Formative research to co-develop a Yoga-based intervention for antenatal depression in rural women in Maharashtra, India

Background: Yoga is increasingly promoted within India’s public health system as an evidence-based mind–body intervention. However, its sustained adoption and effectiveness depend on designing culturally relevant and contextually appropriate interventions. This study aimed to co-develop a Yoga-based intervention for antenatal depression in rural women and iteratively refine pathways for its effective delivery in real-world settings. Methods: We conducted a multi-phased, mixed-methods study grounded in the principles of Human-Centred Design (HCD). The study incorporated: (i) qualitative in-depth interviews with pregnant women, (ii) a series of Co-Development Workshops, (iii) an Intervention Cohort to assess feasibility, (iv) community engagement activities, (v) a Theory of Change workshop, and (vi) a stakeholder feedback session. Quantitative data were summarised descriptively, and qualitative data were audio-recorded, transcribed, translated, and thematically analysed using NVivo 9. Insights from all phases were triangulated to develop Yoga-Sanskar intervention. Results: Across all activities, participants included pregnant and postnatal women, family members, community health workers, Yoga instructors, and project staff. Participants consistently reported physical discomfort, fatigue, emotional distress, and household responsibilities as key challenges during pregnancy. Co-development workshops generated context-specific solutions, refined the Yoga sequence, and informed the design of user-friendly resource materials. The intervention cohort demonstrated feasibility and acceptability of Yoga practice. Stakeholder feedback confirmed the clarity, cultural appropriateness, and practicality of intervention materials, leading to final refinement of the Yoga-Sanskar intervention package. Conclusions: This formative research process enabled the systematic co-development and adaptation of a culturally appropriate Yoga-based intervention that aligns closely with the lived context of pregnant women in rural settings. Our approach demonstrates how human-centred, evidence-informed models can guide the design, refinement, and real-world testing of interventions to enhance their feasibility, acceptability, and implementation potential.