Understanding How Yoga Relates to Adults’ Experiences and Their Relationships with Oneself and Others After Gynecologic Cancer Treatment

Abstract

This dissertation synthesizes findings from four novel studies exploring how yoga relates to adults’ experiences and their relationships with oneself and others after gynecologic cancer treatment. Study 1 (article 1) explored the self-perceptions of adults diagnosed with gynecologic cancer and the role of yoga in altering those perceptions via qualitative methods. The four main themes identified emphasized the complex interplay between body functionality, appearance, and sexual health as well as the potential pitfalls of negative self-perceptions stemming from preconceived expectations and attitudes while practicing yoga. Study 2 (articles 2 and 3) was a qualitative meta-synthesis that synthesized findings from primary qualitative articles and developed an overarching interpretation of women’s experiences participating in yoga after a cancer diagnosis. Two main focal areas emerged, presented in two parts: (1) impact of yoga on women's wellbeing and quality of life (QoL) after a cancer diagnosis, and (2) women’s motives, barriers, and program preferences for yoga after a cancer diagnosis. Findings from Part 1 (article 2) demonstrated yoga yields a range of perceived benefits categorized into five broad QoL dimensions that interact: physical, emotional, psychological, cognitive, and social. Findings from Part 2 (article 3) illustrated the individual and situational motivators and barriers to participating in yoga for women diagnosed with cancer. Across the different modes of delivery, supportive and knowledgeable instructors, opportunities to connect with others, and comprehensive yoga classes that focus on more than just movement were identified as preferential qualities of yoga interventions and programs. Drawing on the evidence from Studies 1 and 2, Study 3 (article 4) used a three-phase co-creation approach guided by the Knowledge-to-Action framework to co-create a community-based yoga program for adults with gynecologic cancer and an instructors’ manual to guide delivery. End-users (i.e., adults diagnosed with gynecologic cancer, yoga instructors) facilitated the creation of a 12-week bi-modal hatha yoga program with two weekly 60-minute classes and optional supplemental features. Study 4 (articles 5 and 6) used a mixed-methods series N-of-1 feasibility trial to assess the feasibility, acceptability, and potential benefits of the yoga program. The findings are presented in two manuscripts addressing distinct objectives. Overall, the yoga program was well-received, and the study methods were moderately successful (article 5). While visual analysis and hierarchical linear modelling showed improvements in QoL, perceived cognitive abilities, sexual distress, negative body image, and perceived stress; however, visual analysis also suggests there may be some variability in participants’ responses to the program (article 6). Collectively, the studies comprising this dissertation underscore the value of yoga as a holistic intervention for enhancing QoL and wellbeing of adults diagnosed with gynecologic cancer, advocating for its integration into survivorship care. The findings highlight the necessity of designing yoga programs that are appropriately tailored to address the nuanced self-perceptions of body functionality, appearance, and sexual health, while also considering the motivators and barriers to participation in yoga post-cancer diagnosis. The successful co-creation of a community-based yoga program illustrates the value of participatory design, suggesting that engaging end-users in the development process ensures programs are more aligned with participants’ needs, thereby enhancing engagement and perceived relevance. However, the variability in participants’ responses to yoga highlights the importance of individualized approaches both in delivering and evaluating programs. As the field continues to advance, a multidisciplinary approach that embraces the benefits of holistic and patient-centered care is imperative.