The mixed methods feasibility design was based on Creswell and Plano Clark [22] (Figure 1). Phase 1 used a modified Delphi process to develop and validate a theory-based, digitally supported mindfulness curriculum tailored for community-dwelling older adults. Phase 2 consisted of a single-group pilot study with embedded qualitative interviews (QUAN→qual) to evaluate feasibility and acceptability and explore the curriculum’s preliminary effects on healthy aging outcomes.

Participants were recruited from a community care station in Chiayi City offering frailty prevention and disability-delay programs. Recruitment was initiated through announcements at Long-Term Care Service C Stations, followed by referrals from social workers and case managers. These stations are community centers that provide primary long-term care by integrating disability prevention strategies, connecting preventive care with active aging programs to reduce physical decline, promoting health and well-being, and improving quality of life [1].

The eligibility criteria were as follows: (1) aged 65 years or older, (2) able to communicate in Mandarin or Taiwanese and participate in group discussions, (3) owning and regularly using a smartphone and being familiar with the LINE application, and (4) willing and able to attend all scheduled sessions during the intervention period. The exclusion criteria included (1) a prior diagnosis of cognitive impairment (eg, dementia), (2) severe hearing, speech, or communication difficulties that would prevent participation in group activities, and (3) severe or unstable physical conditions that would make participation unsafe or impractical. Ten older adults were ultimately enrolled in the pilot study.

Each participant signed a written consent form prior to study participation. We received ethical approval for this study from the Chang Gung Medical Foundation institutional review board (number 202400087B0). Before data collection, the research team explained the study objectives, procedures, participants’ rights, and measures to protect confidentiality and research data to all eligible participants. Participation was voluntary, and participants were assured they could discontinue at any stage of the study without penalty or negative impact. Original paper documents were kept in locked cabinets at the study institution. After the removal of personally identifiable information, research data were maintained in institutional cloud-based storage systems and on password-protected computers, and access was restricted to approved members of the research team. Data will be preserved until 2027 and subsequently destroyed in accordance with institutional data management requirements. A signed copy of the informed consent form was provided to each participant. To acknowledge their time and contribution, participants received a NT$100 gift voucher, approximately US $3, for each completed study-related task.

The modified Delphi process yielded strong expert consensus on the 8-week mindfulness curriculum (Tables 1 and 2). Qualitative feedback from round 1 was synthesized and used to revise items in subsequent rounds. In rounds 2 and 3, all items received strong consensus, with median scores of 4 and IQRs ≤1.0 across sessions. By round 3, agreement remained high, with at least 88% of experts rating each session as “suitable” or “very suitable” (Table 2). These results supported the curriculum’s content validity and expert acceptability, including its digital learning materials, and justified advancing to pilot feasibility testing.

In this mixed methods feasibility study, we developed and piloted an 8-week digitally supported mindfulness curriculum integrating MBSR, MBEC, and MSA frameworks for community-dwelling older adults in Taiwan. Assessments at 4 time points revealed significant improvements in mindfulness and sleep quality, along with more positive attitudes toward aging. However, physical function showed only a slight (but significant) improvement, and no significant changes were observed in cognitive function, physical activity, or HRV indices. The quantitative data were supported by the qualitative interview results, which indicated that participants developed more effective relaxation and emotional regulation techniques and became more capable in daily activities and interpersonal relationships. Overall, the findings indicated that the program was successful, with participants providing positive feedback on both culturally adapted content and digital support components.

The program integrated MBSR with MBEC and MSA frameworks while adapting content to the cultural and educational contexts of older adults in Taiwan. Mindfulness interventions offered via structured courses and digital platforms require careful cultural adaptation [35], and research highlights the importance of incorporating cultural values, language, social interaction styles, and accessible technology to enhance participant engagement and overall effectiveness [36-38]. In this study, we used 3 strategies to address reported barriers related to low literacy and abstract mindfulness concepts: simplified language, locally relevant exercises, and embodied practices. Participants described the LINE reminders and YouTube videos as useful digital tools that facilitated between-session practice. However, some participants reported the need for family assistance to access and use the materials due to limited reading ability. These findings highlight both the potential and practical challenges of digital support for older adults and underscore the importance of age-friendly, accessible interface design.

The observed improvement in sleep quality is consistent with participants’ descriptions of using breathing techniques and gentle stretching to manage sleeplessness. By reducing presleep cognitive arousal and facilitating relaxation, these practices likely contributed to the marked decline in PSQI scores. This finding aligns with previous research showing that mindfulness training improves sleep quality by supporting emotional regulation and reducing stress-related hyperarousal symptoms, which can affect older adults [39].

Improvements in aging perceptions and healthy aging perspectives reflect the cognitive reappraisal and acceptance techniques emphasized by both the MBEC and MSA approaches. Mindfulness practices enable individuals to distance themselves from unpleasant thoughts, cultivate self-compassion, and recognize meaningful moments throughout their day. Participants reported experiencing shorter episodes of negative emotions as they learned to manage difficult situations, which align with an adaptive aging orientation. This transition may have significant health implications, as individuals who believe they are aging well tend to preserve their physical abilities and remain active in later life [2,4].

Median SPPB scores remained high throughout and showed a small but statistically significant improvement, whereas physical activity levels assessed by the PASE-C did not change significantly. This outcome is consistent with previous studies demonstrating that mindfulness training produces variable improvements in physical movement quality, balance, and mobility [14,40,41]. The curriculum focused on teaching safety and awareness during light exercise rather than increasing overall exercise duration; consequently, changes in short mindful movement sessions—such as bed-based stretching and mindful walking—are unlikely to be captured by the PASE-C, which primarily measures the frequency of leisure activities and household tasks. Although mindfulness training does not aim to increase activity duration, it can facilitate improvement in movement quality and physical awareness during these exercises.

Despite participants’ numerous positive subjective reports, no statistically significant improvement was observed in cognitive function as measured by MoCA. This finding is likely attributable to the ceiling effect. Participants showed normal cognitive abilities at baseline, as their MoCA scores were already near maximum and concentrated within a narrow range. The MoCA test fails to detect small changes in executive function and attention that mindfulness may produce in cognitively healthy older adults under specific conditions. Future research should include a more diverse group of participants who remain under observation for an extended period while using various cognitive tests to measure the effectiveness of interventions [12].

The HRV indices (SDNN and LF/HF ratio) did not show significant variations. However, HRV can fluctuate widely owing to factors such as the testing environment, breathing patterns, body position, measurement timing, and concurrent medications. Meta-analytic research indicates that mindfulness practices have small and variable effects on HRV, which are influenced by vagal nerve function [42,43]. Future studies should aim to determine when physiological changes occur by employing larger sample sizes, longer observation periods, and standardized resting-state measurement protocols.

Several study limitations should be noted. First, the small sample size (N=10) and single-site recruitment reduce the statistical power and generalizability of the findings. Second, since the majority of older adults at the Long-Term Care Service C Stations are female, all participants were women, restricting the applicability of findings to older men [44]. Third, the PASE-C instrument lacked the sensitivity to detect changes in mindful light-intensity movements, which likely contributed to the null finding in physical activity levels. Finally, although digital tools supported program engagement, several participants with limited literacy required family assistance to access online materials, emphasizing the need to create digital solutions that are both age-friendly and inclusive.

Our findings support previous studies showing that mindfulness programs benefit older adults’ sleep quality and mental health [12] by demonstrating that similar gains are achievable within a digitally supported, community-based format that also enhances aging-related perceptions and functional outcomes. This hybrid learning model—combining weekly in-person sessions with LINE reminders and instructor-recorded videos—offers a potentially cost-effective approach to sustaining home practice and maintaining engagement in real-world settings, addressing common challenges to program adherence [13].

Based on this pilot study, findings should be interpreted as preliminary evidence of feasibility and perceived usefulness rather than as a basis for immediate large-scale implementation. The program structure may nonetheless inform future evaluations at Long-Term Care Service C Stations and other community-based aging services, serving as a potential model for incorporating brief mindfulness practices—such as mindful breathing, chair-based stretching, and brief body scans—into regular group activities. A train-the-trainer approach supported by a structured manual (including session scripts, safety cues, and culturally relevant examples) may facilitate standardized delivery across sites. Importantly, suggestions regarding age-friendly digital interfaces (eg, larger text, simplified navigation, structured screens, and short audio/video materials delivered via familiar platforms) were derived from participants’ reports of accessibility barriers (eg, limited reading ability and reliance on family assistance) rather than from formal usability testing; therefore, these design implications should be validated in future work using established usability evaluation methods.

Future research should assess program effectiveness and scalability using adequately powered randomized controlled trials with longer follow-up, objective activity monitoring, more sensitive cognitive measures, standardized protocols, and hybrid effectiveness-implementation designs that assess both outcomes and adoption metrics (eg, reach, fidelity, and cost). Formal usability evaluation (eg, task-based testing and validated usability measures) and objective engagement metrics should also be incorporated to optimize the digital support components.

This study makes a dual contribution: it demonstrates expert consensus on the content validity of a culturally adapted, theory-grounded mindfulness curriculum for community-dwelling older adults in Taiwan, and it provides preliminary evidence of the program’s feasibility, acceptability, and beneficial effects across psychological, sleep-related, and aging perception domains. The hybrid delivery format was generally well-received and appeared to support home practice. Importantly, this work extends existing research by showing that mindfulness benefits are not only confined to sleep and mental health but also extend to how older adults perceive and engage with aging. Additional trials are needed to confirm these preliminary effects, refine assessment methods, and establish conditions for scalability.