Barriers and facilitators for the implementation of Tuina (Jingjin) for neck pain in primary care settings in China: a qualitative study protocol

Introduction: Neck pain is the fourth leading cause of disability worldwide. In China, primary care institutions face considerable challenges in the management of neck pain, primarily due to insufficient allocation of medical resources, resulting in an overreliance on pharmacological interventions in clinical practice. As an evidence-based and standardized non-pharmacological therapy, Tuina (Jingjin) offers distinct advantages in primary care settings, including high safety profiles and strong patient acceptance. However, its application and dissemination in frontline primary healthcare practice remain insufficient. The primary aim of this study will be to identify the barriers and facilitators for implementing Tuina (Jingjin) in primary care settings in China from the perspectives of multiple stakeholders. Methods: This qualitative study will utilize the five core domains of the Consolidated Framework for Implementation Research (CFIR 2.0)-Intervention Characteristics, Outer Setting, Inner Setting, Individual Characteristics, and Process-to inform the development of a semi-structured interview guide and data analysis. Recruitment will target patients with neck pain, traditional Chinese medicine general practitioners, and institutional managers from geographically diverse primary care institutions across China, with the sample size contingent upon achieving information saturation. Discussion: This study will contribute to the understanding of the multi-level factors that influence the implementation of Jingjin Tuina and provide strategies to enhance the adoption of this evidence-based intervention in primary care settings with limited resources.