Determinants of Qi Gong,Tai Chi,and Yoga Use for Health Conditions: A Systematic Review Protocol

Abstract

Background

While mind-body movement interventions such as qi gong, tai chi, and yoga are recommended in clinical practice guidelines for several common health conditions, implementation of these interventions within healthcare settings is rare. A systematic synthesis of implementation determinants–commonly referred to as barriers and facilitators–is needed to increase adoption or other implementation outcomes such as reach or sustainability within healthcare systems. Thus, the objective of this review is to: (1) identify determinants of qi gong, tai chi, and yoga for health conditions; and (2) evaluate whether determinants differ by intervention type, health condition, implementation setting, or implementation outcome.

Methods

In this systematic review, we will include original research articles in English that identify determinants to adoption of qi gong, tai chi, and yoga by adults with health conditions. We will search MEDLINE, EMBASE, Web of Science, CINAHL, PsycInfo, Google Scholar, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and WHO Clinical Trials database from inception. We will code determinants identified in each article using a codebook informed by the Consolidated Framework for Implementation Research (CFIR). We will report on how determinants relate to intervention type, health condition (e.g., low back pain, fall prevention), implementation settings (e.g., primary care clinic, community organization), or implementation outcome (e.g., adoption, sustainability). Study quality will be assessed using the Mixed Methods Appraisal Tool.

Discussion

Findings will inform implementation strategies by identifying context-specific determinants that influence uptake of qi gong, tai chi, and yoga for health conditions. Results will provide practical insights to guide clinicians, researchers, and health systems in integrating mind-body movement interventions within diverse healthcare and community settings.

Conclusion

This review will generate a comprehensive synthesis of implementation determinants to support the use of qi gong, tai chi, and yoga in evidence-based care for health conditions.

Keywords

Qi Gong Tai Chi yoga determinants barriers facilitators systematic review mind-body movement interventions

Background

Qi gong, tai chi, and yoga are mind-body movement interventions that combine body positions or postures with mindful movement, controlled breathing, and meditation.^1-5 The practice of these mind-body movement interventions can lead to improved physical function, general health, and disease-specific outcomes.^6-13 For example, tai chi and qi gong have been shown to improve balance and prevent falls, increase function in older adults with knee and hip osteoarthritis, and improve several patient reported outcomes among adults with neuropsychiatric and neuromuscular disorders.^6-8,14-19 Similarly, yoga has been shown to improve health outcomes for adults with low back pain, diabetes and cancer-related symptoms.^20-24 Accordingly, qi gong, tai chi, and yoga are recommended in major clinical practice guidelines for several common health conditions as shown in Table 1.^9,25-31 It is estimated that 20% of adults in the United States practice these mind-body movement interventions,³² and use of yoga is exponentially increasing over time.^33,34 However, practice of qi gong, tai chi, and yoga is mainly reported as a form of exercise to support general wellbeing.³⁵ Thus, despite growing evidence that these interventions can improve outcomes and reduce morbidity in persons living with common health conditions,^9,25-31,36 utilization for specific health conditions remains low.³⁵

Table 1.

Select Clinical Practice Guidelines That Recommend Qi Gong, Tai Chi, and Yoga

Organization	Recommendation
American College of Physicians	Yoga/Tai chi recommended for chronic low back pain in 2017 guideline⁹
American College of Rheumatology and Osteoarthritis Research Society International	Tai chi recommended for hip and knee osteoarthritis in 2019 guideline^27,28 Qi gong recommended for rheumatoid arthritis in 2022 guideline³¹
American Society for Clinical Oncology and Society of Integrative Oncology	Yoga/Tai chi/Qi gong recommended during cancer care for symptom management in 2022 guideline²⁹
International Society on Hypertension	Yoga recommended for hypertension in 2020 guideline²⁵
American Diabetes Association	Yoga/Tai chi recommended for diabetes management in 2024 guideline³⁰
US Preventative Services Task Force	Tai chi recommended for falls prevention in 2024 guideline²⁶

In the healthcare context, implementation science involves the study of methods to promote the systematic uptake of evidence-based practices into routine clinical care.^37,38 Understanding the implementation determinants of an evidence-based practice–commonly referred to as barriers and facilitators–is an important first step in developing effective implementation strategies that increase the use of these interventions in a specific setting or context. Furthermore, barriers to intervention use can occur at multiple socio-ecological levels.^39-44 For example, barriers of mind-body movement interventions in healthcare settings can occur at the level of the patient (e.g., competing health demands), referring provider (e.g., low self-efficacy to describe or refer to tai chi), health system (e.g., referral to yoga is not possible in electronic health record), or policy-maker (e.g., payers not reimbursing mind-body movement interventions).^45-51 Thus, identifying and prioritizing modifiable barriers is needed to design tailored implementation strategies that can increase the use of qi gong, tai chi and yoga for specific health conditions that are recommended by clinical practice guidelines.⁵²

The Consolidated Framework for Implementation Research (CFIR) was developed to guide the systematic assessment of implementation determinants.⁵³ CFIR includes 67 distinct constructs–providing a comprehensive taxonomy of implementation determinants–which are organized into 5 domains: Innovation (e.g., tai chi), Outer Setting (e.g., policy makers including insurers), Inner Setting (i.e., the setting where implementation occurs such as a health system or clinic), Individuals (e.g., clinicians that may refer to Qi Gong), and the Implementation Process.⁵³ The systematic assessment and mapping of determinants to these specific constructs can be used to develop tailored strategies to increase the use of evidence-based practices.⁵⁴ As clinical guidelines increasingly support the use of qi gong, tai chi, and yoga for specific health conditions, and healthcare systems or community organizations begin to implement these interventions,^55-58 there is a growing need to understand implementation determinants to increase the effectiveness and efficiency of these implementation efforts.^49,59,60 This need is driven by the persistent gap between strong clinical evidence supporting these interventions and their limited real-world uptake, highlighting the importance of identifying which contextual factors help or hinder their integration into routine care. While the explicit use of implementation science theories or frameworks (e.g., CFIR) in implementation of mind-body movement interventions is just emerging,^49,61 there are lessons to learn from prior literature. However, we are unaware of systematic reviews that summarize the existing knowledge around implementation determinants of mind-body movement interventions.

The purpose of this systematic review will be to: (1) apply CFIR constructs to identify and report barriers and facilitators to the use of qi gong, tai chi, and yoga in treating various health conditions, and (2) identify sources of heterogeneity in determinants of intervention use, including variation in barriers and facilitators by type of mind-body movement intervention, health condition, implementation setting, or implementation outcome.⁶²

Methods

Design

We will conduct a systematic review with a qualitative meta-analysis of original studies to synthesize evidence on implementation barriers and facilitators.⁶² We selected qi gong, tai chi, and yoga as the focus of this review because they are 3 of the most widely studied mind–body movement interventions, each with substantial evidence demonstrating benefits across multiple health conditions and consistent recommendation in major clinical practice guidelines. Despite this strong evidence base, their use for specific health conditions in healthcare and community settings remains low. Understanding the determinants that influence their adoption and sustained use is therefore essential to closing this implementation gap and improving access to effective, low-risk, nonpharmacologic treatment options. To organize and present our findings in common language that subsequently informs the development of implementation strategies, we will use an a priori codebook, informed by CFIR 2.0, to code and organize data from the original studies.⁵³ During data extraction, we will code data from the included primary studies in order to organize all information into the CFIR domains and constructs (see Table 2).⁶² We will also allow for emerging themes not captured by the CFIR constructs.

Table 2.

Description of CFIR Domains

Domain	Description
Innovation	The innovation is the “thing” being implement (i.e., qi gong, tai chi, or yoga for specific health conditions). Characteristics of the innovation (e.g., innovation cost, evidence base for a specific health condition, relative advantage vs other already available innovations) will be characterized as barriers or facilitators.
Individuals	The roles and characteristics of individuals. We anticipate that the main ‘individuals involved’ will be the innovation recipients (i.e., patients who receive mind-body movement interventions) and intervention deliverers (instructors, clinicians who refer) and health system leaders. We will categorize papers as reflecting patient perspectives or non-patient perspectives or both. For these groups we will identify barriers and facilitators align with the needs, capability, motivation, and opportunity of these various individuals to use or implement recommend mind-body movement interventions for health conditions.
Inner setting	The setting in which the innovation is implemented, e.g., primary care clinic or community organization. There may be multiple inner settings and/or multiple levels within the inner setting, e.g., hospital, department, clinic. Characteristics of the inner setting (e.g., physical space to practice tai chi, information technology infrastructure to facilitate referrals to qi gong, communication channels between primary care providers and yoga instructors) will be characterized as barriers or facilitators.
Outer setting	The setting in which the inner setting exists (e.g., surrounding communities) or other external pressures (e.g., state or federal policy, insurance). Characteristics of the outer setting (e.g., local attitudes toward mind-body movement interventions, local conditions available to support implementation, policies or laws, or external pressure to implement mind-body movement interventions) will be characterized as barriers or facilitators.
Process	The activities and strategies used to implement the innovation. This involves documentation of the implementation process and what activities or strategies were used to implement the innovation. For studies that have defined implementation efforts, characteristics of the implementation process (e.g., forming teams to implement mind-body movement interventions, compacity to assess needs of inner setting or to tailor implementation process) will be characterized as barriers or facilitators.

The protocol for this systematic review was registered with the international prospective register of systematic reviews (PROSPERO #CRD42024569493). This study protocol is informed by the PRISMA guidelines for study protocols (PRISMA-P), and reporting of the review findings will be informed by the PRISMA guidelines.⁶³

Eligibility Criteria

This systematic review will include original peer-reviewed empirical studies including cross-sectional and longitudinal observational studies, randomized and non-randomized clinical trials, and qualitative and mixed method evaluations of implementation or quality improvement programs. We will conduct reference list checking, as described by the Terminology, Application, and Reporting of Citation Search (TARCiS) statement,⁶⁴ on the articles that we include in our review as well as other relevant articles (e.g., systematic reviews, literature reviews).

Inclusion Criteria

Studies are eligible if they meet the PICOS framework (Population, Intervention, Comparison, Outcome, Study design). (P) We will include studies of adults with a specific health condition or those considered “at-risk” for a given health condition and described by the authors as such (e.g., older adults at risk for falls, cancer survivors). We will also include studies of other key informants (e.g., clinicians, health system or community leaders, policy makers). For example, we will include studies of clinicians if qi gong, tai chi, or yoga is relevant to a health condition they manage (e.g., geriatricians may recommend tai chi for knee osteoarthritis or fall prevention). (I) We will include studies of qi gong, tai chi, or yoga. We will also include multicomponent interventions (e.g., combined acupuncture-yoga intervention, mindfulness-based stress reduction) if we can identify facilitators or barriers specific to the qi gong, tai chi, or yoga component of the program.^61,65 (C) Studies with or without a comparator group will be included (O) The outcomes of interest are the determinants (i.e., barriers or facilitators) to use of qi gong, tai chi, or yoga in adults with health conditions. When possible we will specify whether the determinants are specific to a particular implementation outcome such as feasibility, adoption or sustainability. We will not include studies that only measure implementation outcomes (e.g., measuring feasibility without collecting information on barriers or facilitators) or studies identifying barriers or facilitators that may only be relevant to the conduct of clinical trials (e.g., barriers to recruitment of trial participants). (S) We will include qualitative and quantitative studies that report one or more barriers and/or facilitators.

Exclusion Criteria

Healthy populations (i.e., those without a specified health condition or not designated as at-risk for a health condition); populations under the age of 18 years; conference proceedings, commentaries, editorials, dissertations, letters, books, book chapters, and reviews; and articles written in languages other than English will be excluded. We will exclude studies written in languages other than English because it may be difficult to accurately code translated text while maintaining a common language from the field of implementation science (i.e., CFIR constructs) where term homonymity, synonymy, and instability are major challenges.^66-68 Although our search strategy includes grey literature sources to ensure that all potentially eligible peer-reviewed studies are identified, only peer-reviewed empirical articles will be included in the final review.

Search Strategy

An initial search of studies was conducted from database inception until May 2024 using the electronic databases: MEDLINE (OVID platform), Embase (OVID platform), CINAHL, PsycInfo, and Web of Science. In addition, a grey literature search was conducted using Google Scholar, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials database in March of 2025. Searches for all data bases will be updated prior to completion of the review.

Search terms were variations on 2 concepts: qi gong, tai chi, or yoga AND barrier, facilitators, or implementation. Search strings varied slightly depending on the MESH and subject heading terms within each database. Truncation (*) was used to capture variations in terms. Results were limited to the English language. See Online Appendix 1 for full search strategies for each database. Endnote was used to remove duplicates and double-checked by librarians with expertise in systematic review methods. Additional duplicates were identified and removed in the systematic review software, Covidence (Veritas Health Innovation, Melbourne, Australia).

Data Extraction

Through team meetings and the use of exemplar articles, an extraction form was developed (Online Appendix 2) to capture information on each study. We will extract the following information on general study characteristics: author(s), year, country where the study was conducted, study design, sample size, and data collection method (e.g., interviews, focus groups, surveys). We will collect information on the sample including participant demographic characteristic such as age, sex, race/ethnicity, and other characteristics that define the population of interest (e.g., military veterans, healthcare workers). We will identify what stakeholder perspectives(s) are being captured (e.g. patients, instructors of mind-body movement interventions, primary care providers, medical specialists, medical educators, hospital leadership, community leaders, policy makers). We will extract information on strength of evidence of the intervention for the specific health condition as justified by the original investigator. The authors rationale for implementation efforts will be characterized as: (1) the mind-body movement intervention is recommended for the specific health condition (e.g., a guideline recommending yoga for low back pain⁹); (2) a component of the mind-body movement intervention is recommended for the specific health condition (e.g., a guideline recommending exercise or mindfulness for cardiovascular health⁶⁹); or (3) implementation is occurring without a clinical practice guideline supporting either the intervention or its components for the specific health condition.

We will extract information on several potential sources of heterogeneity in our evaluation of implementation determinants for mind-body movement intervention use for health conditions. First, we will identify the intervention type (i.e., qi gong, tai chi, yoga) and intervention delivery method (e.g., in-person, virtual). Second, we will identify health conditions of interest (e.g., low back pain, knee osteoarthritis). Third, the implementation setting will be characterized by the location where implementation is occurring (e.g., primary care clinic, community organization). We will also document if practice of qi gong, tai chi, or yoga occurs elsewhere (e.g., if primary care providers refer to community-based interventions or when virtually delivered interventions are practiced at home). When possible, we will also identify the specific implementation outcome(s) of interest in each study, with implementation outcomes defined by Proctor et al shown in Table 3.⁷⁰ This will allow us to evaluate whether determinants vary by implementation outcome (e.g., was the determinant a barrier to adoption and/or sustainability?). Acceptability, appropriateness, and feasibility are considered pre-implementation outcomes, i.e., outcomes that can precede implementation efforts that can predict other implementation outcomes such as adoption or sustainability.⁷¹

Table 3.

Definitions of Implementation Outcomes⁷⁰

Implementation outcome	Definition
Acceptability^a	The perception among implementation stakeholders that a given treatment, service, practice, or innovation is agreeable, palatable, or satisfactory, e.g., do patients or providers think that mind-body movement interventions are attractive as a treatment option?
Adoption	The intention, initial decision, or action to try or employ an innovation or evidence-based practice. Adoption also may be referred to as “uptake.” for example, what proportion of patients with knee osteoarthritis are referred to tai chi within a primary care clinic.
Appropriateness^a	The perceived fit, relevance, or compatibility of the innovation or evidence-based practice for a given practice setting, provider, or consumer; and/or perceived fit of the innovation to address a particular issue or problem, e.g., do patients, providers and health system leaders perceive tai chi as appropriate for preventing falls?
Cost	The cost impact of an implementation effort. The cost of implementing a treatment depends upon the costs of the particular intervention, the implementation strategy used, and the location of service delivery.
Feasibility^a	The extent to which a new treatment, or an innovation, can be successfully used or carried out within a given agency or setting (e.g., primary care clinic, community organization).
Fidelity	The degree to which an intervention or innovation was implemented as it was prescribed in the original protocol or as it was intended by the program developers, e.g., is tai chi delivered in real-world settings is similar to tai chi delivered in clinical trials that have informed clinical practice guidelines?
Penetration	The integration of a practice within a service setting and its subsystems, e.g., the number of clinics or community organization locations that offer yoga for low back pain.
Sustainability	The extent to which a newly implemented treatment is maintained or institutionalized within a service setting’s ongoing, stable operations.

^aAcceptability, appropriateness, and feasibility are considered pre-implementation outcomes, i.e., outcomes that can precede implementation efforts that can predict other implementation outcomes such as adoption or sustainability.⁷¹

Barriers and facilitators will be identified through coding of relevant quantitative data (e.g., surveys) and qualitative findings (e.g., themes) from the results section of each study using a codebook informed by CFIR version 2.0.⁵³ We have piloted this codebook in several prior and ongoing studies designed to inform the development of implementation strategies.^49,52 We will also allow for emerging determinants (i.e., those that are not captured by CFIR) to arise throughout the coding process. Data from each article will be independently reviewed and extracted in duplicate by 2 reviewers. Disagreements in data extraction will be resolved by senior reviewers and/or team consensus meetings.

Data Synthesis and Qualitative Meta Analysis

We will describe the frequency of identified barriers and facilitators and use heatmaps to illustrate high-density areas of CFIR.⁷² We will explore whether barriers and facilitators differ based on intervention type (e.g., tai chi vs yoga), health condition (e.g., back pain vs cancer symptom management), setting (e.g., primary care clinic vs community organization), and implementation outcome (e.g., adoption vs sustainability). In regard to health condition, we will explore whether barriers and facilitators differ when qi gong, tai chi, and yoga are being implemented for different clinical indications (e.g., fall prevention, osteoarthritis, or symptom management in cancer care). In regard to setting, we will explore whether barriers/facilitators differ when qi gong, tai chi, and yoga are implemented in different contexts. Clinical settings may include primary care clinics, medical specialty clinics (e.g., pain medicine, rheumatology, orthopedics, physical medicine and rehabilitation, integrative medicine, sports medicine), community settings (e.g., nursing homes, community centers, parks, home-based programs), or other specific settings where qi gong, tai chi, or yoga may be delivered for health conditions. In regard to implementation outcomes, we will explore whether barriers and facilitators differ when a specific implementation outcome is specified. We will characterize each study as having no specified implementation outcomes or one or more of the following implementation outcomes: acceptability, appropriateness, feasibility, adoption, fidelity, penetration, cost, and sustainability of intervention delivery.⁷⁰

Risk of Bias Assessment

Study quality will be assessed using the Mixed Methods Appraisal Tool (MMAT) Version 2018.⁷³ The MMAT is a grading check list that can be used to assess the risk of bias in 5 types of study designs: (1) Qualitative, (2) Quantitative randomized controlled trials, (3) Quantitative non-randomized trials, (4) Quantitative descriptive, and (5) Mixed methods. Two reviewers will independently use the appropriate checklist to grade each included study. Discrepancies between the 2 reviewers will be discussed at team meetings and/or arbitrated by a third reviewer.

Discussion

The benefits of qi gong, tai chi, and yoga have been established for several health conditions. Thus, we anticipate our systematic review will identify studies on barriers and facilitators to the appropriate, evidence-based use of these interventions for specific health conditions. For example, guidelines endorse one or more of these mind-body movement interventions for low back pain (American College of Physicians⁹), osteoarthritis (American College of Rheumatology and the Osteoarthritis Research Society International guidelines²⁷ and the American College of Rheumatology and Arthritis Foundation⁷⁴), hypertension (International Society of Hypertension Global Hypertension²⁵), and fall prevention (United States Preventive Services Task Force²⁶). While several studies have looked at barriers to implementation of a specific intervention or within a particular clinical context, we are unaware of any publications that have synthesized what is known about implementing qi gong, tai chi, or yoga across broad settings where people with health conditions receive services. Furthermore, our review will include a comprehensive search that is broad enough to inform our understanding of whether implementation barriers and facilitators differ by intervention type, health condition, implementation setting, or implementation outcome.

One reason for the absence of prior reviews may be the limited familiarity, awareness, or use of CFIR or other evolving determinant frameworks^44,75 within the clinical research communities studying mind-body movement interventions. Applying the common language codified in CFIR to code the existing literature may help synthesize and better document prior work, thus elucidating known barriers and informing future implementation efforts. It may also be that heterogeneity exists in the factors that influence the implementation of mind-body movement interventions (e.g., if barriers to implementing tai chi for knee osteoarthritis are different than the barriers that impede implementation of yoga in cancer care). Understanding these differences will aid the development of implementation strategies that are appropriately tailored to the intervention, health condition, implementation setting, or the relevant implementation outcomes.

Identifying barriers is essential for developing effective implementation strategies that can support their adoption in routine care settings. Implementation strategies that target specific known barriers may be more effective than general strategies. While developing implementation strategies that have multiple components is also thought to be effective, it is important to tailor resources to those strategies most likely to be successful within a specific context.^76,77 Thus, identifying a range of barriers and facilitators, and whether they are relevant to a range of contexts, is essential to inform future dissemination and implementation efforts in research and practice.^60,78 Our qualitative meta-analysis will help us to organize and interpret information on implementation determinants using the common set of terminology defined in CFIR domains and constructs.

Our systematic review protocol has important limitations. First, we anticipate that few studies we will identify will use contemporary frameworks from the field of implementation science.⁷² We will code or translate language on barriers or facilitators to the CFIR lexicon, which could introduce bias. To limit potential bias, we will have weekly team meetings to conduct implementation science training for all team members, to discuss discrepancies in double coded transcripts, and create an audit trail of how disagreements are resolved through consensus. While our preliminary searches support the feasibility of identifying many relevant articles, we anticipate that some of our subgroups of interest (i.e., subgroups based on intervention type, health condition, implementation setting, or implementation outcome) may have a smaller number of studies, limiting our ability to explore barriers and facilitators in all potential subgroups.

We anticipate our findings will be reported in multiple manuscripts utilizing and organizing the determinants and framework that best synthesize the perspectives of the stakeholders (e.g., one that is patient-focused, another that is healthcare system-focused). Additionally, this review will inform the implementation of tai chi for knee osteoarthritis in 4 large healthcare systems in the context of a multi-site embedded pragmatic trial funded by the National Center for Complementary and Integrative Health (NIH Grant #: UG3AT012413; ClinicalTrials.gov ID: NCT06384898). We also anticipate our review will inform other implementation efforts of qi gong, tai chi and yoga for specific health conditions in health care systems or community organizations.⁷⁹

Conclusion

This systematic review will generate a comprehensive synthesis of implementation determinants affecting the adoption of qi gong, tai chi, and yoga for specific health conditions. By applying the Consolidated Framework for Implementation Research (CFIR) to organize findings across diverse populations and contexts, our review will provide a foundation for developing tailored evidence-informed implementation strategies. The results will guide healthcare systems, community organizations, and policymakers in optimizing the integration and sustainability of mind-body movement interventions recommended in clinical guidelines. Ultimately, this work aims to advance equitable access to effective nonpharmacologic care options and support the broader translation of evidence-based mind-body practices into routine care.

Supplemental Material

Supplemental Material - Determinants of Qi Gong, Tai Chi, and Yoga Use for Health Conditions: A Systematic Review Protocol

Supplemental Material for Determinants of Qi Gong, Tai Chi, and Yoga Use for Health Conditions: A Systematic Review Protocol by Ryan S. Wexler, Christopher T. Joyce, Rocky Reichman, Cora Pereira, Emma Fanuele, Emily Hurstak, Lance Laird, Helen Lavretsky, Chenchen Wang, Rob Saper, Karen S. Alcorn, Brian S. Mittman, Eric J. Roseen in Global Advances in Integrative Medicine and Health

Footnotes

Acknowledgements

We would like to acknowledge Joanne Doucette, an expert systematic review librarian who helped our team develop the search strategy for this review.

ORCID iDs

Ryan S. Wexler

Emily Hurstak

Lance D. Laird

Helen Lavretsky

Robert Saper

Karen S. Alcorn

Eric J. Roseen

Ethical Considerations

Ethics approval will not be obtained for this review of published, publicly accessible data. The results from this systematic review will be disseminated through conference presentations and journal publications.

Author Contributions

Study concept and design: RSW, CJ, RR, CP, and EJR. Acquisition, analysis, or interpretation of data: RSW, CJ, RR, CP, EM, EH HL, CW, RS, BM, KSA, JD, and EJR. Critical revision of the manuscript for important intellectual content: RSW, CJ, RR, CP, EM, EH, HL, CW, RS, BM, KSA, JD, and EJR. Statistical analysis: n/a. Obtained funding: n/a. Administrative, technical, or material support: CJ, EJR. Study supervision: EJR. All authors read and approved the final manuscript.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: National Center for Complementary and Integrative Health (K23AT010487, K24AT007323, U24AT009676, UG3AT012413, UH3AT012413), National Institute of Neurological Disorders and Stroke (K12NS130673), the National Institute of Allergy and Infectious Diseases (NIAID), the National Cancer Institute (NCI), the National Institute on Aging (NIA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute of Nursing Research (NINR), the National Institute of Minority Health and Health Disparities (NIMHD), the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the NIH Office of Behavioral and Social Sciences Research (OBSSR), and the NIH Office of Disease Prevention (ODP).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.*

Registration

PROSPERO #CRD42024569493.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of NCCIH, NIAID, NINDS, NCI, NIA, NHLBI, NINR, NIMHD, NIAMS, OBSSR, or ODP, or the NIH.

Supplemental Material

Supplemental material for this article is available online.

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