Developing a School-based Mindfulness Intervention for Delivery in Rwanda and Ethiopia: Cultural Adaptation through Knotworking

Abstract Objectives This paper reports on the development of a culturally adapted, school-based mindfulness intervention (SBMI) for delivery in schools in Rwanda and Ethiopia as part of an interdisciplinary applied health research project on child and adolescent mental wellbeing. Against a backdrop of rising global concern about child and adolescent mental health and limited evidence-based interventions in Sub-Saharan Africa (SSA), this study investigates the processes through which a universal mindfulness curriculum was co-constructed with teacher educators, mindfulness experts, and community representative. Methods In this qualitative research, semi-structured interviews were conducted with the teacher educators, community representative and mindfulness experts involved in the project. The interview transcripts were analysed in NVivo using Clarke and Braun’s updated six-phase thematic analysis approach. Final themes were teacher learning, adaptations, negotiation as knotworking, tensions and trade-offs. Results The findings show that curriculum development involved sustained teacher learning, extensive cultural and contextual adaptation, and dynamic forms of collaborative problem-solving conceptualised as knotworking. These processes responded to constraints such as large class sizes, limited resources, linguistic diversity, and religious sensitivities. The resulting curriculum emphasises short, contextually grounded practices integrated across the school day. Conclusions The development of this school-based mindfulness curriculum for Rwanda and Ethiopia illustrates the complexity of designing mental wellbeing interventions that are culturally resonant, contextually feasible, and educationally meaningful within low resource settings. The study contributes new evidence on curriculum co-design for wellbeing in low-resource contexts and provides insights into how universal SBMIs can be meaningfully adapted for Low- and Middle-Income Country (LMIC) educational systems.