Stroke survivors personal efficacy beliefs and outcomes expectations of tai chi exercise: a qualitative descriptive study
Authors: Taylor-Piliae R , Dolan H , Yako A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Laurence B. Emmons Research Award

Background
Strokes are a leading cause of serious long-term disability, often compounded by post-stroke depression. Prior Tai Chi research conducted among stroke survivors has focused mainly on physical functioning yet understanding the potential benefits and challenges of participating in Tai Chi exercise during stroke recovery is limited. Social Cognitive Theory and Complex Systems Biology provided the theoretical framework to examine stroke survivors’ personal efficacy beliefs, behaviour (Tai Chi intervention), and outcome expectations (Figure 1).

Purpose
To describe community-dwelling stroke survivors’ experiences of being in an 8-week Tai Chi intervention, including any benefits or challenges they had, and allow the participants to offer any suggestions for improving how the Tai Chi classes were structured.

Methods
A qualitative descriptive approach was used, with focus group interview data collected from stroke survivors after participation in a Tai Chi intervention. Due to COVID-19, the focus group interview was conducted via on-line video conferencing. The interview was audio-recorded, then transcribed using an online transcription service. Content analysis of the de-identified transcript was conducted using online analysis software with a priori codes based on the theoretical framework, and inductive codes that were added during the analysis process. The transcript was coded independently by two researchers and discussed until consensus was reached. Lincoln and Guba’s criteria were followed to ensure trustworthiness of the data.

Results
Community-dwelling stroke survivors (n = 7) participating in the focus group interviews were on average 68 years old, mainly retired (71%, n = 5), married women (57%, n = 4) with &gt;13 years education (86%, n = 6), reporting depression symptoms (Center for Epidemiological Studies-Depression = 15.9 ± 9.6) with 43% (n = 3) taking anti-depressant medications. The major findings are summarized according to three major themes: Personal Efficacy Beliefs, Tai Chi Intervention Active Ingredients and Outcome Expectations. Personal Efficacy Beliefs centered on the participants’ ability to do the Tai Chi movements. The Tai Chi Intervention Active Ingredients experienced during the classes were evident, apart from ‘natural freer breathing’ which was not discussed or described. Outcome Expectations centered on the physical, mental, and social benefits experienced, challenges encountered, and suggestions for improving the Tai Chi classes.

Conclusion
Social Cognitive Theory underscored stroke survivors’ personal efficacy beliefs, behaviour, and outcome expectations. While Complex Systems Biology highlighted the active ingredients of Tai Chi intervention they experienced. Participation in the 8-week Tai Chi intervention led to perceived holistic (physical, mental, social) benefits post-stroke.