ical
powe was adequa e. Ano he limi a ion is he use o
a scale wi h only one i em o assess pe cei ed wo k-
ela ed s ess, since his is a complex cons uc . How-
e e , his wo k is an explo a ion ha should be con-
i med in u u e s udies. The inal limi a ion is he
ype o design used, which, being c oss-sec ional, does
no pe mi us o es ablish causal ela ionships. C oss-
sec ional da a is always limi ed o examine a esea ch
ques ion which en ails a ela ionship (mind ulness
educes s ess). Bu maybe i is he o he way ound
and hose people who ha e less s ess, ha e mo e
ime o do p ac ice mind ulness. So, in u u e s udies,
he po en ial causal ela ionships be ween a iables
de i ed om he obse ed associa ion should be s ud-
ied using app op ia e designs.
Conclusions
Gi en he high pe cen age o p ima y ca e p o ide s
who expe ience wo k- ela ed s ess, and he ac ha
Mind ulness-Based In e en ions seem o be use ul o
educe his p oblem, heal h au ho i ies and manage s in
cha ge o con inuous aining p og ams should ake
hem in o accoun in he p ima y ca e se ing.
Mind ulness-Based In e en ions a e e y e sa ile
echniques, ideal o p ima y ca e con ex s o simila ,
and ha achie e hei g ea es deg ees o e ec i eness
no only in pa ien s wi h symp oms o s ess, anxie y o
dep ession, bu also in heal h p o essionals. I is neces-
sa y o ca y ou in e en ion s udies di ec ed a hese
heal h p o essionals in o de o e i y i he s anda dized
p og ams o ins uc ion in mind ulness manage o e-
duce he le el o s ess and bu nou .
Supplemen a y In o ma ion
The online e sion con ains supplemen a y ma e ial a ailable a h ps://doi.
o g/10.1186/s12875-021-01375-2.
Addi ional ile 1.
Magallón-Bo aya e al. BMC Family P ac ice (2021) 22:29 Page 7 o 9
Abb e ia ions
FFMQ: Fi e Face Mind ulness Ques ionnai e; RIS: Residen In e n Specialis s;
SD: S anda d de ia ion; 95% CI: 95% con idence in e al; SPSS: S a is ical
Package o he Social Sciences
Acknowledgemen s
The au ho s would like o exp ess hei g a i ude o he membe s o he
coo dina ing o ganism o he PAPPS and he Spanish Socie y o Medicine o
Family and Communi y (semFYC) o suppo ing his p ojec .
Au ho s’con ibu ions
RM, JV, LP and CP designed and de eloped he s udy p o ocol. LP, CB, HM,
JG and RM conduc ed he s udy and collec ed he da a. LP and RM analyzed
he da a and w o e he manusc ip . All au ho s in e p e ed he da a, and
ead and app o ed he inal manusc ip . NL and JG p o ided c i ical
e isions.
Funding
The p ojec has ecei ed unding om DGA g oup (B17-17R) and he
Ne wo k o P e en ion and Heal h P omo ion in P ima y Ca e (REDIAPP)
g an om he Ins i u o de Salud Ca los III (ISCIII) o he Spanish Minis y o
Economy and Compe i i eness, co- inanced wi h Eu opean Union ERDF
unds (RD16/0007/0005). The ole o he unding body has consis ed in pay-
ing he cos s o ansla ion and publica ion o he a icle.
A ailabili y o da a and ma e ials
The aw da a suppo ing ou indings is in he companion ile
(Supplemen a y Ma e ial).
E hics app o al and consen o pa icipa e
The p ojec has been app o ed by he E hics and Clinical Resea ch
Commi ee o he Reina So ía Hospi al in Có doba ( e . 3845). The in o med
consen o he pa icipan s was eques ed. The w i en in o med consen o
he pa icipan s was ob ained by indica ing i in he da a collec ion o m
used.
Consen o publica ion
No applicable.
Compe ing in e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
Au ho de ails
1
Family and Communi y Medicine Teaching Depa men o Za agoza Sec o
1, Ins i u e o Heal h Ca los III ( edIAPP 06/18), IIS-A agon, G oup B21-R17,
Uni e si y o Za agoza, Za agoza, Spain.
2
Mul i-p o essional Teaching Uni o
Family and Communi y Ca e o Có doba, Heal hca e Dis ic o Có doba and
Guadalqui i , Ins i u e Maimónides o Resea ch Có doba (IMIBIC)/Hospi al
Reina So ía/Uni e si y o Có doba, Isla de Lanza o e, 3, 14011 Có doba, Spain.
3
Ins i u e o Heal h Ca los III ( edIAPP 06/18), IIS-A agon, G oup B. Uni e si y
o Za agoza, Za agoza, Spain.
4
Family and Communi y Medicine Teaching
Depa men o Bu gos, Bu gos, Spain.
5
Family and Communi y Medicine
Teaching Depa men o Jaen, Jaen, Spain.
6
Hospi al Uni e si a io Miguel
Se e , Za agoza, Spain.
7
Mul i-p o essional Teaching Uni o Family and
Communi y Ca e o Alme ia, Alme ia, Spain.
Recei ed: 19 Ma ch 2020 Accep ed: 17 Janua y 2021
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Publishe ’sNo e
Sp inge Na u e emains neu al wi h ega d o ju isdic ional claims in
published maps and ins i u ional a ilia ions.
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