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

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 progams that both facilitated and impeded study participation and/or posttrial adherence. Direct facilitators included convenience of class locations and times, alternative teaming 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 arc 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.