Amigas Latinas Motivando el Alma (ALMA):

an Evaluation of a Mindfulness Intervention

to Promote Mental Health among Latina
Immigrant Mothers
Daron Ryan, MPH
Serena Maurer, PhD
Liliana Lengua, PhD
Bonnie Duran, DrPH
India J. Ornelas, PhD, MPH

Abstract
Latina immigrants are at increased risk for poor mental health. Amigas Latinas Motivando el
Alma (ALMA) is a group-based intervention to reduce symptoms of depression, anxiety, and stress
among Latina immigrants. Based on participants’ feedback and growing evidence supporting
mindfulness as a way to reduce stress and improve mental health, additional sessions of the ALMA
intervention were developed and pilot tested to provide more training on mindfulness as a coping
strategy. The feasibility and potential efficacy were evaluated in a community sample using a pre-
and post-test study design. Findings suggested that women were satisfied with the sessions and
used mindfulness strategies they learned in their daily lives. The program also reduced symptoms
of depression and anxiety (19% reduction in mean depression scores and 26% reduction in mean
anxiety scores). Further evaluation is needed to test the efficacy of the intervention.

Background
Latino immigrants face many stressors during migration and resettlement that put them at
increased risk for anxiety, depression, and other adverse mental health outcomes.1 Latina
immigrant women are particularly at risk due to the unique social, cultural, and economic
challenges they face, including migration-related trauma and added gender role expectations.2 As

Address correspondence to India J. Ornelas, PhD, MPH, Health Services, University of Washington, Seattle, WA, USA. .
Daron Ryan, MPH, Health Services, University of Washington, Seattle, WA, USA.
Serena Maurer, PhD, Department of Women Studies, University of Washington, Seattle, WA, USA.
Liliana Lengua, PhD, Center for Child and Family Well-Being, University of Washington, Seattle, WA, USA.
Bonnie Duran, DrPH, School of Social Work, University of Washington, Seattle, WA, USA.

)
Journal of Behavioral Health Services & Research, 2017. 280–291. c 2017 National Council for Behavioral Health. DOI
10.1007/s11414-017-9582-7

280 The Journal of Behavioral Health Services & Research 45:2 April 2018
such, Latina immigrant women suffer from higher rates of anxiety and depressive symptoms than
their male counterparts and are often found to have worse mental health outcomes than women in
other racial/ethnic groups.1, 3–6 These disparities are exacerbated for Latina immigrant mothers,
who are also caring for their families in the context of low education, poverty, and limited access to
social and economic resources. Latina mothers also experience higher rates of parenting-related
stress than white, non-Latina mothers.7 Therefore, there is a need for culturally relevant
interventions to promote mental health among Latina immigrant mothers.8
Amigas Latinas Motivando el Alma (ALMA), which translates to BLatina Friends Motivating
the Spirit,^ is a culturally relevant and group-based intervention developed in response to this need.
ALMA aims to improve the mental health of Latina immigrants by increasing their coping skills,
enhancing social support, and decreasing barriers to accessing mental health care, all while
incorporating the social and cultural context of immigration-related stressors. Pilot testing of the
original program in North Carolina and Washington indicated high levels of participant satisfaction
and decreased levels of stress and depressive symptoms following the intervention.9 Women
participating in these previous pilot studies also reported that they were particularly interested in
aspects of the program that focused on mindfulness approaches.
A growing body of research points to the efficacy of mind-body interventions, such as
mindfulness and yoga, in promoting physical and psychological well-being.10, 11 Mindfulness
practices encourage nonjudgmental awareness to what is happening in the present moment and
have been linked to reduced depressive and anxiety symptoms.12,13 Yoga, a physical activity
focused on stretching, balance, and breathing, has also been shown to improve mental health.14–17
Despite these promising findings, few mindfulness interventions have been evaluated among racial/
ethnic minority and immigrant communities.
Given participant interest and increasing evidence linking mindfulness practices to improved
mental health, the research team sought to further develop and pilot test additional mindfulness
content for the ALMA intervention. The present study’s aims were to assess the feasibility and
potential efficacy of a five-session mindfulness intervention to improve mental health among
Latina immigrant mothers. It was hypothesized that women would have high levels of satisfaction
with the intervention and that levels of depression, anxiety, and stress among participants would be
lower after the intervention.

Methods
ALMA Mindfulness Intervention
The intervention consisted of five weekly 2-h classes, which occurred in the evening at a
community-based organization providing economic and educational opportunities to Latino
immigrants in Seattle, Washington. These opportunities included a day labor worker center, ESL
classes, job training, and leadership development. Sessions were led by a Spanish-speaking
mindfulness and yoga instructor with previous experience developing and teaching mindfulness
programs in immigrant and other underserved communities. Sessions were open to all clients of the
community-based organization, with childcare and refreshments provided at each session. Sessions
were held in the evening to accommodate participants’ work and family commitments. To
incentivize retention and overall attendance, study participants received Bwellness tote bags^ if
they attended four or more sessions. The tote bags were filled with scented candles, bath products,
and other items to encourage practicing relaxation and self-care at home.
Evidence-based yoga and mindfulness techniques served as the anchoring content for the ALMA
intervention sessions, which were adapted to be culturally relevant to Latina immigrant mothers.
The original ALMA intervention consisted of six sessions with content related to migration
stressors, identifying mental health symptoms, and coping strategies for adjusting to life in the

Mindfulness Intervention for Latina Immigrants RYAN ET AL. 281

USA; only one session covered yoga and mindfulness techniques.9 The new five-session
intervention was designed to provide more in-depth training to promote coping and self-care and
ultimately, mental health. Mindfulness refers to intentional, nonjudgmental awareness of what is
happening as it is happening, within and outside the bodies and minds of those engaged in
mindfulness practice. This program’s approach to mindfulness draws on Buddhist and secular
versions of mindfulness philosophy and practice, as well as The Center for Compassion and
Altruism Research and Education’s Compassion Cultivation Training.18 This training introduced
participants to compassion and awareness as the Btwo wings of mindfulness^ and guided them
through practices focused on the cultivation of compassionate awareness of self and others. The
sessions explored compassionate awareness of physical sensations, thoughts, and emotions using
meditation, movement, and interaction between participants (see Table 1). They also offered
participants opportunities to explore compassion towards others and cultivate compassion towards
self in their relationships with others, particularly their children. With guided instruction,

Table 1
ALMA intervention and evaluation session content
Session Title Content

Pre Orientation Pre-survey interviews; introduction to mindfulness

• Dialog about key terms and concepts
• What do awareness and compassion look and feel like for
you?
ALMA Introduction to • Two wings of mindfulness: compassion and awareness
1 compassionate • Meditation and yoga: compassionate awareness of breath
awareness • Mindfulness in our daily lives
ALMA Mindful movement • Barriers to mindfulness in our daily lives
2 • Meditation and yoga: mindfulness of thoughts/feelings
ALMA Compassion for others • Building compassion for others
3 • Bringing mindfulness to parenting and family interactions
• Yoga and meditation: compassion and loving kindness for
someone you love
ALMA Compassion for self • Discussion of the challenges and possibilities of
4 self-compassion
• Yoga and meditation for self-compassion
• Self-compassion and loving kindness writing and drawing
exercise and group share: BMay I be…^
• Everyday mindfulness: self-compassion break
ALMA Barriers to practicing • Meditation review: breath, thoughts and emotions, physical
5 mindfulness sensations, compassion and loving kindness for self and
others
• Self-compassion letter
• Closing circle: cultivating compassionate awareness in our
daily lives
Post Reflections of the journey Post-survey interviews
• Final discussion: which practices worked best for you?
Which will you continue to use?
• Open sharing time and closing celebration

282 The Journal of Behavioral Health Services & Research 45:2 April 2018
participants were encouraged to develop Beveryday mindfulness^ practices they could continue in
their day-to-day lives after the program ended. This included practicing mindful awareness of daily
mind patterns and their effects on participants’ interactions with their children, as well as exploring
ways to practice moments of compassion in their daily lives. Participants were also guided through
sequences of yoga poses during sessions to allow for mindfulness of the body, breath, and mind in
motion, while facilitating further physical and mental relaxation.
All instruction and materials were provided in Spanish to increase the program’s cultural
relevancy to Latina immigrant mothers. The commonly used Batención plena^ served as a
translation to convey meaning of and themes related to mindful awareness in all program sessions
and materials. Instruction built upon women’s own understanding of mindfulness, including how
they previously found moments of calm and relaxation in their daily lives. Each session
emphasized the use of these various techniques for relaxation and self-care in order to combat the
stressors of migration, resettlement, and raising children as a Latina immigrant in the USA. Latino
culture and imagery were also incorporated through vignettes, games, and creative activities to
present program topics in culturally relevant and relatable ways. Sessions included periods of
participants resting on their backs and sides to help with fatigue, lack of sleep, and physical
exhaustion. Time was also provided for discussion, socialization, and meals.

Study Procedures
All study procedures occurred on-site at the community-based organization, and staff from the
organization recruited participants from their pool of existing clients. To be eligible for the study,
women had to be at least 18 years old, Spanish-speaking, born outside of the USA and have at least
one child. All participants provided consent and all procedures were approved by the University of
Washington Human Subjects Division.
Trained bilingual interviewers administered the surveys to participants in separate sessions
before and after the intervention’s five sessions. Participants received a gift card in the amount of
20 dollars for each survey completed. During the initial meeting, the program instructor outlined
the content of the intervention and introduced mindfulness to participants by defining key terms
and asking them to share where they experience awareness and compassion in their daily lives. At
a follow-up session that was held 1 week after the final intervention session, the research team
asked the group to debrief their experience in the program by sharing their experiences and
recommendations for future programs. During this time, interviewers pulled out participants from
the larger group one-by-one to administer the final survey. Eight measures, described in detail
below, were utilized in the survey to collect data on the following: depression, anxiety, parenting
stress, perceived stress, mindful awareness, demographic characteristics, participant satisfaction,
and attendance.

Depression A Spanish version of the Patient Health Questionnaire-9 (PHQ-9) was used to
measure depressive symptoms.19 The 9-item measure asks participants to report how often they
have experienced various depressive symptoms over the last 2 weeks. Responses range from 0 (Not
at all) to 3 (Almost every day), for a total score range of 0 to 27. A score of 10 or greater indicates
moderate to severe depression. This measure has been found reliable when used in a Spanish-
speaking community sample.20

Anxiety Anxiety symptoms were measured using a Spanish version of the Generalized Anxiety
Disorders-7 (GAD-7) scale.21 This 7-item scale measures symptom frequency of symptoms over
the past 2 weeks, with responses ranging from 0 (Not at all) to 3 (Nearly every day). Total scores

Mindfulness Intervention for Latina Immigrants RYAN ET AL. 283

range from 0 to 21, with a score of 10 or greater indicating moderate to severe anxiety. The GAD-7
has been validated in a Spanish-speaking community sample.22

Parenting Stress The 17-item Likert-type Parental Stress Scale (PSS) was used to assess changes
in stress associated with parent-child interactions.23 Participants were asked to report to what
degree they agree with parenting-related statements. Negative items are reverse scored and
responses are summed for a possible score range from 18 to 90. Higher scores indicate greater
levels of parental stress. The Spanish version of this scale has been validated when used among
Spanish-speaking populations.24

Perceived Stress The Perceived Stress Scale (PSS) was used to assess each participant’s overall
stress level. The 10-item scale measures to what degree events in the participant’s life are stress-
inducing.25 Recalling the last month, participants were asked how often they experienced certain
overwhelming thoughts or feelings. Total scores range from 0 to 40, with higher scores indicating a
higher measured perceived level of stress. The PSS has been found reliable when used among
Spanish-speaking populations.26

Mindful Awareness The Mindfulness Attention Awareness Scale (MAAS) was utilized to
evaluate quality of consciousness and well-being associated with increased self-awareness.27 The
15-item measure uses a 6-point scale to ask participants how often they experience mindful
awareness, with response options ranging from 1 (Almost always) to 6 (Almost never). An average
is taken of the 15 responses for a total possible score range from 1 to 6, with higher scores
indicating greater mindful awareness. A translated version of this scale has been previously used in
Spanish-speaking community settings.28

Demographic Characteristics These questions included age, country of birth, years spent in the
USA, years spent in the Seattle, Washington area, highest level of education completed,
employment status, marital status, and languages spoken. They were also asked to report their
weekly family income, number of children, and household composition.

Participant Satisfaction Post-intervention, participants were asked to respond to a set of open-

ended questions regarding their overall satisfaction with the program and research process.
Qualitative questions covered use of content (BWhat were the most helpful things you learned in
the ALMA program? Can you describe a situation when you used a strategy you learned?^),
connection to parenting (BHow has the program impacted your parenting?^), and suggestions for
program modification (BIs there anything that could be done to improve the program? Do you have
any other comments for the research team about your experience in the program?^). Because
interviews were not recorded, interviewers were required to write notes during the survey that
included quotes and main ideas for each of the participant’s responses.

Attendance Research staff recorded the number of participants present for each of the five
intervention sessions and the pre- and post-intervention survey sessions. These counts include
study participants and all attendees, as sessions were not restricted to solely those who enrolled in
the study.

284 The Journal of Behavioral Health Services & Research 45:2 April 2018
Data Analysis
Descriptive statistics were used to calculate the frequencies of demographic characteristics and
mental health outcomes in the sample. Levels of depression, anxiety, parenting stress, perceived
stress, and mindful awareness were assessed among participants prior to and following the 5-week
intervention, calculating paired t tests using a 90% confidence interval. This wider confidence
interval was selected to account for the relatively small sample size. Additionally, participant
outcomes were compared across different levels of attendance.
Interviewers’ notes on participants’ open-ended survey responses during follow-up data
collection were analyzed for content and consistent themes. Responses were grouped into
categories by two members of the research team and specific quotes were chosen as examples.
Results and quotes were also presented to participants and community-based organization staff to
confirm interpretations. Quotes were ultimately translated into English for reporting and
dissemination to broader audiences.

Results
A total of 24 mothers were recruited and enrolled in the study. Descriptive statistics for
participant demographics, baseline mental health, and session attendance are presented in Table 2.
Most women in the study were Mexican (n = 19, 79%) and married (n = 15, 65%), with a mean age
of 49 and an average of 2.8 children. A majority of participants had lived in the USA for longer
than 10 years (n = 15, 62%) and were employed year-round (n = 13, 54%). Of those enrolled in the
study, 12 women (50%) came to at least four sessions and 12 women (50%) came to three or fewer.
An average of five non-enrolled participants attended each intervention session, as sessions were
open to the public regardless of whether or not they were enrolled in the study. Twenty-one
participants completed the post-intervention survey measures, resulting in an 87.5% retention rate
at follow-up.
Table 3 presents post-intervention changes in levels of stress, mindful awareness, and mental
health outcomes. There were no changes in levels of parenting stress. Although they were not
found to be statistically significant, the mean scores of depression, anxiety, perceived stress, and
mindful awareness decreased after the intervention. Moreover, changes in scores on both
depression and anxiety were greater among participants who attended a greater number of ALMA
sessions. In fact, changes in anxiety levels from baseline to post-intervention were three times
greater for participants who attended four or more sessions (a 42% decrease) compared to those
who attended three or fewer (a 13% decrease). Mean changes in participant depression scores from
baseline to post-intervention followed a similar trend, with a 26% decrease for attendees of four or
more sessions versus a 15% decrease for those who attended fewer than three sessions. However,
these differences were not statistically significant.
Qualitative analysis of participant feedback was grouped into four categories: most useful
content; practical application of the intervention content; how the intervention impacted their
parenting; and improvement suggestions for the program. Illustrative quotes from participants are
presented for each category in Table 4. Overall, participants reported a high level of satisfaction
with curriculum content and activities, as well as frequent use of learned techniques in their daily
lives for stress relief and relaxation. The majority of respondents indicated a desire for the program
to continue on with more frequently occurring sessions.

Discussion
This study assessed the feasibility and potential efficacy of a mindfulness intervention to reduce
depression, anxiety, and stress among Latina immigrant mothers. Participants reported decreased

Mindfulness Intervention for Latina Immigrants RYAN ET AL. 285

 Table 2
Participant characteristics (N=24)
Mean/N (SD) %

Age
Younger than 45 13 54%
45 or older 11 46%
Country of birth
Mexico 19 79%
Peru 3 13%
Years lived in the USA
10 or less 9 38%
More than 10 15 62%
Education
Less than high school 12 50%
HS graduate or more 12 50%
Marital status
Single 4 17%
Married 15 65%
Divorced or widowed 4 17%
Number of Children 2.8 1.2
Weekly household income
Less than $300 6 26%
$300–$500 8 35%
$500–$700 4 17%
More than $700 5 22%
Employment status
Employed year-round 13 54%
Temporarily employed 6 25%
Currently not working 5 21%
Languages spoken
Only Spanish 5 21%
Spanish and some English 19 79%
Mental health Mean/N SD/%
Parenting stress (18–90) 38.1 9.4
Perceived stress (10–50) 27.1 3.8
Anxiety (0–21) 6.1 5.4
Mild 18 7%
Moderate 4 17%
Severe 2 8%
Depression (0–27) 6.7 5.6
Mild 17 71%
Moderate 6 25%
Severe 1 4%
Mindful awareness (1–6) 3.2 0.5

286 The Journal of Behavioral Health Services & Research 45:2 April 2018
 Table 3
Pre-post intervention changes in stress, mindfulness, and mental health outcomes
Measure Pre-intervention Post-intervention Change

Mean SD Mean SD Actual Percent

Parenting stress 37.8 9.9 37.8 10.8 0.0 0

Perceived Stress 26.7 3.9 25.3 5.2 − 1.4 − 5.2
Mindfulness* 3.2 0.5 2.8 0.7 − 0.4 − 12.5
Depression 6.3 5.7 5.1 6.3 − 1.2 − 19.1
Anxiety 5.7 5.5 4.2 5.4 − 1.5 − 26.3
By session attendance
Depression
0–3 sessions 7.5 4.4 6.4 7.0 − 1.1 − 14.7
4–5 sessions 5.2 6.7 3.8 5.8 − 1.4 − 26.9
Anxiety
0–3 sessions 6.9 5.6 6.0 6.3 − 0.9 − 13.0
4–5 sessions 4.6 5.5 2.6 4.2 − 2.0 − 43.5
*Found to be significant at a 90% confidence level
a
Baseline values will differ slightly from Table 2 due to three participants who lost to follow-up

symptoms of depression, anxiety, and stress after receiving the intervention. To the research team’s
knowledge, this is the first study to test the feasibility of a mindfulness-based mental health
intervention among Latina immigrants. This study provides support for further developing
community-based programs that promote coping and self-care strategies within Latina immigrant
communities.

Participant Characteristics
Participant baseline scores of depression and anxiety in the sample were comparable to those
reported in national surveys of Latina immigrants. At baseline, 29.2% (n = 7) of the participants
reported experiencing moderate to high levels of depressive symptoms, which compared to 32.8%
of women who reported similar levels of depression in the Hispanic Community Health Study/
Study of Latinos.6 Overall, few studies have reported rates of anxiety among Latina immigrant
women, making it difficult to compare the findings to other samples. In this study, 25% (n = 6) of
participants reported experiencing moderate to severe anxiety symptoms. In comparison, the
National Latino and Asian American Study (NLAAS) found that the lifetime prevalence of anxiety
disorder was 21% among Latina women, including both U.S. citizens and immigrants.1 However,
this NLAAS figure only included those that have been diagnosed with an anxiety disorder,
excluding those that are undiagnosed or have not sought treatment.
The perceived stress scores in this sample were comparable to those reported in other diverse
community samples.29 However, parental stress scores were higher among participants in this study
than those in previous studies using this measure. While no previously published studies have used
the Parental Stress Scale (PSS) measure with Latina immigrant mothers, a study validating a
Spanish version of the PSS among Spanish mothers reported a mean score of 22.3, somewhat
lower than the mean in the present sample (38.1).24 Further research in larger samples should
assess levels of parental stress in this population.

Mindfulness Intervention for Latina Immigrants RYAN ET AL. 287

 Table 4
Participant satisfaction categories and illustrative quotes
Most useful content Practical application Impact on parenting Suggested
of intervention improvements
content

Uso los ejercicios de

Las más útiles fueron el Han sido muy buenos El programa está bien,
yoga y la meditación. meditación. Trabajo para mi. A veces pero quisiera más
El yoga me gustó en housekeeping y estaba enojada y grité sesiones. Que. sería
mucho para aprender cuando tengo tiempo mucho a mis hijos más largo y más
a encontrarme a mi hago algunos de los pero ahora puedo intenso.
misma; mis valores. ejercicios que escucharme a mí The program is good,
Me ayudó a meditar y aprendí. También voy misma y a mis but I would like more
a tener mi espacio y al parque donde están necesidades. Mis sessions. [I would
cambiar a los arboles y veo los hijos notan la prefer] that they were
pensamientos más pájaros y siento el diferencia en mis longer and more
positivos. viento. emociones. intense.
The most useful were I use the meditation [The classes] have
classes on yoga and exercises. I work as a been really good for
meditation. I really housekeeper and me. Many times, I
liked yoga because it when I have time, I do would get angry and
helped me to some of the exercises yell at my children but
rediscover myself and that I learned. now I can listen to
my values. It helped [Referring to myself and to my
me to meditate in my mindfulness needs. My children
own space and change techniques.] I also go notice the difference in
my thoughts to be to the park where there my emotions.
more positive. are trees and just
watch the birds and
feel the wind.
...Quererme más, Si, el yoga en la casa. Se Me ayudó Hablar más del tema de
meditar más, me quita el estrés positivamente con mis la compasión. En
conocerme más a cuando hago el yoga. hijos. Pienso cómo nuestra cultura, no
fondo y aprender a También la ayudar a mis hijos y nos hablan mucho de
relajarme. meditación del pecho aprendí a controlar mi este tema.
[The classes have me sirve mucho con estrés para que [It would be better to]
helped me] love el estrés. maneje mejor las speak more about the
myself more, meditate Yes, [I like to do] yoga situaciones con ellos. subject of compassion.
more, know myself at home. When I do [The program] has In our culture, they do
deeper, and learn to yoga, it alleviates my helped me positively not speak to us much
relax. stress. The chest with my children. I about this.
meditations also really think of how to help
help me to feel less them and I have
stressed. learned how to control
my stress so that I can
better handle situations
with my kids.

288 The Journal of Behavioral Health Services & Research 45:2 April 2018
 Women in this study reported low to moderate levels of mindful awareness at baseline. Similar
to parental stress, previous research utilizing the Mindful Attention Awareness Scale (MAAS)
among Latino populations is limited. Brown and Ryan, the researchers that developed the scale,
reported a mean MAAS score of 4.2 among four independent community samples of adults,
indicating a moderately high level of dispositional mindfulness and a higher mean than the present
sample (3.2).21 However, it is difficult to discern the relative value of this sample’s mean due to a
lack of research validating this scale among Spanish-speaking Latino immigrants.

Pre-post Intervention Changes in Mental Health and Mindfulness

Overall, women in this study reported decreases in depression, anxiety, and perceived stress after
the intervention, with greater increases among those who attended more sessions. It should be
noted, however, that the women who attended more ALMA sessions had lower overall mental
health scores. Participants who attended fewer sessions reported higher levels of both depression
and anxiety at baseline and post-intervention compared to those with more frequent attendance. It
is plausible that higher levels of distress prevented these women from attending more sessions.
Future research on community-based mindfulness interventions should be devoted to developing
strategies to increase participation for women with poor mental health to determine whether they
would benefit to the same degree as women who completed more sessions.
An unexpected finding was that mindful awareness scores in the sample decreased after the
intervention. Because mindfulness was unfamiliar to most participants prior to the intervention,
they may not have fully understood the concepts conveyed through the questions until after the
intervention. It is also possible that this measure did not adequately capture mindful awareness in
this sample, since it has not been previously validated in Spanish-speaking populations.
Interviewers reported that they often had to repeat or explain items, indicating that the translated
phrases were not well understood by study participants and may not have adequately captured the
degree of mindful awareness among the sample.
Validity was also a concern for the measure of parenting stress used. During data collection,
several women were confused when asked about the extent to which they agree with statements
such as, BDisfruto de mi(s) hijo(s)/ I find my children enjoyable,^ and, BSi tuviera que hacerlo de
nuevo, podría decidir no tener hijos/ If I had it to do over again, I might decide not to have
children.^ Given the variation of scores on this measure, both pre- and post-intervention, it is
difficult to interpret any changes in scores. Unfortunately, the lack of culturally appropriate
measures continues to be a barrier for conducting research and implementing parenting
interventions among Latino populations.30 In order to support interventions aimed at improving
the mental health of this community, future efforts should be directed at developing better measures
of mindfulness and parenting stress for Latina/o populations.

Participant Attendance and Satisfaction

The findings related to participant attendance were encouraging, especially among a sample of
women with very little free time outside of work and caregiving. Participants noted that the
consistent location and time were helpful. The findings from the participant feedback portion of
data collection suggest that the mindfulness content was well-received and engaging for the
women in the sample. Participants reported a high degree of satisfaction with not only the
curriculum content, but also the research team and group dynamic. Although many participants
revealed that yoga and mindfulness were new concepts to them, these activities received the most
positive feedback. Many women reported using the techniques learned in the session in their daily
lives for relaxation and stress relief. This indicates that the program is both feasible and acceptable
to this population.

Mindfulness Intervention for Latina Immigrants RYAN ET AL. 289

Study Limitations
Some limitations to this study merit discussion. Most participants were recruited from a group of
existing clients at the community-based organization where the sessions were held. This may have
resulted in participants that differ from the overall population in areas of social-connectedness,
social cohesion, and mental health status. As such, caution must be taken when interpreting the
results and generalizing them to the larger Latina immigrant population. Future studies should
involve multiple sites and varied recruitment efforts to reach a wider representation of the
community. Similarly, while the outcomes suggest potential efficacy of the intervention in reducing
poor mental health, the relatively small size of the sample limits the ability to attribute these
changes solely to the intervention. A stronger study design would yield more robust conclusions
about the impact of the intervention.

Implications for Behavioral Health

This study illustrates the feasibility and potential efficacy of a mindfulness intervention to
improving mental health among a vulnerable population with limited access to mental health care.
The pillars of the original ALMA program, to increase coping skills and self-care behaviors, are
rooted in the belief that in order to care for others, one must first care for oneself. While the reach
of the program appears conservative due to the small sample size, feedback from participants
highlights the potential multigenerational impact of a mental health intervention for Latina
mothers. The women involved in the program are not only mothers, but grandmothers, caretakers,
respected community elders, and key social figures. By fostering more positive interactions and
relationships, health professionals can reduce rates of stress, depression, and anxiety among
women of this community, as well as others in their social networks. Future studies should assess
the multigenerational impact of maternal mental health interventions in order to build upon this
notion of interconnectedness within the Latino immigrant community. Researchers and healthcare
professionals serving this population should consider the value of community-based mental health
interventions that incorporate the cultural and social context of immigration in Latino families.

Funding
This study was funded by the Center for Child and Family Well-being at the University of
Washington.

Compliance with Ethical Standards

Conflict of Interest Liliana Lengua is the Director of the Center for Child and Family Well-being
which also funded the study. None of the other authors have any conflicts of interest to report.

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