We used a descriptive qualitative approach to analyze participants’ feedback, focusing on elements of online participation in yoga sessions [14-16]. After participation in the online MY-Skills intervention feasibility randomized controlled pilot, participants shared their overall experiences with the intervention in one-on-one interviews (Schmid et al, unpublished data, 2023). The primary qualitative analysis for the pilot focused on the perceived benefits of dyadic treatment for persistent pain [17]. This analysis targeted feedback solely related to online delivery.

The primary goal of the pilot was to test the feasibility of MY-Skills among dyads experiencing persistent pain. MY-Skills is a standardized and progressive intervention that offered yoga and health education in 120-minute sessions (2 times per week for 8 weeks) via Zoom (Zoom Video Communications Inc) videoconferencing from October 2020 to June 2021. The yoga component was based on our prior studies [18] and was further developed specifically for dyads with persistent pain (Multimedia Appendix 1). The education component was based on literature regarding the self-management of persistent pain [19] and on stakeholder engagement [20]. Sessions included guided discussions, reflective activities, and brainstorming to address the common areas that are necessary in self-management education—problem-solving, action plans, the development of coping skills, and effective communication [21,22]. We included information about yoga for pain and a weekly mantra that was related to the education topic to merge the yoga and education sessions seamlessly. Yoga was delivered by a yoga therapist, and group education was provided by trained research assistants who identified as therapists (ie, occupational therapist or marriage and family therapist). Participants randomized to the control group participated in online, low-intensity exercise and health education that excluded yoga practice (ie, breath work and meditation) and self-management strategies (eg, goal setting, problem-solving, and health tracking).

The Colorado State University Institutional Review Board approved all procedures (protocol number: 19-9095H). All participants were consented to participate via Zoom videoconference. Potential participants were provided with an e-consent form via REDCap (Research Electronic Data Capture; Vanderbilt University). The research assistant reviewed the consent form, answered any questions, and assessed participants’ understanding of this study. The participants and research assistant e-signed the consent form. All participants consented to this study prior to assessment and intervention. Participants received a US $50 Amazon e-card before and after intervention assessments and were provided with a yoga mat, blocks, and other props as needed. Data were captured via REDCap, Zoom, and phone; secured by using study IDs; and stored on servers behind university firewalls. All study personnel were trained in the conduct of human subject research.

We recruited dyads (ie, caregivers and care receivers) with persistent pain from a local pain management clinic and through advertisements in the local newspaper, flyers, and community partners' newsletters and websites. To participate, both members of the dyad were required to be older than 18 years, report chronic musculoskeletal pain, and experience moderate or worse pain severity and pain interference (based on a score of >5 on the Brief Pain Inventory [23]). Additional inclusion criteria were reported elsewhere [24]. After the completion of the pilot, all participants (N=18) were invited to share their experiences in an interview. All participants agreed, and all completed the interview.

Within 2 weeks after completing the MY-Skills intervention, we conducted one-on-one telephone interviews to acquire feedback from participants regarding dyadic experiences, perceived benefits of the intervention, and online delivery. Master- and doctoral-level research assistants with previous qualitative research experience used a semistructured interview guide that included questions about online intervention acceptability (Textbox 1). Before interviews, study investigators (CF and JP) conducted mock interviews with the team to prepare for data collection. Interviews were conducted with individuals separately or as a dyad, depending on participants’ preferences, and took around 20 minutes to complete.

We used rapid, qualitative, analytic methods to identify themes related to the acceptability of online delivery [25]. Interviews were audio recorded, interview summary notes were used for coding, and we revisited audio recordings to transcribe exemplar quotes for each code. Field notes from the time of the interviews were first entered into REDCap and exported to Excel (Microsoft Corporation) for coding. Field notes were coded (AF) and reviewed by the investigator team (JP, CF, and MVP). After codes were agreed upon by the team, exemplar quotes from the recordings were added and organized in Excel. Codes focused on the impact of MY-Skills on the dyad relationship, benefits experienced by participants, and feasibility feedback. For this paper, we focused solely on codes pertaining to the acceptability of online versus in-person delivery. First, JP reviewed online acceptability codes and collapsed codes into broad categories, which were then discussed with secondary coders (AF and MVP). To form overall findings, we conducted a heading and subheading thematic analysis, focusing on delivery preferences and recommendations for improved online delivery [26].

A total of 16 dyads (N=32) enrolled in the online trial, and 9 dyads (n=18) were randomized to the MY-Skills group. MY-Skills participants were, on average, aged 62.7 (SD 19) years; were primarily women; were primarily White; and had a mean of 5.5 (SD 3) chronic conditions (Table 1). Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory.

Overall, participants’ responses indicated good acceptability of online MY-Skills delivery. Participants specified benefits for both the online format and the in-person format and provided several recommendations for improving online delivery (Textbox 2).

Participants enjoyed the online delivery of MY-Skills due to easy access and convenience. Many participants experienced transportation concerns related to their chronic conditions or distance to health care. The online option allowed individuals to participate regularly. Participants also appreciated online delivery because they felt safe and comfortable in their home environment. Participants indicated that instructors were able to modify and adjust individuals verbally as needed.

Some participants explained that in-person yoga would also have potential benefits. For example, practicing yoga in their home was occasionally distracting. Therefore, participating in person would encourage them to leave their home, allowing them to better focus on yoga practice. Other participants suggested that pose corrections would likely be easier in person and would make them feel safer when trying new poses. Several participants also suggested that in-person options would be more engaging, allowing for improved group interactions and dynamics.

To improve online delivery, participants recommended providing additional technical support and training. Several participants experienced issues with Zoom and internet connectivity; therefore, participants wanted more training to properly prepare for online sessions. Additional aids, such as manuals and videos with step-by-step instructions for connecting, muting, and using the chat function, among others, were also suggested for troubleshooting. In addition to technical support, participants recommended that more time be spent setting up their home environment for yoga practice.