Use of pragmatic community-based interventions to enhance recruitment and adherence in a randomized trial of Tai Chi for women with osteopenia

Abstract

Objectives To qualitatively evaluate the feasibility of utilizing a pragmatic network of community-based Tai Chi schools to deliver 9-month exercise interventions to osteopenic women and to explore the impact of this design feature on facilitators and barriers to trial recruitment and participant adherence during and following the trial. Methods Within a randomized trial comparing 9 months of Tai Chi plus usual care to usual care alone for post-menopausal women with moderately low bone mass, exit interviews were conducted with 43 participants randomized to the pragmatically-delivered Tai Chi intervention. Transcripts were digitially recorded, transcribed and imported into NVivo, a computer-assisted qualitative data analysis software. Qualitative content analysis was used to code the data. Patterns emerging from among the codes were further examined and clustered into themes. Results Analyses revealed features of pragmatically-delivered Tai Chi programs that both facilitated and impeded study participation and/or post trial adherence. Direct facilitators included: convenience of class locations and times, alternative learning modalities, quality of teaching, community and social support and perceived health benefits. Barriers consisted primarily of time-related issues. A possible causal mechanism--self-efficacy--was also identified. Conclusions Factors related to using pragmatically-delivered intervention were beneficial in fostering both study participation and post-trial adherence to the Tai Chi programs. The qualitative sub-study was valuable for identifying these factors and a possible causal mechanism. These findings will assist in the design and conduct of future studies exploring the use of Tai Chi in fracture prevention and health-related quality of life in post-menopausal women.

Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart Failure

“…Each of these elements are paramount in a class of tai chi where all participants are part of a unique shared transformative experience, and the environment fosters connection, support and shared success. Recent qualitative studies linked to clinical trials of tai chi support the relevance of each of these first three facilitators of self-efficacy (15, 27,28). The fourth precept refers to physiological cues that can feed back on self-efficacy, and this can be positive or negative.…”

“…Tai chi incorporates cultivation of mindfulness, slow deep breathing, and low-impact physical exercise. Importantly, it has been described as modifiable, non-threatening, accessible to the elderly and deconditioned, and prior studies have suggested increases in self-efficacy (12, 13, 14, 15). We have previously reported that a 12 week tai chi program in patients with HF was effective in increasing exercise self-efficacy, as well as disease-specific quality of life and mood, as compared to an education control.…”

Impact of Short- and Long-term Tai Chi Mind-Body Exercise Training on Cognitive Function in Healthy Adults: Results from a Hybrid Observational Study and Randomized Trial

“…All TC interventions were administered pragmatically at 1 of 5 prescreened TC schools within the Boston area that met specific guidelines described elsewhere. 23 , 24 In brief, schools were chosen to ensure that they provided valid, stable TC programs led by experienced teachers. Eligibility criteria included long-standing community-based programs, curricula taught in English language that emphasized core TC principles, and curricula based on Yang, Wu, Chen, or Sun TC styles.…”

How is Qigong Conducive to Women’s Health?

“…Few research studies have researched the feasible differences between these modes; however, just as peer support is important for interventions and rehabilitation [115][116][117], so it is for Qigong [110]. Therefore, this gap provides scholars with opportunities for health promotion.…”