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The online delivery of yoga interventions rapidly expanded during the COVID-19 pandemic, and preliminary studies indicate that online yoga is feasible across multiple chronic conditions. However, few yoga studies provide synchronous online yoga sessions and rarely target the caregiving dyad. Online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples. However, the perceived acceptability of online yoga, including self-reported satisfaction and online delivery preferences, is underexplored among individuals with chronic conditions and their caregivers. Understanding user preferences is essential for successful and safe online yoga implementation.
We aimed to qualitatively examine the perceived acceptability of online yoga among individuals with chronic conditions and their caregivers who participated in an online dyadic intervention that merged yoga and self-management education to develop skills (MY-Skills) to manage persistent pain.
We conducted a qualitative study among 9 dyads (>18 years of age; individuals experiencing persistent moderate pain) who participated in MY-Skills online during the COVID-19 pandemic. The intervention consisted of 16 online, synchronous yoga sessions over 8 weeks for both dyad members. After the completion of the intervention, participants (N=18) participated in semistructured telephone interviews for around 20 minutes, discussing their preferences, challenges, and recommendations for improved online delivery. Interviews were analyzed by using a rapid analytic approach.
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. Both participants and caregivers reported moderate pain severity scores (mean 6.02, SD 1.3) on the Brief Pain Inventory. The following three themes were identified related to online delivery: (1) participants indicated a preference for the intervention to be in person rather than online because they were distracted in the home setting, because they felt that in-person yoga would be more engaging, because the yoga therapist could physically correct positions, and because of safety concerns (eg, fear of falling); (2) participants indicated good acceptability of online MY-Skills delivery due to convenience, access, and comfort with being in their home; and (3) recommendations for improving online delivery highlighted a need for additional and accessible technical support.
Both individuals with chronic conditions and their caregivers find online yoga to be an acceptable intervention. Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Some participants preferred in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Convenience and access were the primary reasons for preferring online delivery. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support.
ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320
Digital health technology has the potential to increase access to complementary and integrated health interventions for individuals with chronic conditions and their caregivers, including meditative movement approaches such as yoga [
Preliminary studies indicate that online yoga is feasible across multiple chronic conditions [
Although online chronic disease management interventions have been evaluated across conditions, life spans, and diverse samples [
We used a descriptive qualitative approach to analyze participants’ feedback, focusing on elements of online participation in yoga sessions [
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 [
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 [
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 (
“What was it like for you to complete the intervention online?”
“Do you have a preference for online or face-to-face intervention?”
“What challenges did you have completing the yoga/exercise in an online format?”
“Did you feel safe completing the yoga/exercise on your own with only the online guidance of the facilitators?”
“What could we have done to improve the online yoga/exercise?”
“Do you have any additional comments, concerns, questions (including those about the online format and delivery)?”
We used rapid, qualitative, analytic methods to identify themes related to the acceptability of online delivery [
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 (
Caregiver and care receiver characteristics (N=18).a
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Caregivers (n=9) | Care receivers (n=9) | |
Age (years), mean (SD; range) | 60.33 (20.72; 31-90) | 65.00 (18.97; 27-86) | |
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Male | 3 (33) | 1 (11) |
|
Female | 6 (67) | 8 (89) |
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|||
|
Partnered | 4 (44) | 5 (56) |
|
Not partnered | 5 (56) | 4 (44) |
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|
Black | 1 (11) | 1 (11) |
|
White | 7 (78) | 8 (89) |
|
Other | 1 (11) | 0 (0) |
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|
Hispanic or Latinx | 1 (11) | 1 (11) |
|
Not Hispanic or Latinx | 7 (78) | 7 (78) |
|
Other or no answer | 1 (11) | 1 (11) |
|
|||
|
Some high school | 0 (0) | 0 (0) |
|
High school graduate | 0 (0) | 1 (11) |
|
Some college | 3 (33) | 4 (44) |
|
College graduate | 6 (67) | 4 (44) |
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|
Pain severity | 6.00 (1.48) | 6.03 (1.11) |
|
Pain interference | 5.65 (2.49) | 6.08 (2.03) |
aFrequencies may not sum to 100% due to unreported or missing data.
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 (
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.
Home distractions
“Would prefer face-to-face because of the distraction of watching the children during sessions and not being able to get the full benefit.” (Caregiver 4_07)
Movement corrections
“I would like to do it face-to-face to get the complete moves and make sure I am doing it 100% right.” (Care Receiver 2_04)
Engagement
“My preference would be face-to-face but that's not a possibility so I enjoyed what I got. I thought it was easy but I like the personal aspect of in person.” (Care Receiver 6_12)
Safety concerns
“We were a little concerned with more complicated exercises because we want the instructor to be able to make sure I was doing the exercises right to make sure I wouldn't get hurt.” (Care Receiver 7_14)
Transportation or driving
“It worked better for me because of my inability to travel.” (Care Receiver 1_02)
Convenient
“I really liked the online format. It was fun and engaging and also much more convenient than a face to face thing would have been.” (Caregiver 12_2)
“Thought the online was very good. For me to be face to face with this group of people, it would never happen, but doing it online was quite interesting and enjoyable. Parking was a breeze!” (Caregiver 14_2)
Comfort of home environment
“I really liked it online, I think I would prefer it online-way more accessible and when you can take a break, it's really a break (because you're at home in a calm environment).” (Care Receiver 13_2)
Felt safe
“The instructor was amazing at noticing if anything was going wrong and stepping in. I felt very safe with it.” (Care Receiver 8_16)
Technology access and support
“Verify participants' internet access/compatibility with Zoom prior to starting intervention. A little bit of Zoom training prior to, to practice and become familiar with Zoom before starting.” (Caregiver 1_1)
Improve internet connection
“I think the main challenge was connection issues sometimes.” (Caregiver 13_2)
Additional visual aids
“Visual aids for the exercises itself. If there was an illustration of what muscle groups I was meant to tackle, that would've been helpful.” (Caregiver 11_2)
Home space and setup
“The first day that we did it, we didn't really set up a stable platform in our living room so it was a little shaky but we corrected it by putting some particle board down-stabilized the floor so we could exercise which turned out today.” (Care Receiver 11_2)
Our findings indicate that both individuals with chronic conditions and their caregivers found MY-Skills online yoga acceptable. Perceived health benefits and additional feasibility analyses of the pilot are currently under review elsewhere. Participants expressed preferences for either online yoga or in-person yoga and provided recommendations for improving online delivery. Leveraging these lessons learned may improve future MY-Skills and yoga studies.
Participants who preferred in-person yoga did so due to distractions in the home and group dynamics. Similarly, in a study (N=152) that compared in-person yoga conducted before the COVID-19 pandemic to online yoga conducted during the pandemic, in-person yoga participants provided higher ratings for feeling connected to other people and socializing before and after class [
Participants preferred both online yoga and in-person yoga for different safety reasons. Some participants chose in-person corrections to ensure correct positioning, while others felt safe with verbal modifications in their homes. Although adverse events are rare in yoga research [
Convenience and access were the primary reasons for preferring online delivery. This is similar to previous telehealth research [
Although this is one of the few studies that describe participants' reported acceptability of and preferences for online yoga, several limitations exist. Our sample is homogenous, indicating that these findings may not represent the perspectives of care receivers and caregivers from diverse backgrounds. Further, the lack of transcription may have resulted in additional bias in coding participant feedback. However, we followed standard, rapid, analytic techniques, such as group coding and discussion, to mitigate this concern. In addition, we did not collect validated measures of intervention usability or acceptability that could have contributed to a greater understanding of online acceptability.
In conclusion, participants find MY-Skills online yoga to be an acceptable intervention. To improve online delivery, future yoga studies should include specific activities for fostering group engagement, enhancing safety protocols, and increasing technical support.
Summary of online yoga sessions.
Research Electronic Data Capture
This study was funded by the National Center for Complementary & Integrative Health of the National Institutes of Health (R34AT009688). JP is supported by a National Institute on Aging career development award (K76AG059934).
The data sets generated during and analyzed during this study are available from the corresponding author upon reasonable request.
None declared.