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

Fischer, Mary PhD, WHNP-BC, NCMP1; Fugate-Woods, Nancy PhD, RN, FAAN2; Wayne, Peter M. PhD3

doi: 10.1097/GME.0000000000000257
Original Articles

Objective: This study aims to qualitatively evaluate the feasibility of using a pragmatic network of community-based Tai Chi schools to deliver 9-month exercise interventions to women with osteopenia and to explore the impact of this design feature on facilitators and barriers to trial recruitment and participant adherence during and after the trial.

Methods: In a randomized trial comparing 9 months of Tai Chi plus usual care with usual care alone for postmenopausal 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 posttrial 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 the use of pragmatically delivered interventions are beneficial for fostering both study participation and posttrial adherence to the Tai Chi programs. This qualitative substudy is 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 postmenopausal women.

From the 1Harvard Vanguard Medical Associates Obstetrics and Gynecology, Watertown, MA; 2University of Washington School of Nursing, Seattle, WA; and 3Osher Center for Integrative Medicine, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

Received January 28, 2014; revised and accepted March 18, 2014.

Funding/support: This study was supported by grant R21 AT003503 from the National Center for Complementary and Alternative Medicine at the National Institutes of Health and by grant UL1 RR025758 (supporting the Harvard Clinical and Translational Science Center) from the National Center for Research Resources.

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine, National Center for Research Resources, or National Institutes of Health.

Financial disclosure/conflicts of interest: P.M.W. is the sole proprietor of a community-based Tai Chi school in the Boston area that served as one of the seven sites for this study but received no financial compensation. M.F. and N.F.-W. declare that they have no competing interests.

Address correspondence to: Peter M. Wayne, PhD, Osher Center for Integrative Medicine, Division for Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, 900 Commonwealth Ave, Boston, MA 02215. E-mail:

© 2014 by The North American Menopause Society.