Clarity and inclusivity as precursors to disseminate, implement, and translate yoga principles for behavioral health

Abstract

Translating health evidence is key to advance human flourishing. However, it takes 15-17 years to translate health interventions into real-world practice. Dissemination and implementation science can help bridge this gap for multiple interventions, including yoga-based ones. Yoga principles have positively impacted myriad populations and outcomes and align with scientific rigor across physiology, psychology, and neuroscience. However, several barriers to translating yoga principles exist. This dissertation presents three studies that highlight the importance of clarity and inclusivity as precursors for translation of yoga principles for behavioral health. The first study is a systematic review that used a novel qualitative synthesis to examine how yoga is defined and described in peer-reviewed mental health and wellbeing literature. Of 5206 studies identified, we included and reviewed 129. We present a qualitative analysis of 1291 meaning units (i.e., distinct pieces of data) of yoga definitions and descriptions. Furthermore, these data are presented via a sub-analysis across five continents and three study populations (e.g., population with chronic health conditions). While no one singular yoga definition arose from the data, yoga was most prominently operationalized as a mind-body practice comprised of mental, physical, and breathing components. We recommend a findings-based comprehensive framework combined with established reporting guidelines to define and describe yoga. The second study used a mixed methods cross-sectional survey to explore yoga end-user input for communicating and disseminating yoga benefits and yoga-based interventions. We surveyed 150 current and potential yoga end-users (mean age 36 years; 50% female; 54% people of color; 29% with higher body weight) with 28 open-ended questions. A subset of questions (n=4) was based on a dissemination model which posits that information is disseminated through various channels, messages, and sources. Using these overall themes, end-users contributed to 1133 meaning units. End-users overall preferred inclusive and clear content for yoga health messages, social media and fitness settings as channels, and health professionals and health organizations as sources. We propose an update to the dissemination model to include end-user input on health interventions, including yoga-based interventions. The final study is a sequential pre-implementation intervention study that used participatory and co-creation methods to adapt an existing yoga-based employee wellness intervention for community health educators. In this study, we triangulated data from integrated research-practice partners and data from focus groups (n=21) and a follow-up survey (n=17) with community health educators from multiple states (90% female, 62% White). Several data-driven contextual factors provide important insights for tailoring intervention materials and scheduling. We present lessons on how to enhance fit of intervention function and form to context and also on the importance of patience and slowing down for co-creation and participatory processes. Based on these findings, applying precursors of clarity and inclusivity to methods in dissemination and implementation science is key for translation of yoga-based interventions. Furthermore, these findings can be expanded and applied to bridge translation of other health evidence and interventions – towards meaningfully advancing human flourishing.