Adapting Yoga Therapy to Meet the Needs of Inpatients Undergoing Hematopoietic Stem Cell Transplantation: Insights From an International, Multisite, Qualitative Study.

Abstract

Yoga therapy (YT) is a growing mind-body approach in oncology. However, its integration into hematopoietic stem cell transplantation (HSCT) remains limited, particularly in non-Western and resource-constrained settings. This formative qualitative study aimed to explore the lived experiences of HSCT patients in the United States, India, and Tanzania to inform the development of a culturally adapted YT protocol. Fifteen post-HSCT adult participants were recruited from three international cancer centers using purposive sampling. Semistructured interviews were conducted in participants' preferred languages, transcribed, and thematically analyzed by an interdisciplinary team. Themes were mapped to domains of the Adaptome framework to guide adaptation decisions. Across sites, fatigue, sleep disruption, isolation, and emotional distress were common. Participants expressed interest in supportive, noninvasive interventions like yoga, but familiarity varied by region. Cultural adaptations included neutral, nonreligious language for meditation, flexible session timing, caregiver inclusion, same-language preference, and same-sex therapist. Contextual adaptations addressed environmental limitations (eg, space constraints, infection precautions), such as bed- and chair-based modules. Participants recommended short (20-30-minute), afternoon sessions with hybrid delivery options. Trust in the person introducing yoga (eg, physician <i>v</i> therapist) emerged as a culturally relevant factor. This formative study offers critical insights into adapting (YT) for patients undergoing HSCT across diverse global contexts. Using the Adaptome framework, we applied a systematic, culturally, and contextually responsive approach that preserved core therapeutic elements while enhancing feasibility and relevance. These evidence-based adaptations directly informed the design and implementation of a single-arm, phase II trial of adjunct yoga in HSCT patients.