The concept of mindfulness in Thailand traditionally follows the Noble Truth and the Three Characteristics of Theravada Buddhism (impermanence, suffering, and not self). (1-3) There are only few studies on the application of mindfulness meditation in daily life for patients with psychiatric disorders, and none of these studies directly measures the state of mindfulness. (4,5) Therefore, the association between mindfulness skills and clinical outcomes was not empirically demonstrated. To examine this, direct measure of mindfulness skills is imperative. Currently, mindfulness assessment instruments are based on western psychology and cultures. (6,7) Data showed that the stability of the construct of mindfulness across cultures is inconclusive, with reported findings being in support of and against the construct. Christopher et al (1) explored the Kentucky Inventory of Mindfulness Skills and Mindful Attention Awareness Scale (MAAS) among Thai and American students. They concluded that there was a significant difference in the concept of mindfulness between the cultures. (1) Recently, Cardaciotto et al (7) developed the Philadelphia Mindfulness Scale (PHLMS) consisting of the dimensions of awareness and acceptance. This scale has been translated into Thai (PHLMS-Th) and its psychometric properties have been tested in highly educated hospital staff. The results showed that the Thai version had similar factor loadings as the original version. (8) We also found that some items of the acceptance domain of PHLMS-Th were difficult to comprehend, especially among people who had never undertaken formal learning in mindfulness. These findings suggest that a culturally specific instrument may be needed. This study aimed to validate a questionnaire measuring the state of mindfulness among people with different meditation experiences in the context of the Thai culture and concept of Satipatthana (foundations for or the presence of mindfulness in the Buddhist tradition). (3,9)
Two steps, namely, item generation and psychometric property study, were carried out from June to September 2012. The study protocol was approved by the ethical committee of Srithanya Hospital, Thailand.
Item Generation and Selection
To obtain the operational definition of mindfulness in the Thai context, we interviewed 2 psychiatrists who had experiences with mindfulness for > 5 years, as well as a meditation teacher. We concluded that mindfulness contained 3 aspects, namely awareness of body; awareness of thought and feeling; and self-recollection. Five items were derived from 3 meditation experts. Of these, 2 were on awareness of thought and 3 on self-recollection. For awareness of body and feelings, 5 items of the PHLMS-Th, indicated by the meditation teacher and having factor loading values of > 0.6 from a previous study,8 were adopted. The first draft consisted of 10 items.
Ten mental health experts with meditation experience reviewed the first draft and compared it with MAAS and PHLMS-Th. All of them agreed on the 10 items and suggested addition of items concerning body movement and body sensation. Thus, we added 4 more items on body sensation and movement. To test the face validity, the 14-item questionnaire was sent to 18 mental health experts with more than 15 years' experience. They were invited to rate the appropriateness of each item on the 5-point Likert scale (1 = very poor to 5 = very good). Responses from 2 experts were discarded due to incompleteness. Items which were rated > 3 by at least 13 of 16 experts were retained. No item was discarded by this criterion. The final version was named Srithanya Sati Scale (SSS) consisting of 3 subscales, namely awareness (SSS_aw) [items 1-6], acceptance (SSS_ac) [items 7-9], and self-recollection (SSS_se) [items 10-14].
A total of 466 from 500 copies of questionnaires were collected. Among these, 192 were participants of a mindfulness course (PT group), 175 were medical students (ST group), 48 hospital staff, 29 Buddhist monks, and 22 medical staff. …