Inter-related mechanisms of engagement in adaptive yoga for acquired brain injury: a qualitative implementation mapping study.

BACKGROUND

Acquired brain injury (ABI) is associated with chronic physical, cognitive, emotional, and social impairments requiring long-term rehabilitation. Adaptive yoga is an evidence-based intervention that may address these needs; however, implementation remains limited. Thus, determinants of engagement must be translated into actionable, theory-informed implementation strategies. This study aimed to (1) identify determinants of engagement in adaptive yoga for individuals with ABI using the Theoretical Domains Framework (TDF), and (2) operationalize these determinants into mechanisms and implementation strategies.

METHODS

We conducted an implementation mapping study using qualitative data from participants (n = 9) who completed an 8-week adaptive yoga randomized controlled trial. Data were collected through focus groups and semi-structured interviews and analyzed using the framework method. Inductive in-vivo coding was followed by deductive mapping to TDF domains. Determinants were aligned to the Capability, Opportunity, Motivation-Behavior model to specify mechanisms of action and mapped to implementation strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy. Strategies were further specified by actor, action, target, temporality, and dose.

RESULTS

Qualitative data mapped to 12 TDF domains. Knowledge and Environmental Context and Resources represented barriers related to communication, scheduling, and navigation. Skills, Social Influences, Emotion, and Beliefs about Capabilities facilitated engagement. Determinants influenced engagement through three inter-related mechanisms: (1) adequately trained personnel, (2) adaptable yet structured program delivery, and (3) socially driven group processes. These mechanisms reflect capability, opportunity, and motivation-related processes through which 12 ERIC implementation strategies are expected to act.

CONCLUSIONS

Engagement in adaptive yoga for individuals with ABI is shaped by inter-related mechanisms rather than isolated determinants. Linking determinants, mechanisms, and strategies provides a theory-informed pathway for intervention refinement and future hybrid effectiveness-implementation testing.