Equity-focused barriers and facilitators to implementing a prenatal yoga intervention in a health system: Patient and provider perspectives

Background: History of depression is a risk factor for the development of postpartum depression (PPD). Racial/ethnic minorities have higher rates of PPD and are less likely to initiate treatment. Prenatal yoga presents a promising avenue for preventing PPD among individuals from diverse racial/ethnic backgrounds. The purpose of this study was to gather feedback from pregnant individuals and healthcare professionals to identify facilitators and barriers to the equitable implementation of an 8-week prenatal yoga intervention to prevent PPD. Methods: Equity-based framework for Implementation Research (EquIR) informed data collection and analysis. Four virtual focus groups with pregnant individuals (N=18) and interviews with healthcare professionals (N=11) were conducted. Participants were given an overview of the intervention and invited to provide feedback on the design/study procedures. Pregnant individuals also participated in an abbreviated intervention. The Framework Method was used to analyze transcripts. Results: Facilitators/barriers were grouped into themes aligned with EquiR outcomes: 1) knowledge/attitudes; 2) logistics; 3) content/instructor; 4) cost; and 5) advertising. Facilitators included: recognizing the benefits of prenatal yoga (Theme 1), the option to participate virtually (Theme 2), and providing relevant modifications (Theme 3). Barriers included safety concerns (Theme 1), time constraints (Theme 2), and potential discomfort when participating (no prior experience, physical limitations, or limited diversity reflected in the group) (Theme 3). Conclusion: This study represents an important step towards optimizing the equitable implementation of a prenatal yoga intervention to prevent PPD for those at risk. Future work will test the feasibility, acceptability, and effectiveness of the intervention to prevent PPD.