An iterative design process to develop a randomized feasibility study and inform recruitment of minority women after stillbirth

Abstract

BackgroundYearly, approximately 25,000 US women experience stillbirth and African American women have a 2.2 fold increased risk of stillbirth compared with white women. After stillbirth, women are subject to a sevenfold increased risk of post-traumatic stress compared with women after a live-birth. This paper presents findings from phase one of a National Institutes of Health funded, two-phase feasibility study to examine an online yoga intervention to reduce symptoms of post-traumatic stress in mothers after stillbirth. An iterative design was used to (1) inform the development of the online yoga intervention and (2) inform recruitment strategies to enroll minority women into phase two.MethodsTen mothers (N = 5 stillbirth moms with no yoga experience, N = 5 nonstillbirth moms with yoga experience) participated in a series of online yoga videos (N = 30) and were assessed for self-compassion (SC) and emotional regulation (ER) before and after each video. An independent group of five minority women who had experienced stillbirth were interviewed about cultural barriers to recruitment and perceptions/opinions of yoga. A mean was calculated for SC and ER scores for each video at pre- and post-time points. The percent change of the mean difference between pre-post SC and ER scores were used to select videos for phase two. Videos with a negative change score or that had a 0% change on SC or ER were not used. A combination of deductive and inductive coding was used to organize the interview data, generate categories, and develop themes.ResultsFive of the 30 tested yoga videos were not used. An additional 12 videos were developed, filmed, and used in the prescription for phase two. Topics from interview findings included perceived benefits/barriers of and interest in yoga, preferred yoga environment, suggested recruitment methods, content of recruitment material, and recommended incentives.ConclusionsOnline yoga may be beneficial for improving emotional regulation and self-compassion, but further testing is needed. Additionally, minority women express interest in online yoga but suggest that researchers apply culturally specific strategies regarding methods, content of material, and incentives to recruit minority women into a study.

Physical relaxation for occupational stress in healthcare workers: A systematic review and network meta-analysis of randomized controlled trials

“…The recent need for social distancing has driven many activities online, and yoga enjoys obvious logistical advantages over massage therapy in keeping with these measures. Pilot studies of online yoga programs have shown improvements in mental well-being in specialized populations, 122,123 and tele-yoga has been suggested as a specific means of stress management in the era of COVID-19. 124 Our study has several limitations.…”

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial

“…The intervention groups (LD and MD) were asked to follow a 12-week online yoga prescription developed by the research team [18]. Briefly, the prescription included 12 videos developed for women who had experienced stillbirth [18] and the remaining 48 videos were chosen using Udaya's existing library of more than 600 yoga videos. Udaya is an online streaming platform that provides yoga videos that vary in length, style, and language, instructed by experienced yoga teachers (e.g., 200 h or more of yoga training).…”

“…Second, the sample was not necessarily representative of the population of the women who have had stillbirths in the US, as most were white and higher income. Although in a previous study we asked minority women who had experienced stillbirth about cultural barriers to recruitment and about their perceptions and opinions on yoga [18], additional recruiting methods are needed for representative samples to ensure generalizability of the results. Third, this study had a high number of dropouts.…”

“…It has been reported to reduce symptoms of PTSD, anxiety, and depressive symptoms in a number of populations [15,16], and it is a complementary approach to reduce stress during pregnancy and aiding in postpartum depression [17]. In a small non-randomized trial in mothers after stillbirth, Huberty and colleagues reported the majority of participants were satisfied with a 60 min per week online yoga intervention with reported benefits such as reducing mental and physical stress, improved mindfulness and calm, and getting more time for themselves [18].…”

Relationships Between Strong Black Woman Belief, Coping Behaviors, Perceived Social Support, and Psychological Distress Symptoms for Black Mothers After Stillbirth

“…5 In addition, Black women are less likely to seek professional help for psychological distress symptoms in general due to a lack of compassionate care from health care professionals, 8,9 lack of Black health care providers, 10,11 and stigma surrounding mental health care within Black communities. 12,13 Instead, they tend to emphasize spiritual and religious practices, talking with a few close friends, and solitude. 5,14 Although both Black and White women agree social support is important for healing from a stillbirth, Black women tend to find other women most supportive, whereas White women often find the child's father most supportive.…”