Equity-focused barriers and facilitators to implementing a prenatal yoga intervention in a healthcare system: patient and provider perspectives.

BACKGROUND: Individuals with a history of depression are at increased risk for postpartum depression. Further, racial and ethnic minority groups have higher rates of postpartum depression and are less likely to initiate mental health treatment. Prenatal yoga presents a promising avenue for preventing postpartum depression among these high-risk groups. The purpose of this study was to gather feedback from pregnant patients and healthcare professionals to identify facilitators and barriers to the equitable implementation of an 8-week prenatal yoga intervention to prevent postpartum depression. METHODS: An equity-based framework for Implementation Research (EquIR) informed data collection and analysis. Participants were given an overview of the intervention and invited to provide feedback on the design and study procedures. Pregnant patients also participated in an abbreviated version of the intervention. The Framework Method was used to analyze transcripts. RESULTS: Four virtual focus groups with pregnant patients (N = 18) and individual interviews with healthcare professionals (N = 11) were conducted. Facilitators and barriers to implementation were grouped into themes aligned with EquIR outcomes: (1) knowledge and attitudes; (2) logistics; (3) intervention (content and instructor); (4) cost; and (5) advertising. Common barriers included safety concerns (Theme 1), time constraints (Theme 2), potential discomfort when participating (due to no prior experience, physical limitations, or limited diversity reflected in the group) (Theme 3), financial constraints (Theme 4), or perceptions about the limited safety or appropriateness of prenatal yoga (Theme 5). Conversely, key facilitators included recognizing the benefits of prenatal yoga (Theme 1), the option to participate virtually (Theme 2), providing relevant modifications (Theme 3), no more than $25 per session (Theme 4), and providing safety information and receiving referrals from a trusted medical provider (Theme 5). CONCLUSIONS: This study represents an important step towards optimizing the equitable implementation of a prenatal yoga intervention to prevent postpartum depression for those at risk. Future work will test the feasibility, acceptability, and effectiveness of the intervention to prevent postpartum depression.