Yoga for hypertensive patients: a study on barriers and facilitators of its implementation in primary care

Figures & data

Figure 1. Logical framework of YoH trial

Figure 2. The elements of the Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability covered in this study

Figure 3. Data collection methods

Table 1. Participant characteristics

Characteristics		FGD	IDI	KII	Telephone interview
		n (%)	n (%)	n (%)	n (%)
Age	30–40 years	3 (18.8)	5 (83.3)	1 (25.0)	3 (25.0)
	40–50 years	6 (37.5)	1 (16.7)	3 (75.0)	3 (25.0)
	50 years and older	7 (43.7)	0 (0)	0 (0.0)	6 (50.0)
Sex	Female	10 (62.5)	3 (50.0)	1 (25.0)	8 (66.7)
	Male	6 (37.5)	3 (50.0)	3 (75.0)	4 (33.3)
Education	No formal education	5 (31.3)	0 (0)	0 (0)	7 (58.3)
	Primary	3 (18.8)	0 (0)	0 (0)	0 (0)
	Secondary	6 (37.5)	0 (0)	0 (0)	3 (25. 1)
	Bachelor	1 (6. 2)	0 (0)	0 (0)	1 (8.3)
	Post-graduate	1 (6.2)	6 (100.0)	4 (100.0)	1 (8.3)
Occupation	Employed	7 (43.7)	6 (100.0)	4 (100.0)	5 (41.7)
	Homemaker	8 (50.0)	0 (0)	0 (0)	7 (58.3)
	Retired	1 (6.3)	0 (0)	0 (0)	0 (0)

FGD, focus group discussion; IDI, in-depth interview; KII, key informant interview

Figure 4. Factors influencing the implementation of yoga intervention in the primary care setting

Table 2. Barriers and facilitators of effective implementation of yoga intervention

Barriers and facilitators	Intervention component
	Five-day, health-centre-based yoga training	Home-based yoga practice
Attitude towards yoga intervention
Positive attitude towards intervention	+	+
Burden
Short duration of a single yoga session (30 minutes)	+	+
Weekly frequency of home-based yoga sessions and overall duration of the intervention (5 days a week for 90 days)		-
Opportunity cost
Competing priorities (e.g. household work)		-
Perceived effectiveness
Belief that yoga has a positive health impact	+	+
Prioritising ‘instant relief’ types of treatment	-	-
Intervention characteristics
Brevity and simplicity of the yoga programme	+	+
Low cost of implementation	+	+
Adaptability in regard to the mode of intervention delivery and time schedule (i.e. participants are free to practise yoga at home at any time of the day)	+	+
External context
High priority of yoga in the government policy	+	+
High demand in the community	+	+
Low awareness of yoga as a health-promotion activity in rural communities	-	-
Health-centre-related
Active participation of the health centre leadership in the implementation of the intervention	+	+
Existing personnel resources	+	+
Other available resources	+	+
Previous experience in implementing yoga programmes	+	+
Dedicated staff for yoga	+	+
High priority given to yoga	+	+
Implementer characteristics
Good knowledge	+	+
High skills	+	+
High motivation (among lead implementers)	+	+
Low motivation (among supporting staff) due to a lack of financial incentive	-	-
Implementation process
Delivery of the intervention according to its protocol	+	+
Ability of participant to perform yoga	+	+
Sustainability of the intervention
Sustained practice of yoga	+	+
Institutionalising the use of yoga intervention	+	+

‘+’ sign denotes a facilitator; ‘-’ sign denotes a barrier

Table 3. Characteristics of health centres that implemented the yoga intervention

Centre	Leadership engagement^†	Personnel resources (Instructors) ^‡	Yoga studio^§	Experience in implementing yoga programme^||
Dhading	Yes	health assistant and medical officer	Yes	Yes
Kaski	Yes	medical officer	Yes	Yes
Nuwakot	Yes	health assistant	No	Yes
Ramechap	Yes	medical officer	Yes	Yes
Rolpa	Yes	medical officer	No	Yes
Rupandehi	Yes	health assistant	Yes	Yes
Surkhet	Yes	health assistant and medical officer	Yes	Yes

^†Involvement of the medical officer in planning and execution of the trial

^‡Dedicated personnel resources for instructing yoga

^§Whether the yoga training studio is inside the trial centre

^||Experience in implementing yoga programmes

Table 4. Implementers’ characteristics

Participants	Yoga knowledge		Yoga skill		Motivation for implementation
Health centre	Lead implementer^†	Other staff^‡	Lead implementer	Other staff^‡	Lead implementer	Other staff^‡
Dhading	Yes	Yes	Yes	Yes	Yes	NS^§
Kaski	Yes	Yes	Yes	Yes	Yes	Yes
Nuwakot	Yes	Yes	Yes	NS	Yes	NS
Ramechap	Yes	Yes	Yes	NS	Yes	NS
Rolpa	Yes	Yes	Yes	Yes	Yes	Yes
Rupandehi	Yes	Yes	Yes	Yes
Surkhet	Yes	Yes	Yes	NS	Yes	Yes

^†Lead implementer of YoH trial and participant in the current study

^‡Supporting staff

^§Not sufficient

Table 5. Results of telephone interviews with intervention participants

Question	n (%)
Did you attend yoga training?
Yes	12 (100)
How useful was the training for you to learn yoga?
Very useful	7 (58.3)
Useful	2 (16.7)
Somewhat useful	3 (25.0)
Not useful	0 (0)
Not at all useful	0 (0)
How satisfied were you with the yoga training?
Very satisfied	9 (75.0)
Satisfied	3 (25.0)
Somewhat satisfied	0 (0)
Not satisfied	0 (0)
Not at all satisfied	0 (0)
Did you practise yoga at home regularly as instructed?
Yes	12 (100)
No	0 (0)
Did you find any barriers in home-based yoga practice?
Yes	6 (50.0)
No	6 (50.0)
What were the barriers? (n = 6)
The routine is difficult to follow	2 (333)
I don’t have necessary skills	0 (0)
I have other medical conditions	2 (33.3)
I feel too lazy	1 (16.7)
I am not convinced about its positive effects	0 (0)
I have family/work commitments	2 (33.3)
It is too physically demanding	0 (0)
I lack motivation	1 (16.7)
I lack time	1 (16.7)
It is too inconvenient	0 (0)
It is boring	1 (16.7)
I am too tired	0 (0)

Availability of data and material

The study materials are available from the corresponding author upon a reasonable request.