Acceptability of Online Yoga Among Individuals With Chronic Conditions and Their Caregivers: Qualitative Study.

BACKGROUND: 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. OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: ClinicalTrials.gov NCT03440320; https://clinicaltrials.gov/ct2/show/NCT03440320.

Matching Exercise Volume in Active Control Groups for Yoga Interventions.

Context: The selection of a control group should foremost be determined by the study's primary intended outcome and trial design. When examining the effects of the physical movements that comprise yoga postures, an active control group, with physical exercise as the control, is often recommended. Objective: The current study aimed to define an active control group that participates in physical exercise, emphasizing the importance of matching the exercise's volume to that of an intervention group's yoga, and to provide a tangible example from a federally funded, recently completed, randomized controlled trial. Design: The research team designed a control group, providing a case study as a example of it. Setting: The study took place at Colorado State University. Intervention: The exercise component for the control group included 60 minutes of low-intensity exercise, matched with 60 minutes of Hatha yoga for the intervention group. Because the intervention included chronic pain self-management in addition to the exercise component, the education component for the control group included 45 minutes of group-based, general health-and-wellness education and discussion. Conclusions: Future randomized trials for yoga and other complementary or integrative health interventions should continue to use appropriate active control groups, which will serve to enhance the scientific rigor of conclusions that can be drawn with respect to the effectiveness of these interventions.

Merging Yoga and self-management Skills (MY-Skills) to influence self-efficacy among individuals with persistent pain: A pilot study.

CONTEXT: Individuals with persistent pain-related disability have lower self-efficacy, which impacts daily function and health. AIM: To explore self-efficacy among individuals with persistent pain who were part of a dyad (caregiver and care-recipient) who completed the Merging Yoga and self-management Skills intervention (MY-Skills). METHODS: Participants completed MY-Skills, an 8-week group, dyadic-based self-management and yoga program. Self-efficacy outcomes were collected using the Chronic Pain Self-Efficacy Scale; PROMIS® Self-Efficacy for Managing Daily Activities; and PROMIS® Self-Efficacy for Managing Symptoms. RESULTS: Eight participants completed the study (50.23 ± 14.77 years old, 77% female, (69%) with pain >10 years). Self-efficacy improved across all measures and domains, with significant improvement for physical function self-efficacy (38.97 ± 19.45 vs. 59.10 ± 18.60, p = .004). CONCLUSIONS: MY-Skills improved self-efficacy to varying degrees, which may contribute to participants' confidence in performing activities. Further research is needed to examine dyadic outcomes among caregivers and care-recipients.

Manual development for a multi-modal, dyadic intervention for persistent pain: A Qualitative Study.

Background: People who experience persistent pain often require help from a family member, partner, or friend. These caregivers frequently have pain but are often not included in interventions. Caregivers and care receivers who both experience pain are more likely to be socially isolated, and experience communication conflict and decreased quality of life. Interventions should target caregiving dyads to help them manage their pain together. However, there are few intervention manuals or research protocols developed to support the dyad. Objective: The purpose of this qualitative study was to explore the needs of caregiving dyads, including input from dyads and medical and allied health experts to inform the development of an intervention manual for dyads with persistent pain. Method: A total of 16 caregiving dyads experiencing persistent pain, one care receiver (caregiver could not participate), and 8 health experts, recruited from the community, participated in focus groups. Data were transcribed verbatim, uploaded into NVivo software, and analyzed using constant comparison qualitative methods. Results: Findings identified the importance of a new intervention to focus on modifiable approaches to managing pain as a dyad, addressing the emotional and psychological effects of experiencing pain as a dyad, and careful consideration of logistics to implement an intervention with dyads in persistent pain. Conclusion: These results highlight important considerations to meet the needs of caregiving dyads with pain. This study informed the development of the MY-Skills intervention, a novel program that merges self-management education with adaptive yoga to treat persistent pain in caregiving dyads.

Positive Health Behavior Changes in Custodial Grandparents and Grandchildren Following an Intervention.

BACKGROUND: Custodial grandparents experience greater physical health declines and higher rates of depression than their same-age peers who do not provide care, and grandchildren in grandfamilies often have behavior problems. However, few researchers have explored the impact of self-care education on decreasing these negative outcomes. Our study examined how a self-care and life-skills intervention influenced health behavior change in a sample of grandparents and grandchildren. METHODS: Data were collected during eleven focus groups (and two interviews) with 55 grandparents, and one focus group with five grandchildren, at 6 months after the 6-week intervention detailed in this paper. Grandparents ranged in age from 46 to 84 years old (M = 62.19, SD = 8.24). Participating grandchildren ranged in age from 9 to 12 years old. Focus group transcripts were coded for content related to grandparents' and grandchildren's positive behavior changes following the intervention. FINDINGS: Grandparents reported taking more time for themselves, reducing negative self-talk, increasing healthy physical choices, and having better communication skills after participating in the intervention. Similarly, grandchildren reported increased confidence in making friends, making good decisions, and getting along with others. Findings suggest that a self-care and life skills program show promise for improving the health and wellness of grandfamilies.

Feasibility of Implementing Physical Activity Behavior Change Counseling in an Existing Cancer-Exercise Program.

PURPOSE: This study examined the feasibility and acceptability of implementing research-tested physical activity (PA) behavior change counseling (BCC) sessions in an existing cancer-exercise program, and the preliminary effects on cancer survivor's self-efficacy and PA. METHODS: Participants were cancer survivors undergoing or within six-months of completing cancer treatment(s), and exercise program staff. Cancer survivors were randomized to receive the exercise program plus PABCC, or the standard exercise program. Feasibility and acceptability were assessed by recruitment, adherence, satisfaction, and a focus group with program staff. Qualitative data were analyzed using descriptive thematic analysis. Self-report questionnaires measured PA and exercise self-efficacy. RESULTS: Recruitment was 33 out of 93 (36.7%), and n = 13 (39%) provided post-program data. Cancer survivors enjoyed PABCC sessions, but reported face-to-face delivery was an added time burden. Program staff expressed desire to implement PABCC, but perceived staff capacity and time as barriers to sustainability. Exercise self-efficacy increased by 21.5% in the PABCC group vs. 4.2% in the control. PA increased by 81.3% in the PABCC group vs. 16.6% in the control group. CONCLUSIONS: Implementing PABCC in an existing cancer-exercise program was acceptable and promising for increasing moderate to vigorous PA, but additional research is needed to enhance the feasibility and sustainability of translating efficacious behavioral interventions into existing cancer-exercise programs.

Should I Do This? Factors Influencing the Decision to Raise Grandchildren Among Custodial Grandparents.

BACKGROUND AND OBJECTIVES: Grandparents often step in to raise grandchildren when the middle generation is unavailable or unwilling. Although the consequences of raising grandchildren are well researched, little is known about the factors influencing grandparents' decisions to raise grandchildren. The objectives of this study were to (a) explore the factors that influence decision-making processes among grandparent caregivers, and (b) investigate the extent to which these factors reflect a multifaceted, dualistic framework. RESEARCH DESIGN AND METHODS: Data were collected from 108 custodial grandparents who answered an open-ended question about their decision to raise grandchildren. RESULTS: Content analyses of participants' answers yielded 15 factorial dimensions defined in terms of their negative/push or positive/pull poles, as it related to their decision to raise grandchildren. Chi-squared tests were used to examine each dimension to the extent to which elicited frequencies were differentially represented for positive versus negative poles. For 12 dimensions, the negative decisional parameters outweighed those that were positive. DISCUSSION AND IMPLICATIONS: Grandparents report both positive and negative parameters when reflecting on their decision to raise grandchildren. These results call for further research to advance the understanding of the decision-making processes that caregiving grandparents make and the role that they may have on their experiences.

Yoga for Caregiving Dyads Experiencing Chronic Pain: Protocol Development for Merging Yoga and Self-Management to Develop Skills Intervention.

CONTEXT: Caregivers often provide unpaid care for family members and friends with physical disabilities, often to the detriment of their health and well-being. Caregivers often experience pain, and individuals with physical disabilities also are likely to experience pain. Merging yoga and self-management to Develop Skills Study (MY-Skills) is an intervention that merges self-management education with yoga for dyads experiencing chronic pain. AIM: This article presents the yoga protocol for the MY-Skills intervention. METHODS: The yoga protocol was revised based on feedback from six caregiving dyads. The protocol focuses on reducing pain interference and supporting the caregiving dyad. RESULTS: The final yoga protocol incorporated the following elements: Centering and mantra, prana vidya and pranayama, asanas, mudra, and guided savasana/dhyana. CONCLUSION: The MY-Skills yoga protocol was modified by a yoga therapist with feedback from study participants. Revisions focused on the caregiving dyad, with specific attention to reducing pain interference.

Merging Yoga and Occupational Therapy for Parkinson's Disease: A Feasibility and Pilot Program.

The purpose of this study was to assess feasibility and changes in outcome measures following the Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT for PD) program: a 14-session program which combined community-based yoga for PD, and fall-risk focused group occupational therapy sessions. Seventeen participants completed an 8-week control period consisting of their normal participation, and an 8-week intervention period (14 MY-OT for PD sessions). There were fewer self-reported falls in the intervention (6) vs. control periods (10). One fall risk factor management scale (the Fall Prevention and Management Questionnaire, p=.02), and balance (p<.01) showed significant improvement between the control and intervention. The MY-OT for PD program is an encouraging occupational therapist-led program, which may improve balance and reduce self-reported falls.

Health-related quality of life changes after the merging yoga and occupational therapy for Parkinson's disease program: A mixed-methods study.

BACKGROUND: To understand changes in health-related quality of life (HRQoL) after the Merging Yoga and Occupational Therapy for Parkinson's Disease (MY-OT for PD) program. MATERIALS AND METHODS: We used a mixed-methods convergent design and administered the Parkinson's Disease Questionnaire-8 (PDQ-8), a measure of HRQoL, with 17 participants. We considered scores 8 weeks before MY-OT for PD, just before, and upon completion. Additionally, we completed two focus groups following the program with 16 participants to assess qualitative changes in HRQoL. RESULTS: There were no significant differences in PDQ-8 scores between time points, F(2,32) = 1.60, p = 0.22, partial η2 = 0.09. Participants did discuss improvements in all 8 HRQoL domains, frequently regarding mobility and activities of daily living. CONCLUSION: Results diverged, with quantitative results showing no significant improvement in HRQoL and qualitative results indicating participant perceived improvements in all domains of the PDQ-8. The program should be explored further, and longitudinal follow-up completed.

Social work students' Service Learning experiences with grandfamilies: Contact, comfort, and attitudes.

One way to increase student learning about older adults and aging family issues is to engage in community-based field experiences. Results from pre- and post-surveys with 29 Bachelors of Social Work students enrolled in a year-long practicum course to assess their change in the level of contact, comfort, and attitudes with older adults and grandfamilies (i.e., grandparents/kin and the children in their home) are discussed. Students who met with grandfamilies (n = 9) were compared to students who met with older adults in a nursing home (n = 6) and students who met with children from an afterschool program or child treatment facility (n = 9). One-way ANOVA's revealed group differences in contact and quality of contact with grandfamilies. No significant differences were found for contact with older adults or comfort working with older adults and grandfamilies, or for attitudes toward older adults between the three groups. As a result of this project, educators should develop learning opportunities for students to increase their contact and comfort with older adults and aging families.

Grandparent Caregivers' Resilience: Stress, Support, and Coping Predict Life Satisfaction.

OBJECTIVES: Do support and coping strategies moderate the link between stress and life satisfaction among grandparent caregivers? BACKGROUND: Grandparents raising grandchildren often experience stress, which may compromise their subjective well-being. Thus, it is important to understand the role of support and coping as protective or promotive factors in relation to grandparent caregivers' resilience (i.e., life satisfaction). METHODS: Grandparent caregivers (N = 74) reported their daily hassles, life satisfaction, social support, and coping. RESULTS: These grandparent caregivers are a vulnerable population in terms of stress and limited social support and coping. Structural equation modeling supported direct, promotive effects of social support and coping on life satisfaction, but not moderation. CONCLUSION: Despite high levels of stress, half of the grandparent caregivers were satisfied with their lives, which was explained by their social support and coping skills. Some grandparents who assume this role likely would benefit from interventions that promote social support and coping skills.

"Call a Teenager That's What I Do!" - Grandchildren Help Older Adults Use New Technologies: Qualitative Study.

BACKGROUND: Although family technical support seems intuitive, there is very little research exploring this topic. OBJECTIVE: The objective of this study was to conduct a subanalysis of data collected from a large-scale qualitative project regarding older adults' experiences in using health information technology. Specifically, the subanalysis explored older adults' experiences with technology support from family members to inform strategies for promoting older adults' engagement with new health technologies. Although the primary analysis of the original study was theoretically driven, this paper reports results from an inductive, open-coding analysis. METHODS: This is a subanalysis of a major code identified unexpectedly from a qualitative study investigating older adults' use experience of a widespread health technology, the patient portal. A total of 24 older patients (≥65 years) with multiple chronic conditions (Charlson Comorbidity Index >2) participated in focus groups conducted at the patients' primary clinic. While conducting the primary theoretically driven analysis, coders utilized an open-coding approach to ensure important ideas not reflected in the theoretical code book were captured. Open coding resulted in 1 code: family support. This subanalysis further categorized family support by who provided tech support, how tech support was offered, and the opinions of older participants about receiving family tech support. RESULTS: The participants were not specifically asked about family support, yet themes around family assistance and encouragement for technology emerged from every focus group. Participants repeatedly mentioned that they called their grandchildren and adult children if they needed help with technology. Participants also reported that family members experienced difficulty when teaching technology use. Family members struggled to explain simple technology tasks and were frustrated by the slow teaching process. CONCLUSIONS: The results suggest that older adults ask their family members, particularly grandchildren, to support them in the use of new technologies. However, family may experience difficulties in providing this support. Older adults will be increasingly expected to use health technologies, and family members may help with tech support. Providers and health systems should consider potential family support and engagement strategies to foster adoption and use among older patients.

Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT.

The purpose of this feasibility pilot study was to assess benefits of 8 weeks of yoga in people with chronic pain. Participants completed baseline assessments and were randomized to yoga or usual care. Yoga was offered twice a week for 8 weeks. We assessed feasibility and the Brief Pain Inventory (BPI) was the primary outcome, assessing pain-severity and pain interference on daily activities. Eighty-three people were recruited; 67 people completed the study and were included in the analyses. Average age of participants was 50.78 ± 10.43 years and most participants had pain >10 years. The intervention appeared feasible and there were significant improvements (P < .05) in multiple measures for the yoga group, including a decrease in BPI interference scores from 7.15 ± 1.70 to 6.14 ± 2.21 (P = .007). There was a significant difference in body responsiveness and pain management scores between groups at 8 weeks. It appears that yoga was feasible and positively influenced multiple outcome measures for people with chronic pain.

Yoga improves occupational performance, depression, and daily activities for people with chronic pain.

BACKGROUND: Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. OBJECTIVES: In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. METHODS: Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. RESULTS: 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. CONCLUSION: Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.

Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade?

BACKGROUND AND OBJECTIVES: In this manuscript, we update the literature over the last decade in addressing several new content areas that have emerged in the grandfamilies literature, along with issues that are still important to understanding grandparents raising their grandchildren today. RESEARCH DESIGN AND METHODS: The social science and gerontological literature since 2004 was accessed, reviewed, organized topically, and integrated, based upon an exhaustive PsychINFO literature search. RESULTS: Our review indicates an ongoing and/or growing emphasis on (a) the strengths of grandparent raising grandchildren, (b) diversity among grandfamilies along a number of parameters, (c) the social-interpersonal, cultural, and policy-related contexts of grandfamilies, (d) process-focused research, (e) parenting, parenting skills, and family relationships, (f) grandparent psychological distress, (g) targets for and the efficacy of interventions with grandfamilies, and (h) methodological issues relevant to the study of grandfamilies. IMPLICATIONS: We discuss the implications of our findings in terms of more completely understanding grandfamilies along a number of parameters, as well as presenting specific recommendations for future research and practice.

Understanding Latino Grandparents Raising Grandchildren Through a Bioecological Lens.

The purpose of this article is to provide a summary of the published research addressing the challenges and strengths of Latino grandparents raising grandchildren in the United States. Using the bioecological framework as a guide to organize and understand the published literature addressing Latino grandparent caregivers, we examined refereed articles published over the past 19 years. This framework provides a lens for understanding and situating research on Latino grandparents raising grandchildren to discover Latino grandparents' strengths and challenges. The areas of foci include financial challenges, intergenerational relationships, reasons for caregiving, health status, language barriers, and culture. This article concludes with future research opportunities and a call to action for more research on Latino grandparents raising grandchildren.

The Daily Experiences of Pleasure, Productivity, and Restoration Profile: A case study: Étude de cas sur l'utilité du Daily Experiences of Pleasure, Productivity, and Restoration Profile.

BACKGROUND: Occupational therapy enables clients to self-manage their health through the use of occupation; however, additional occupation-focused assessments are needed to capture people's subjective experiences associated with everyday activities as awareness of one's experiences can help promote change. PURPOSE: This qualitative case study explored the utility of one such assessment, the Daily Experiences of Pleasure, Productivity, and Restoration Profile (PPR Profile). METHOD: Five spousal caregivers completed and discussed the PPR Profile with an occupational therapist. Interviews with the caregivers and therapist occurred during and following use. Content analysis revealed several themes. FINDINGS: Both caregivers and the occupational therapist reported that use of the PPR Profile provided benefits but not without challenges. IMPLICATIONS: The findings support preliminary utility of the PPR Profile; however, additional research is needed and occupational therapists need to be aware of the challenges when deciding to use the tool.

"Merging Yoga and Occupational Therapy (MY-OT): A feasibility and pilot study".

OBJECTIVE: To examine the feasibility and benefits of the Merging Yoga and Occupational Therapy (MY-OT) intervention. DESIGN: This is the primary analysis of a non-controlled pretest-posttest pilot study to understand the feasibility and impact of MY-OT on balance, balance self-efficacy, and fall risk factor management in people with chronic stroke. SETTING: University research laboratory. PARTICIPANTS: People with chronic stroke were included in the study if they: had sustained a fall or had fear of falling, were able to stand, and hand impaired balance and were at risk for falls (≤46 on the Berg Balance Scale (BBS)). INTERVENTIONS: Individuals completed an 8 week intervention that included 16 sessions of both yoga and group occupational therapy (OT). Yoga included physical postures, breathing exercises, and meditation. OT focused on post-stroke fall risk factor management. MAIN OUTCOME MEASURES: The BBS was used to assess balance, the Activities-specific Balance Confidence Scale (ABC) was used to measure balance self-efficacy. Five fall risk factor management scales were used. RESULTS: Overall, the intervention was considered feasible, as individuals were able to safely complete the intervention with little attrition and high attendance. Balance improved by 30% (p=0.002). Balance self-efficacy improved by 15% (p=0.034). Each of the five fall risk factor management scales improved, but only two significantly improved (Fall Prevention and Management Questionnaire, 29%, p=0.004 and Fall Prevention Strategy Survey, 42%, p=0.032). CONCLUSION: The results demonstrate that MY-OT is a potential intervention to improve multiple fall related outcomes for people with stroke. Therapists may consider these interventions for people with stroke, but additional research is warranted.