| Interventions characteristics |
Instructional methods
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Instructor’s qualities (i.e., use of clear speech, adequate tone, nice manner; made the classes interesting; had a calming personality and professional competency) (Participants).
He's a very, very warm, delightful man and I felt at ease immediately with…with him (02004P-FG)1.
He makes it really interesting. He’s got a very nice manner (…) He’s right at the top of his field in what he’s doing, so, I mean, you’re very lucky to be working with him (01004C-FG).
… clearly <Instructor> is a superb instructor (01004C-FG); Yeah, because of the clarity of speech and everything isn’t it? (010002C-FG).
<Instructor>'s so good that it's really brought it home to me what the various movements are (02004P-FG).
…he's a good man, isn't he (02001P-FG).
… an excellent instructor who made the classes fun (01002P-FG).
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Adaptation of the classes to participants’ needs or requests (Instructor and researcher).
Tai Chi is about you, this is your Tai Chi (…) everybody has different flexibility, different hips. Please don’t worry about looking as anybody else (Instructor-O).
The instructor says in the next class it was planned to introduce something new, but comments he’ll not do this, to adapt the class to the group’s needs (Researcher notes).
02001C asks the instructor “what’s the breathing with that one?” –The instructor responds to 02001C’s question “that’s actually a good thing, let´s do it incorporating breathing”- and at the end of the practise the instructor adds “I like questions, questions are good!” (Researcher notes).
“Breathing makes me dizzy” (01004P-O) – <Instructor > said not to focus on breathing then (Researcher notes).
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Provision of regular positive feedback (Observed by researcher).
Good stuff, your movement is great (to 01002P), everybody´s movement is great ;
You´re doing great <02004P>;
Excellent, that´s good, that´s perfect, wonderful (Instructor –O)
Creation of a reassuring, failure free and warm class environment (Observed by researcher). -
Use of everyday life examples to facilitate copying the movements and create rapport with participants (Observed by researcher).
… raising your hand as if you're taking your cup of tea;…like asking for money; …Imagine you are riding a horse (Instructor –O).
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Amount of content delivered during the classes (Participants).
As that was only a short course. I think if you'd concentrated on the warm-ups, to be perfectly honest (02004C-FG); Yeah (02003C-FG); Because you get…you do get quite a bit of benefit in that (02004C-FG); Yeah (02001C-FG); Yeah (02003C-FG); And these people here are pretty limited, you know…(02004C-FG); Yeah (02003C-FG); you know, they can't help it, but they'll only grasp so much. And I think to…to concentrate on a few movements every week…would benefit them (02004C-FG); …if you're gonna go to the few that probably do grasp it, there's gonna be a lot that don't … The ones that can't are the ones that really need the help, aren’t they really. (02004C-FG); (…)I picked hold of them reasonably well, but… you have to realise everyone's got their own limitations (02004C-FG).
The worry I got is if it, um, if it progressed and it was more complicated, how she would cope with the complicated bits (01003C-FG); I would have expected that
<Instructor> would manage that side of things. I don’t think he’s going to push people beyond what they could be expected to reasonably do (01004C-FG).
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Lack of tailored support to individuals who kept performing the movements wrong after correction (Observed by researcher).
Keeps doing the movement in the wrong direction, stays on a side (Researcher - O).
I got muddled up there (01004P-O) (and we could see this).
<Instructor> said actually she did it right but only got footwork slightly wrong (in heel not in toe). Second time she still didn’t confidently do it and got stuck again (Researcher - O).
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Class-based Tai Chi
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Movements’ repetition - most of the movements were practised twice (Participants and researcher).
Misses some parts of the pattern (the instructor repeats the pattern) (Researcher –O).
Participants’ ability to sustain attention for 45 minutes (Participants and researcher). -
Participants’ ability to stand for 45 minutes (Participants and researcher).
I think 45 minutes of the actual exercise is…is probably quite enough (01004C-FG); It is enough, yes (01002P-FG); There’s a lot of concentration… (01002C-FG); Concentration… (01002P-FG); Yeah (01004C-FG); Yes (01004P-FG).
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Chosen venues (Participants and researcher).
[Venue] It's not bad (02001C-FG); And there's easy…Easy parking…convenient isn’t it? (…) I mean, there are various ways of getting in here if you can't drive, for example. And if the classes were going on for long periods, um, you know, there may be times when you didn't have a car or something like that,
or weren't able to drive. There's no problem because access, <Location Research site 2> which is pretty easy for most people, I'd say. (02003C-FG);
It is. By bus or anything else really (02002C-FG).
And the actual venue itself, do you think this is a good venue or do you think we could try and…? (Researcher); Oh yes.
Yes (01004P-FG); Yes (01004C-FG); Yes. Very good (01002P-FG). It’s ideal (01002C-FG). A car park and a, and a nice room, small (01002P).
Timings (Participants and researcher). -
Length of the classes (Participants and researcher).
I think that's perfect the timing….And the time of the day and the length of time (02003C-FG); Yes (02001C-FG); By the time my wife gets up, it is anyway [laugh] (02004C-FG).
Group sizes (Participants and researcher). Allocation of socialising time at the end (Participants and researcher). |
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Home-based Tai Chi
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Carers supporting practice (Participants). -
Role of routine (Participants).
… I find everything’s easier…life is routine in our household, and it, and it works very, very well (01002C-FG); Yeah (01002P-FG); That’s interesting…. I’m afraid we’re quite the opposite (01004C-FG); Yeah… I find routine helps me (01004P-FG); We don’t have a lot of routine. We… We, we found it far better to do the Tai Chi in the mornings after breakfast… <01004P> gets tired towards the end of the day so, you know, we listen to the news and things… But if, um, if we had a, a shopping day and got up, had breakfast and went out and came back, those are the days we, we might have given it a miss… So it…I, I…routine is important, um, but it, it depends how busy you are (01004C-FG); Yes (01004P-FG).
It's good, isn't it, this time of year when the winter's coming on and, um, to help people, er,..you know, the people who are caring to, um, ex…keep exercising without having to go out time. Well, apart from the lessons, obviously, um…(02003C-FG); It becomes the routine really doesn't it? (02004C-FG)(…) It's fitting it in what we do, isn't it (02001C-FG).
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Importance of repetition to improve practice and get the benefits of the intervention (Participants).
It’s the, it’s the repetition that’s the important…part of it (01002P-FG).
Just when he…you, you practice over and over again…I mean, it’s much better than you saying, well, do this and then, and then the next minute you’ve forgotten all about it… (01004P-FG).
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Participants’ determination to achieve perceived benefits (Participants).
[Home practice]Um, not every day, I must say [laughs], but mostly we have, yes. Um, and yes, I found that beneficial and in… I don’t know that, um, we…I don’t…some of the things are probably not, um, we’re not…We’re not probably doing them properly… And I, and I do forget…(01004P-FG); And us [laughs] (01003C-FG); Yeah. I do forget whether you should be going up there or down there or, you know, and if… But then somehow it doesn’t really seem to matter all that much [laughs] (01004P-FG); It’s still doing us some good (01003C-FG).
Participants’ pointing to unexpected events as barriers to practice and being positive providing ways to overcome these difficulties and do the practice (Instructor). (When conducted) Instructor´s home-visits were useful to clarify and make home-practice easier (Participants). |
Early start of home-practice (Participants). -
Booklet (overwhelming and unclear). (Participants)
“I felt depressed” (01004P-F) when she was not able to follow the booklet.
The class sessions were very good but at home we found the book slightly overwhelming and perhaps a DVD of <Instructor> would have been more helpful. (01003C-FG)
“Booklet not helpful, need a DVD” (02002C-F).
The book I found…I’m not as good as I was at reading and the book was difficult for me to comprehend…Yeah, I’d like to have had him [Instructor] on the screen in front of me so I could copy him [laughs] (01002P-FG); I…I, I basically think it’s that we haven’t had enough practice. We have done one session here…(01002C-FG).
Carers’ lack of confidence guiding the person living with dementia (Participants). -
Difficulty remembering (how to start) the movements/practice (Participants).
The very first weeks participants felt home-practice was difficult as they could not remember what they had been doing in class (Instructor-F).
So one session, and then you go home and you’re doing four different things and you’ve got to do it for so many different times. It was a bit like the blind leading the blind.
(…) Then try to guide somebody else with something you’re not sure about… (01002C-FG).
…once you’ve started the rest…after a couple of movements the rest actually falls into place…It’s starting it that’s the difficult…Your first action is the difficulty…At home, in the lounge, you’re stood there and you…I didn’t really know… We did get into it…but starting was hard (01002P-FG).
Carers’ discontinued engagement in practice due to their lack of confidence (Participants). 01004P reports being practising alone after 01004C stopped practising because he was not sure he was doing the movements right (01004P-F). Instructor’s time constraints to arrange home-visits (Instructor). -
Carers’ difficulties to motivate the person living with dementia to do things or to carry on practising for 20 minutes (Participants).
But, er, as I said to you, we could do the movement, got to do the move…the warm-ups fairly quickly and, er, we did them alright. So we concentrated on the warm-ups more than anything else, to be perfectly honest. When it got to the actual Tai Chi, er, we never really got the hang of that completely. But the warm-ups, yes, it was…(02004C-FG); Yeah, that's what we did (02004P-FG);…it was quite good. So we concentrated on giving warm-ups a little more extra time so that, you know…we tried to get to 20 minutes but, um…(02004C-FG); But our warm-ups is Tai Chi in my mind (02004P-FG); Well, it is Tai Chi, <02004P>, yeah, yes (01004P-FG); Well, call it Tai Chi because it sounds much better than warm-ups (02004P-FG); [laugh] Yeah, well, it was (02004C-FG); Did anyone else do the timer, do you know? I found this business of not being able to concentrate for too long (02003C-FG).
Participants’ not filling their action and coping plans (Instructor). Finding time to practice (Participants).. |
Provide the booklet in smaller volumes (Participants). Delay home practice at least two weeks after starting the class-based practice, so participants are more familiar with the movements and carers feel more confident to guide the person living with dementia (Participants and research team). Create a DVD as requested by participants or provide a crib sheet to guide their practice (Participants and instructor).
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Participant’s reactions
to the intervention
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Feelings towards the intervention and their dyadic
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Chance to take part together in the intervention as a facilitator for people living with dementia’s involvement in Tai Chi practice (Participants). 01004P and 01003P report that they would not have joined the class without their carers (01004P-F and 01003P-F). People living with dementia´s value of their carers´ role supporting their practice (Participants). Participants’ positive or neutral feelings towards Tai Chi before and after the first class (Researcher notes). Carers not feeling burden in taking part together with the person living with dementia and providing support at home (Participants). Rewarding for both members of the dyad (Participants). Willingness to carry on practicing Tai Chi or reengage in previously practised exercises (i.e. Pilates) (Participants). -
Discovery of a new pleasurable activity to practice together (Participants).
They keep…all these people, they sort of say, oh, you've got to do about sixty minutes a day of something……energetic, get your heart moving and all that. But, you know, I couldn't do that, but……as I say, I like this movement (02001C-FG).
Thoroughly delighted and enjoyed the experience (…) I have got my carer at home and he's so updated and he's now able to do Tai Chi every single day (…) he's getting better (…) I love doing the exercises with <02004C> (02004P-FG).
Well, I thought they were…I enjoyed them that's firstly you know. Er, also, um, I also…and learnt something from them really. (…) But I've enjoyed it (02003P-FG);
I have very much enjoyed the experience and would like to continue. (01004P-FG).
Participants’ autonomy to engage in class-based practice (Researcher notes). Attribution of a beneficial effect to their Tai Chi practice (Participants). |
Feeling sceptical about the intervention (Participants). Perception of Tai Chi as an “awkward activity” (Participants). Carers feeling hard to take part in the intervention (although the socialising component would compensate this effort) (Participants). -
Perception of Tai Chi as not appropriate for people living with dementia at more advanced stages, or as being less beneficial for them (Participants).
I've enjoyed it. I've enjoyed it to a point but I've found it hard work being a carer. And, um, but if it helps me wife, so it's all very well, yeah. Um, er, it's nice to meet people, come out and meet people. I think that's why we all kept coming, to meet somebody (02002C-FG); Yeah, I think we all felt that, didn't we? (02004C-FG); Yeah, we did, yeah (02001C-FG); It's nice to meet like-minded people in the same situation…and you feel you're not alone really…that there's other people with the same sort of problems (02004C); That's right (02002C-FG); Yeah, I've enjoyed it. I thought it was quite nice (02001C-FG).
… And, of course, some people are more, unfortunately, afflicted by this dementia, aren't they?
(02004C-FG); Yeah (020002C-FG); So they're not gonna respond quite so well. I mean, <02004P>'s quite good at the moment but, um, er, going forward it's gonna get very much harder (02004C-FG); Yeah (02003C-FG); So whether anyone with quite bad dementia could really benefit from it, I don't know, er. (02004C-FG); I think if they start it earlier…(02003C-FG); I
think they can, <02004C>. (02004P-FG).
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Reinforce the idea that practice is more important than the number of patterns performed, to avoid participants feeling that they are not practising enough (i.e., if they are only practising the warm-ups at home and they feel this is beneficial to them, there is no need to feel like they should be doing all the patterns) (Research team).
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Joint participation and enjoyment (Participants). Participants’ familiarity with the Tai Chi movements over session, allowing them to anticipate the movements (Researcher notes). -
Participants’ perceived progression in practice, getting more into Tai Chi and feeling the “flow” (Participants).
Comments after 3 classes, he´s felt more “getting into it”, he was “flowing more” (Observational notes).
I think the exercises ultimately with people with dementia could help with balance (01002P-FG).
May I say the one thing I have noticed, I love to do my bit of gardening and I rather love to go out and inspect everything daily. And to go into my greenhouse, for instance, I'm very much more careful with my legs. And I have said quietly to myself, um, thank you
Tai Chi, because it has helped me so much with balance. (02004P-FG).
I think if, if one can feel that you…slowly…a slow benefit, an im…improving benefit of better balance perhaps, even feeling better within yourself…I, I feel a little bit better after having done it. Um… (01004C-FG); Yes, I think it does… Yeah (01004P-FG); But it… I think if you, if you put a lot of effort into it and you think, well, I just feel the same as I did before… (01004C-FG); [Laughs] (01003C-FG);…then you think, well, you know… So you’ve got to see a reward. It’s, you know, the effort and the reward’s got to come from it (01004C-FG); Yeah …It ma…it makes you think about what’s going on in your body while you’re doing this. That’s how I feel. You know, or, or…it… Oh, sorry. I don’t know. Yeah. [Laughs]. (01004P-FG).
It’s something to be kind of proud of and, yeah, makes you feel better… you know, that you’re doing something good for yourself.(…) I have to say we’ve almost been quite, um, proud to, to tell our friends we’ve been doing Tai Chi. (01004C-FG).
Well, we…we do quite a bit, don't we, but you need to feel you've gone out somewhere and do some exercises, it sounds pretty basic but that's what it's all about really isn't it…coming together and doing something that breaks the week up [laugh] (02004C-FG).
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Previous health issues (Participants and research team). Adverse events (i.e., feeling dizzy) (Research team). -
Participants’ difficulties to engage in the intervention in a non-familiar (class-based) environment without supports nearby (Participants).
… for some reason, I can do the exercise [at home], which I had difficulty with [in class], that's with my feet and…and my balance. (…) But I think just being at home and, you know, having something nearby that if…that if I happened
to get a little bit dizzy… I can put my hand out. My grandma's chair is down near me (02004P-FG); Yeah, that's true (02004C-FG); (…) And for that reason, I love doing the exercises with <02004C> (02004P-FG).
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Instructors should be aware of participants’ health conditions and provide them a tailored advice on how to practice depending on these conditions or adverse events experienced during their practice.
Similarly, more contact at the end of the session with participants will allow instructors to identify possible difficulties linked to home or class-based settings and provide tailored recommendations to facilitate participants’ adherence to the intervention (Research team).
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Interaction with others
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Creation of a semi-circle of chairs before starting the first class to encourage participants’ conversations whilst waiting for the rest of participants (Researcher notes). Allowing time at the end of the sessions for participants’ socialisation was perceived as something positive particularly for carers (Participants). -
Involving participants in their coffee/tea preparation (Researcher notes).
When participants laugh at the instructor´s jokes they look at each other (Observational notes).
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