Qualitative Study on Influencing Factors of High Exercise Adherence to Tai Chi Training in Older Adults with Subthreshold Depression Based on Self-Efficacy Theory

​ObjectiveTo explore the influencing factors of high exercise adherence to Tai Chi training among older adults with subthreshold depression (StD) based on self-efficacy theory, and to provide evidence for optimizing exercise rehabilitation programs.MethodsA qualitative study method was adopted. Using purposive sampling method, 32 older adults with StD who were recruited from community settings in Fuzhou between July and December 2024, had participated in Tai Chi training, and demonstrated an exercise adherence rate above 80% were selected. Semi-structured one-on-one interviews were conducted within one month after completion of the Tai Chi intervention. A total of 28 valid interviews were included in the final analysis. Data were analyzed using NVivo 14.0 software, applying thematic analysis to extract themes and construct a theoretical model.ResultsThe study identified core elements influencing Tai Chi exercise adherence among older adults with StD, which were summarized into 4 themes and 11 subthemes: skill mastery, role transition, and behavioral internalization were categorized as "internalized proof of success"; role modeling, cultural identification, and group dynamics were categorized as "social role models and group strength"; instructor guidance, family encouragement, and environmental support were categorized as "reliable external support"; physiological and psychological improvements were categorized as "physical and mental health improvements". These four themes corresponded to the sources of influence in self-efficacy theory—mastery experience, vicarious experience, verbal persuasion, and physiological/affective states. These dimensions collectively contributed to enhanced exercise adherence.ConclusionLeveraging the four sources of self-efficacy information—mastery experience, vicarious experience, verbal persuasion, and physiological/affective states can effectively enhance exercise adherence to Tai Chi training among older adults with StD. In future practice, exercise intervention strategies centered on self-efficacy can be further optimized by focusing on the following aspects: establishing a hierarchical goal-setting system, fostering a group-based exercise atmosphere, enhancing the sense of meaning in exercise participation, strengthening exercise supervision and family support, and implementing a feedback mechanism for physical and mental improvements.