{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T15:12:05Z","timestamp":1779289925812,"version":"3.51.4"},"reference-count":20,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Acupunct Med"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twelve participants were included, with data saturation occurring after 10 interviews. The analysis revealed both a number of important \u2018facilitators\u2019 and \u2018barriers\u2019. 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\u2019 skills and experience and the high cost of TCM. Recommendations to overcome barriers included further patient education about TCM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Policymakers should take into account the various feasibility factors identified in this study when developing and implementing a TCMCMC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number:<\/jats:title>\n                    <jats:p>NCT03420404 (ClinicalTrials.gov)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09645284211009543","type":"journal-article","created":{"date-parts":[[2021,5,29]],"date-time":"2021-05-29T16:25:29Z","timestamp":1622305529000},"page":"629-636","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Facilitators of and barriers to implementing a traditional Chinese medicine collaborative model of care for axial spondyloarthritis: a qualitative study"],"prefix":"10.1177","volume":"39","author":[{"given":"Yu Heng","family":"Kwan","sequence":"first","affiliation":[{"name":"Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warren","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"},{"name":"Duke-NUS Medical School, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiang Ling","family":"Ang","sequence":"additional","affiliation":[{"name":"Singapore Thong Chai Medical Institution, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiu Yan","family":"Chew","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sungwon","family":"Yoon","sequence":"additional","affiliation":[{"name":"Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuen Seng","family":"Tan","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bee Choo","family":"Tai","sequence":"additional","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youyi","family":"Huang","sequence":"additional","affiliation":[{"name":"Internal Medicine Residency, SingHealth, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcel","family":"Bilger","sequence":"additional","affiliation":[{"name":"Health Economics and Policy Group, Vienna University of Economics and Business, Vienna, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie Kie","family":"Phang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui Chin","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore Thong Chai Medical Institution, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Su-An","family":"Quek","sequence":"additional","affiliation":[{"name":"Singapore Thong Chai Medical Institution, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sing Yee Clara","family":"Eng","sequence":"additional","affiliation":[{"name":"Singapore Thong Chai Medical Institution, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Choy Tip","family":"Tan","sequence":"additional","affiliation":[{"name":"Singapore Thong Chai Medical Institution, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bao Qiang","family":"Dong","sequence":"additional","affiliation":[{"name":"Liaoning University of Traditional Chinese Medicine, Shenyang, People\u2019s Republic of China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hwee Ling","family":"Koh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, National University of Singapore, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Ying","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"},{"name":"Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swee Cheng","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kok Yong","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Thumboo","sequence":"additional","affiliation":[{"name":"Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore"},{"name":"Department of Rheumatology and Immunology, Singapore General Hospital, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Truls","family":"\u00d8stbye","sequence":"additional","affiliation":[{"name":"Program in Health Systems and Services Research, Duke-NUS Medical School, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"key":"bibr1-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31591-4"},{"key":"bibr2-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1111\/1756-185X.13696"},{"key":"bibr3-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210770"},{"key":"bibr4-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-018-0703-z"},{"key":"bibr5-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-201108"},{"key":"bibr6-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2018.03.003"},{"key":"bibr7-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1136\/qshc.2003.009134"},{"key":"bibr8-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-018-3117-2"},{"key":"bibr9-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1177\/1744987108093962"},{"key":"bibr10-09645284211009543","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"bibr11-09645284211009543","volume-title":"Basics 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Singapore: Nanyang Technological University, 2019."},{"key":"bibr14-09645284211009543","unstructured":"TCM and Tui Na or acupuncture package\n                      . 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