Facilitators of and barriers to implementing a traditional Chinese medicine collaborative model of care for axial spondyloarthritis: a qualitative study

Yu Heng Kwan, Warren Fong, Xiang Ling Ang, Xiu Yan Chew, Sungwon Yoon, Chuen Seng Tan, Bee Choo Tai, Youyi Huang, Marcel Bilger, Jie Kie Phang, Hui Chin Tan, Su-An Quek, Sing Yee Clara Eng, Choy Tip Tan, Choy Tip Tan, Bao Qiang Dong, Hwee Ling Koh, Ying Ying Leung, Swee Cheng Ng, Kok Yong FongJulian Thumboo, Truls Østbye

Publication: Scientific journalJournal articlepeer-review


Conventional therapy may be inadequate for many patients with axial spondyloarthritis (axSpA). Traditional Chinese medicine (TCM) may be a viable alternative, but its effectiveness for axSpA is unknown. We are currently conducting a pragmatic randomised controlled trial (RCT) to investigate the effectiveness of a TCM collaborative model of care (TCMCMC), which combines usual rheumatologic care with acupuncture for patients with axSpA. This nested qualitative sub-study aims to identify facilitators of and barriers to the implementation of the TCMCMC.
We conducted individual in-depth interviews with participants who had completed the acupuncture regimen to elicit opinions on the facilitators of and barriers to the implementation of the TCMCMC. The interviews were transcribed and analysed using thematic analysis.
Twelve participants were included, with data saturation occurring after 10 interviews. The analysis revealed both a number of important ‘facilitators’ and ‘barriers’. Facilitators to the implementation of the TCMCMC included effectiveness of TCM to relieve symptoms, inadequacy of conventional treatment and positive social perceptions of TCM. Barriers included scepticism towards TCM, inability of TCM to provide instant relief, needle-related discomfort, variable effectiveness of TCM influenced by physicians’ skills and experience and the high cost of TCM. Recommendations to overcome barriers included further patient education about TCM.
Policymakers should take into account the various feasibility factors identified in this study when developing and implementing a TCMCMC.
Original languageEnglish
JournalAcupuncture in Medicine
Publication statusPublished - 2021

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