A systematic review of barriers and facilitators to acupuncture therapy: based on the consolidated framework for implementation research_Chinese Journal of Evidence-Based Medicine

Authors：

 DUAN Yuting ^1,2 , ZHOU Jinjin ¹ , XU Zhirui ² , SHI Lin ² , YANG Haichun ² , YU Lin ^1,2

1. Evidence-based Medicine Center (Clinical Research Center) of the Affiliated Guangzhou Hospital of TCM of Guangzhou University of Chinese Medicine, Guangzhou 510000, P. R. China;
2. Evidence-based Medicine Center (Clinical Research Center) of the Affiliated Traditional Chinese Medicine Hospital, Guangzhou Medical University, Guangzhou 510000, P. R. China;

Corresponding?author：

DUAN Yuting, Email: 18702009530@163.com

Keywords：

Acupuncture; Barriers; Facilitators; Consolidated framework for implementation research; Systematic review

DOI：

10.7507/1672-2531.202511056

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To identify the barriers and facilitators to acupuncture implementation using the consolidated framework for implementation research (CFIR), provide a reference for proposing a "CFIR framework adapted for acupuncture", and adjust the CFIR-ERIC matching tool to develop specific implementation strategies for acupuncture. Methods The CNKI, WanFang Data, VIP, PubMed, Web of Science, and Embase databases were electronically searched to collect studies on influencing factors in acupuncture implementation. The barriers and facilitators in the included studies were analyzed using the CFIR as a guide. Results 38 studies were included. Based on the five domains (innovation, outer setting, inner setting, individuals, and implementation process) of the CFIR 2.0 framework, 49 facilitators and 54 barriers were summarized. Conclusion Acupuncture implementation is influenced by multiple layers of factors. According to the CFIR framework, many obstructive factors are concentrated in internal factors and individual characteristics, and the obstructive and promoting factors in different countries and medical systems are not exactly the same. However, the existing CFIR framework can well identify the barriers and promotion factors of acupuncture therapy, it is suggested that the CFIR framework should consider the characteristics of acupuncture. This study proposes a revised idea of the "acupuncture version of the CFIR framework", and future research should further improve the framework and adjust the CFIR-ERIC integrated model on this basis to identify and develop specific practical strategies in the acupuncture field.

Citation： DUAN Yuting, ZHOU Jinjin, XU Zhirui, SHI Lin, YANG Haichun, YU Lin. A systematic review of barriers and facilitators to acupuncture therapy: based on the consolidated framework for implementation research. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 439-444. doi: 10.7507/1672-2531.202511056 Copy

1.	陳少宗, 張擎宇, 李愛華, 等. 針灸的國際傳播與針灸的實用價值、科學價值. 醫學與哲學, 2024, 45(9): 74-78.
2.	Wong CHL, Tse JVH, Nilsen P, et al. Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong. BMC Complement Med Ther, 2021, 21(1): 200.
3.	Li H, Darby JE, Akpotu I, et al. Barriers and facilitators to integrating acupuncture into the U. S. health care system: a scoping review. J Integr Complement Med, 2024, 30(12): 1134-1146.
4.	孫立信, 宮恩瑩, 劉逸舒, 等. 實施科學理論、模型與框架概述. 協和醫學雜志, 2025, 16(5): 1332-1343.
5.	Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 2009, 4: 50.
6.	Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated consolidated framework for implementation research based on user feedback. Implement Sci, 2022, 17(1): 75.
7.	張蘭萍, 呂森森, 何文俊, 等. 實施性研究綜合框架(CFIR)更新版的解析和應用. 護理學報, 2023, 30(11): 47-52.
8.	劉瑩, 馬卓, 安卓玲. 新版實施性研究綜合框架(CFIR 2022)的構成要素解讀. 中國循證醫學雜志, 2023, 23(6): 738-744.
9.	于艷蘋, 趙海磊, 于亮, 等. 上海市部分地區針灸醫護人員艾煙暴露現狀及影響因素分析. 上海針灸雜志, 2023, 42(5): 543-549.
10.	楊博, 宋薇薇. 南昌市三級綜合醫院針灸醫師心理彈性、知覺壓力和社會支持的調查. 職業與健康, 2023, 39(15): 2084-2087.
11.	Li H, Doorenbos AZ, Choi H, et al. Administrator, provider, and staff perspectives on implementing acupuncture in medically underserved breast cancer survivors. Cancer Nurs, 2025.
12.	Zheng Z, Stelmach WS, Ma J, et al. Health professionals' attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation. Acupunct Med, 2023, 41(1): 16-26.
13.	Cao X, Liao Y, Wu X, et al. Willingness to use acupuncture: knowledge, attitudes, beliefs, and practices among allergic rhinitis patients. Medicine (Baltimore), 2023, 102(39): e35297.
14.	Harbell MW, Barendrick LN, Mi L, et al. Patient attitudes toward acupuncture in the perioperative setting. J Integr Complement Med, 2022, 28(4): 349-354.
15.	Zhang NM, Daly D, Terblanche M, et al. Doctors' and nurses' attitudes of acupuncture and acupressure use in perioperative care: an Australian national survey. Pain Manag Nurs, 2022, 23(6): 800-810.
16.	El-Jarrah RT, Naji FB, Hamadeh G, et al. Perspectives of patients on medical acupuncture in a primary care setting in Lebanon: a cross-sectional study. Acupunct Med, 2022, 40(1): 50-58.
17.	Ee C, Singleton AC, de Manincor M, et al. A qualitative study exploring feasibility and acceptability of acupuncture, yoga, and mindfulness meditation for managing weight after breast cancer. Integr Cancer Ther, 2022, 21: 15347354221099540.
18.	王麗雯, 吳碧玉, 陳連珠. 中醫醫療技術的感染預防及原因分析. 中國衛生標準管理, 2021, 12(18): 120-123.
19.	曾雪琴, 于偉, 黃宵. 社區居民對中醫藥適宜技術的利用狀況及其影響因素研究. 中國當代醫藥, 2021, 28(34): 184-187.
20.	朱夢迪, 王軍永, 陶士素, 等. 江西省中醫藥服務信任度及其影響因素研究. 中國衛生事業管理, 2020, 37(4): 287-290, 293.
21.	Williams H, Sweet L, Graham K. Acupuncture during pregnancy and the perinatal period: women's attitudes, beliefs and practices. Women Birth, 2020, 33(3): e286-e294.
22.	Kim YJ. Based on survey monitoring for acupuncture management option in stroke rehabilitation. Int J Stroke, 2020, 15(1 Suppl): 250.
23.	Zanardelli I, Robinson N. Factors that influence patients’ decisions to discontinue with an acupuncture service?A qualitative study. Eur J Integr Med, 2019, 25: 92-99.
24.	Li XL, Cao HJ, Zhang YJ, et al. Attitude and willingness of attendance for participating in or completing acupuncture trials: a cross-sectional study. Patient Prefer Adherence, 2018, 13: 53-61.
25.	Ormsby SM, Dahlen HG, Ee CC, et al. 'Acupuncture for antenatal depression: it's worth giving it a go' - A qualitative study. Women Birth, 2018, 31(3): 166-176.
26.	Eriksen WT, Singerman L, Romero SAD, et al. Understanding the use of acupuncture for insomnia among cancer survivors: a qualitative study. J Altern Complement Med, 2018, 24(9-10): 962-967.
27.	蔣妮, 孔巧美, 覃依, 等. 醫務人員職業傷害影響因素分析. 中國公共衛生管理, 2016, 32(2): 143-145, 173.
28.	薛芙珍, 李穎, 高文芳, 等. 某三級甲等醫院醫護人員針刺傷回顧性調查分析. 衛生職業教育, 2016, (3): 133-134, 135.
29.	Asprey A, Paterson C, White A. 'All in the same boat': a qualitative study of patients' attitudes and experiences in group acupuncture clinics. Acupunct Med, 2012, 30(3): 163-169.
30.	Bao T, Li Q, DeRito JL, et al. Barriers to acupuncture use among breast cancer survivors: a cross-sectional analysis. Integr Cancer Ther, 2018, 17(3): 854-859.
31.	Bishop FL, Lewith GT. Patients' preconceptions of acupuncture: a qualitative study exploring the decisions patients make when seeking acupuncture. BMC Complement Altern Med, 2013, 13: 102.
32.	Chan K, Tsang L, Fung TKF. Attitudes toward acupuncture in Hong Kong. Int J Pharm Healthc Mark, 2015, 9(2): 158-174.
33.	MacPherson H, Thorpe L, Thomas K. Beyond needling-therapeutic processes in acupuncture care: a qualitative study nested within a low-back pain trial. J Altern Complement Med, 2006, 12(9): 873-880.
34.	Corbett L, Prestwich S. A questionnaire survey to determine patient's knowledge, opinions and experience of acupuncture in an NHS GP practice. Acupunct Med, 2011, 29(4): 315-316.
35.	Halpin SN, Perkins MM, Huang W. Determining attitudes toward acupuncture: a focus on older U. S. veterans. J Altern Complement Med, 2014, 20(2): 118-122.
36.	Mao JJ, Tan T, Li SQ, et al. Attitudes and barriers towards participation in an acupuncture trial among breast cancer patients: a survey study. BMC Complement Altern Med, 2014, 14: 7.
37.	Norheim AJ, F?nneb? V. A survey of acupuncture patients: results from a questionnaire among a random sample in the general population in Norway. Complement Ther Med, 2000, 8(3): 187-192.
38.	Schapira MM, Mackenzie ER, Lam R, et al. Breast cancer survivors willingness to participate in an acupuncture clinical trial: a qualitative study. Support Care Cancer, 2014, 22(5): 1207-1215.
39.	Wang F, Zheng M, Zhu J, et al. Patients' attitudes to the perioperative application of acupuncture: a Chinese survey. Eur J Integr Med, 2017, 9: 131-140.
40.	Yeh GY, Ryan MA, Phillips RS, et al. Doctor training and practice of acupuncture: results of a survey. J Eval Clin Pract, 2008, 14(3): 439-445.
41.	Tippens KM, Chao MT, Connelly E, et al. Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis. BMC Complement Altern Med, 2013, 13: 293.
42.	Liou KT, Trevino KM, Meghani SH, et al. Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA. Support Care Cancer, 2021, 29(1): 427-435.
43.	Widgren Y, Fransson P, Efverman A. Acupuncture in patients undergoing cancer therapy: their interest and belief in acupuncture is high, but few are using it. Integr Cancer Ther, 2022, 21: 15347354221077277.
44.	Mao JJ, Leed R, Bowman MA, et al. Acupuncture for hot flashes: decision making by breast cancer survivors. J Am Board Fam Med, 2012, 25(3): 323-332.
45.	Garland SN, Trevino K, Liou KT, et al. Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice. J Cancer Surviv, 2021, 15(6): 951-960.
46.	Harrison JD, Reddy S, Liu R, et al. Implementing an inpatient acupuncture service for pain and symptom management: identifying opportunities and challenges. J Altern Complement Med, 2019, 25(5): 503-508.
47.	Dong S, Zhao L, Liu J, et al. Neuroanatomical organization of electroacupuncture in modulating gastric function in mice and humans. Neuron, 2025, 113(19): 3243-3259.
48.	智慧科協. 如何合理開展針灸的循證評價? 2022.

1. 陳少宗, 張擎宇, 李愛華, 等. 針灸的國際傳播與針灸的實用價值、科學價值. 醫學與哲學, 2024, 45(9): 74-78.
2. Wong CHL, Tse JVH, Nilsen P, et al. Barriers and facilitators to promoting evidence uptake in Chinese medicine: a qualitative study in Hong Kong. BMC Complement Med Ther, 2021, 21(1): 200.
3. Li H, Darby JE, Akpotu I, et al. Barriers and facilitators to integrating acupuncture into the U. S. health care system: a scoping review. J Integr Complement Med, 2024, 30(12): 1134-1146.
4. 孫立信, 宮恩瑩, 劉逸舒, 等. 實施科學理論、模型與框架概述. 協和醫學雜志, 2025, 16(5): 1332-1343.
5. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci, 2009, 4: 50.
6. Damschroder LJ, Reardon CM, Widerquist MAO, et al. The updated consolidated framework for implementation research based on user feedback. Implement Sci, 2022, 17(1): 75.
7. 張蘭萍, 呂森森, 何文俊, 等. 實施性研究綜合框架(CFIR)更新版的解析和應用. 護理學報, 2023, 30(11): 47-52.
8. 劉瑩, 馬卓, 安卓玲. 新版實施性研究綜合框架(CFIR 2022)的構成要素解讀. 中國循證醫學雜志, 2023, 23(6): 738-744.
9. 于艷蘋, 趙海磊, 于亮, 等. 上海市部分地區針灸醫護人員艾煙暴露現狀及影響因素分析. 上海針灸雜志, 2023, 42(5): 543-549.
10. 楊博, 宋薇薇. 南昌市三級綜合醫院針灸醫師心理彈性、知覺壓力和社會支持的調查. 職業與健康, 2023, 39(15): 2084-2087.
11. Li H, Doorenbos AZ, Choi H, et al. Administrator, provider, and staff perspectives on implementing acupuncture in medically underserved breast cancer survivors. Cancer Nurs, 2025.
12. Zheng Z, Stelmach WS, Ma J, et al. Health professionals' attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation. Acupunct Med, 2023, 41(1): 16-26.
13. Cao X, Liao Y, Wu X, et al. Willingness to use acupuncture: knowledge, attitudes, beliefs, and practices among allergic rhinitis patients. Medicine (Baltimore), 2023, 102(39): e35297.
14. Harbell MW, Barendrick LN, Mi L, et al. Patient attitudes toward acupuncture in the perioperative setting. J Integr Complement Med, 2022, 28(4): 349-354.
15. Zhang NM, Daly D, Terblanche M, et al. Doctors' and nurses' attitudes of acupuncture and acupressure use in perioperative care: an Australian national survey. Pain Manag Nurs, 2022, 23(6): 800-810.
16. El-Jarrah RT, Naji FB, Hamadeh G, et al. Perspectives of patients on medical acupuncture in a primary care setting in Lebanon: a cross-sectional study. Acupunct Med, 2022, 40(1): 50-58.
17. Ee C, Singleton AC, de Manincor M, et al. A qualitative study exploring feasibility and acceptability of acupuncture, yoga, and mindfulness meditation for managing weight after breast cancer. Integr Cancer Ther, 2022, 21: 15347354221099540.
18. 王麗雯, 吳碧玉, 陳連珠. 中醫醫療技術的感染預防及原因分析. 中國衛生標準管理, 2021, 12(18): 120-123.
19. 曾雪琴, 于偉, 黃宵. 社區居民對中醫藥適宜技術的利用狀況及其影響因素研究. 中國當代醫藥, 2021, 28(34): 184-187.
20. 朱夢迪, 王軍永, 陶士素, 等. 江西省中醫藥服務信任度及其影響因素研究. 中國衛生事業管理, 2020, 37(4): 287-290, 293.
21. Williams H, Sweet L, Graham K. Acupuncture during pregnancy and the perinatal period: women's attitudes, beliefs and practices. Women Birth, 2020, 33(3): e286-e294.
22. Kim YJ. Based on survey monitoring for acupuncture management option in stroke rehabilitation. Int J Stroke, 2020, 15(1 Suppl): 250.
23. Zanardelli I, Robinson N. Factors that influence patients’ decisions to discontinue with an acupuncture service?A qualitative study. Eur J Integr Med, 2019, 25: 92-99.
24. Li XL, Cao HJ, Zhang YJ, et al. Attitude and willingness of attendance for participating in or completing acupuncture trials: a cross-sectional study. Patient Prefer Adherence, 2018, 13: 53-61.
25. Ormsby SM, Dahlen HG, Ee CC, et al. 'Acupuncture for antenatal depression: it's worth giving it a go' - A qualitative study. Women Birth, 2018, 31(3): 166-176.
26. Eriksen WT, Singerman L, Romero SAD, et al. Understanding the use of acupuncture for insomnia among cancer survivors: a qualitative study. J Altern Complement Med, 2018, 24(9-10): 962-967.
27. 蔣妮, 孔巧美, 覃依, 等. 醫務人員職業傷害影響因素分析. 中國公共衛生管理, 2016, 32(2): 143-145, 173.
28. 薛芙珍, 李穎, 高文芳, 等. 某三級甲等醫院醫護人員針刺傷回顧性調查分析. 衛生職業教育, 2016, (3): 133-134, 135.
29. Asprey A, Paterson C, White A. 'All in the same boat': a qualitative study of patients' attitudes and experiences in group acupuncture clinics. Acupunct Med, 2012, 30(3): 163-169.
30. Bao T, Li Q, DeRito JL, et al. Barriers to acupuncture use among breast cancer survivors: a cross-sectional analysis. Integr Cancer Ther, 2018, 17(3): 854-859.
31. Bishop FL, Lewith GT. Patients' preconceptions of acupuncture: a qualitative study exploring the decisions patients make when seeking acupuncture. BMC Complement Altern Med, 2013, 13: 102.
32. Chan K, Tsang L, Fung TKF. Attitudes toward acupuncture in Hong Kong. Int J Pharm Healthc Mark, 2015, 9(2): 158-174.
33. MacPherson H, Thorpe L, Thomas K. Beyond needling-therapeutic processes in acupuncture care: a qualitative study nested within a low-back pain trial. J Altern Complement Med, 2006, 12(9): 873-880.
34. Corbett L, Prestwich S. A questionnaire survey to determine patient's knowledge, opinions and experience of acupuncture in an NHS GP practice. Acupunct Med, 2011, 29(4): 315-316.
35. Halpin SN, Perkins MM, Huang W. Determining attitudes toward acupuncture: a focus on older U. S. veterans. J Altern Complement Med, 2014, 20(2): 118-122.
36. Mao JJ, Tan T, Li SQ, et al. Attitudes and barriers towards participation in an acupuncture trial among breast cancer patients: a survey study. BMC Complement Altern Med, 2014, 14: 7.
37. Norheim AJ, F?nneb? V. A survey of acupuncture patients: results from a questionnaire among a random sample in the general population in Norway. Complement Ther Med, 2000, 8(3): 187-192.
38. Schapira MM, Mackenzie ER, Lam R, et al. Breast cancer survivors willingness to participate in an acupuncture clinical trial: a qualitative study. Support Care Cancer, 2014, 22(5): 1207-1215.
39. Wang F, Zheng M, Zhu J, et al. Patients' attitudes to the perioperative application of acupuncture: a Chinese survey. Eur J Integr Med, 2017, 9: 131-140.
40. Yeh GY, Ryan MA, Phillips RS, et al. Doctor training and practice of acupuncture: results of a survey. J Eval Clin Pract, 2008, 14(3): 439-445.
41. Tippens KM, Chao MT, Connelly E, et al. Patient perspectives on care received at community acupuncture clinics: a qualitative thematic analysis. BMC Complement Altern Med, 2013, 13: 293.
42. Liou KT, Trevino KM, Meghani SH, et al. Fear of analgesic side effects predicts preference for acupuncture: a cross-sectional study of cancer patients with pain in the USA. Support Care Cancer, 2021, 29(1): 427-435.
43. Widgren Y, Fransson P, Efverman A. Acupuncture in patients undergoing cancer therapy: their interest and belief in acupuncture is high, but few are using it. Integr Cancer Ther, 2022, 21: 15347354221077277.
44. Mao JJ, Leed R, Bowman MA, et al. Acupuncture for hot flashes: decision making by breast cancer survivors. J Am Board Fam Med, 2012, 25(3): 323-332.
45. Garland SN, Trevino K, Liou KT, et al. Multi-stakeholder perspectives on managing insomnia in cancer survivors: recommendations to reduce barriers and translate patient-centered research into practice. J Cancer Surviv, 2021, 15(6): 951-960.
46. Harrison JD, Reddy S, Liu R, et al. Implementing an inpatient acupuncture service for pain and symptom management: identifying opportunities and challenges. J Altern Complement Med, 2019, 25(5): 503-508.
47. Dong S, Zhao L, Liu J, et al. Neuroanatomical organization of electroacupuncture in modulating gastric function in mice and humans. Neuron, 2025, 113(19): 3243-3259.
48. 智慧科協. 如何合理開展針灸的循證評價? 2022.

Chinese Journal of Evidence-Based Medicine

A systematic review of barriers and facilitators to acupuncture therapy: based on the consolidated framework for implementation research

Abstract Full text Figures/Tables Video References Cited by

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