{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T19:08:14Z","timestamp":1782846494518,"version":"3.54.5"},"reference-count":44,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Hum Factors"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Taiwan\u2019s status as a super-aged society underscores the need for efficient strategies to promote healthy aging. While the benefits of mindfulness-based interventions for sleep and mental health are evident, there is a shortage of cultural adaptations for Taiwan\u2019s older adults. Current courses mainly focus on mindfulness-based stress reduction, while neglecting mindfulness-based elder care, and mindful sustainable aging principles. However, the abstract nature of some mindfulness concepts, combined with limited digital support and localized resources, makes it challenging for older adults to engage effectively.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To enhance healthy aging outcomes in older community-dwelling adults in Taiwan, this study developed an 8-week theory-based mindfulness curriculum that combined the mindfulness-based stress reduction, mindfulness-based elder care, and mindful sustainable aging frameworks with digital health support.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This research employed a mixed methods feasibility study design. We used the modified Delphi method in phase 1 to reach agreement on curriculum content and digital material selection. Ten older adults participated in the pilot study, which comprised phase 2. We used quantitative measurements to assess mindfulness, sleep quality, cognition, heart rate variability, perceptions of aging, healthy aging perspectives, and physical function and activity at baseline, at weeks 4 and 8, and at a 1-month follow-up. Qualitative interviews were conducted to gather insights into participants\u2019 experiences.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Participants achieved significant improvements in mindfulness, sleep quality, aging perception, healthy aging outlook, and physical function during the study (all\n P<\/jats:italic>\n <.05). Cognition, heart rate variability, and physical activity levels showed no significant changes throughout the study. The qualitative data supported these findings, as participants selected simple practices, such as mindful breathing, which they practiced daily to enhance their emotional well-being and social connections. Participants valued the digital learning materials for aiding their practice; however, some older adults with reading difficulties faced challenges accessing the content.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Using the Delphi method resulted in an acceptable and feasible theory-based digitally supported mindfulness program that improved several indicators of healthy aging in older adults in Taiwan. Our findings need to be validated using longer trials to assess cognitive and physiological effects. Furthermore, digital accessibility requires further development.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/84161","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T20:51:10Z","timestamp":1778705470000},"page":"e84161-e84161","source":"Crossref","is-referenced-by-count":0,"title":["Using a Digital-Based Mindfulness Curriculum to Enhance Healthy Aging Outcomes in Community-Dwelling Older Adults in Taiwan: Mixed Methods Feasibility Study"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6403-8169","authenticated-orcid":false,"given":"Yu-Rung","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2045-1584","authenticated-orcid":false,"given":"Pei-Lun","family":"Hsieh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1381-8077","authenticated-orcid":false,"given":"Chia-Hsiu","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5027-7380","authenticated-orcid":false,"given":"Chia-Chi","family":"Hsiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8867-8216","authenticated-orcid":false,"given":"Mei-Lien","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"R1","unstructured":"Ministry of Health and Welfare . Long-term care plan 2.0. URL: https:\/\/english.ey.gov.tw\/News3\/9E5540D592A5FECD\/332a78c0-0c8e-4064-bd71-8c22477dae75 [Accessed 15-04-2026]"},{"key":"R2","unstructured":"World health organization . UN decade of healthy ageing: plan of action 2021\u20132030. 2020. URL: https:\/\/cdn.who.int\/media\/docs\/default-source\/decade-of-healthy-ageing\/decade-proposal-final-apr2020-en.pdf?sfvrsn=b4b75ebc_28"},{"key":"R3","unstructured":"Ministry of Health and Welfare . World Health Organization's new version - Integrated Care for Older People. 2020. URL: https:\/\/www.mohw.gov.tw\/cp-4631-54550-1.html [Accessed 15-04-2026]"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101821","article-title":"Concepts and definitions of healthy ageing: a systematic review and synthesis of theoretical models","volume":"56","author":"Menassa","journal-title":"EClinicalMedicine"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-023-01481-9","article-title":"Relationship between physical activity and perceptions of ageing from the perspective of healthy ageing among older people with frailty with chronic disease: a cross-sectional study","volume":"22","author":"Wang","journal-title":"BMC Nurs"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1093\/clipsy.bpg016","article-title":"Mindfulness-based interventions in context: past, present, and future","volume":"10","author":"Kabat-Zinn","journal-title":"Clin Psychol Sci Pract"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1177\/1073191105283504","article-title":"Using self-report assessment methods to explore facets of mindfulness","volume":"13","author":"Baer","journal-title":"Assessment"},{"key":"R8","doi-asserted-by":"crossref","unstructured":"Didonna F . Clinical Handbook of Mindfulness. Springer; 2009. ISBN: 978-0-387-09593-6","DOI":"10.1007\/978-0-387-09593-6"},{"key":"R9","unstructured":"Kabat-Zinn J . Full Catastrophe Living: How to Cope with Stress, Pain and Illness Using Mindfulness Meditation. Piatkus; 2013. URL: https:\/\/archive.org\/details\/fullcatastrophel0000kaba_w6g8 [Accessed 15-04-2026]"},{"key":"R10","unstructured":"Santorelli SF Kabat-Zinn J Blacker M Meleo-Meyer F Koerbel L . Mindfulness-based stress reduction (MBSR) authorized curriculum guide. Center for Mindfulness in Medicine, Health Care, and Society (CFM), University of Massachusetts Medical School; 2017. URL: https:\/\/www.rightdecisions.scot.nhs.uk\/media\/2105\/mbsr-curriculum-guide-2017.pdf [Accessed 15-04-2026]"},{"issue":"6","key":"R11","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1007\/s00420-021-01685-z","article-title":"Mindfulness improves health worker\u2019s occupational burnout: the moderating effects of anxiety and depression","volume":"94","author":"Sun","journal-title":"Int Arch Occup Environ Health"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1080\/13607863.2023.2228255","article-title":"The effect of mindfulness-based intervention on cognitively unimpaired older adults\u2019 cognitive function and sleep quality: a systematic review and meta-analysis","volume":"28","author":"Lannon-Boran","journal-title":"Aging Ment Health"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1080\/13607863.2023.2242301","article-title":"Online mindfulness training for older adults during the COVID-19 pandemic: a randomized controlled trial using a multi-method assessment approach","volume":"28","author":"Denkova","journal-title":"Aging Ment Health"},{"issue":"18","key":"R14","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17186556","article-title":"Effects of mind-body interventions involving meditative movements on quality of life, depressive symptoms, fear of falling and sleep quality in older adults: a systematic review with meta-analysis","volume":"17","author":"Weber","journal-title":"Int J Environ Res Public Health"},{"key":"R15","doi-asserted-by":"crossref","unstructured":"Bee LM . Mindfulness-based elder care: communicating mindfulness to frail elders and their caregivers. In: Didonna F , editor. Clinical Handbook of Mindfulness. Springer; 2009:431-445. [doi: 10.1007\/978-0-387-09593-6_24]","DOI":"10.1007\/978-0-387-09593-6_24"},{"key":"R16","doi-asserted-by":"crossref","unstructured":"McBee L . I am sure to grow old: mindfulness-based elder care. In: Baer RA , editor. Mindfulness-Based Treatment Approaches. 2nd ed. Academic Press; 2014:239-265. [doi: 10.1016\/B978-0-12-416031-6.00011-6]","DOI":"10.1016\/B978-0-12-416031-6.00011-6"},{"key":"R17","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2023.01.021","article-title":"The efficacy of a mindfulness-based exercise program in older residents of a long-term care facility in Taiwan","volume":"50","author":"Tsai","journal-title":"Geriatr Nurs"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1080\/15528030.2022.2083743","article-title":"The four-dimensional model of mindful sustainable aging: a holistic alternative","volume":"35","author":"Nilsson","journal-title":"J Relig Spiritual Aging"},{"issue":"3","key":"R19","doi-asserted-by":"publisher","first-page":"494","DOI":"10.5964\/ejop.v11i3.949","article-title":"Mindful sustainable aging: advancing a comprehensive approach to the challenges and opportunities of old age","volume":"11","author":"Nilsson","journal-title":"Eur J Psychol"},{"issue":"1","key":"R20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12671-024-02507-2","article-title":"Defining mindfulness: a review of existing definitions and suggested refinements","volume":"16","author":"Chems-Maarif","journal-title":"Mindfulness"},{"key":"R21","unstructured":"Social and Family Affairs Administration . Strategies to address the challenges of a super-aging society. 2022. URL: https:\/\/www.sfaa.gov.tw\/sfaa\/page\/5fQ [Accessed 15-04-2026]"},{"issue":"8","key":"R22","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1177\/0269216317690685","article-title":"Guidance on conducting and reporting Delphi studies (CREDES) in palliative care: recommendations based on a methodological systematic review","volume":"31","author":"J\u00fcnger","journal-title":"Palliat Med"},{"issue":"3","key":"R23","doi-asserted-by":"publisher","first-page":"231","DOI":"10.7108\/PT.201509_62(3).0003","article-title":"Validation of the Taiwanese version of the Five Facet Mindfulness Questionnaire (T-FFMQ) [Article in Chinese]","volume":"62","author":"Huang","journal-title":"Psychol Test"},{"issue":"4","key":"R24","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1111\/j.1532-5415.2005.53221.x","article-title":"The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment","volume":"53","author":"Nasreddine","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"R25","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1017\/S1041610211002298","article-title":"Psychometrics of the Montreal Cognitive Assessment (MoCA) and its subscales: validation of the Taiwanese version of the MoCA and an item response theory analysis","volume":"24","author":"Tsai","journal-title":"Int Psychogeriatr"},{"issue":"2","key":"R26","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research","volume":"28","author":"Buysse","journal-title":"Psychiatry Res"},{"issue":"8","key":"R27","doi-asserted-by":"publisher","first-page":"1943","DOI":"10.1007\/s11136-005-4346-x","article-title":"Psychometric evaluation of the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) in primary insomnia and control subjects","volume":"14","author":"Tsai","journal-title":"Qual Life Res"},{"issue":"9","key":"R28","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-7-9","article-title":"Cross-sectional validation of the Aging Perceptions Questionnaire: a multidimensional instrument for assessing self-perceptions of aging","volume":"7","author":"Barker","journal-title":"BMC Geriatr"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-14-44","article-title":"Development of the Brief Ageing Perceptions Questionnaire (B-APQ): a confirmatory factor analysis approach to item reduction","volume":"14","author":"Sexton","journal-title":"BMC Geriatr"},{"issue":"6","key":"R30","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1080\/13607863.2020.1734914","article-title":"Validating a Brief Aging Perception Questionnaire (B-APQ) for older persons with chronic disease in Taiwan","volume":"25","author":"Wang","journal-title":"Aging Ment Health"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/8238748","article-title":"Development of the Healthy Aging Perspectives Questionnaire among Older adults with chronic disease in Taiwan","author":"Wang","journal-title":"Health Soc Care Community"},{"issue":"3","key":"R32","doi-asserted-by":"publisher","first-page":"309","DOI":"10.5297\/ser.1503.006","article-title":"Reliability and validity of the Chinese version of the Physical Activity Scale for the Elderly [Article in Chinese]","volume":"15","author":"Ku","journal-title":"SER Rev Med Soc"},{"issue":"2","key":"R33","doi-asserted-by":"publisher","first-page":"M85","DOI":"10.1093\/geronj\/49.2.m85","article-title":"A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission","volume":"49","author":"Guralnik","journal-title":"J Gerontol"},{"issue":"2","key":"R34","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","journal-title":"Qual Res Psychol"},{"key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/55130","article-title":"Cultural and contextual adaptation of digital health interventions: narrative review","volume":"26","author":"Naderbagi","journal-title":"J Med Internet Res"},{"key":"R36","doi-asserted-by":"publisher","DOI":"10.1177\/27536130241247074","article-title":"A qualitative examination of perceptions of mindfulness among Arab, Middle Eastern, and North African Americans: implications for cultural adaptation of mindfulness-based interventions","volume":"13","author":"Haidar","journal-title":"Glob Adv Integr Med Health"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.2196\/67533","article-title":"Design preferences, routines, and well-being of older adults using voice-guided digital mindfulness: qualitative interview study","volume":"12","author":"McCarren","journal-title":"JMIR Hum Factors"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1177\/20552076251349909","article-title":"Co-producing mindful tactile technologies for healthy ageing: cross-cultural insights from India and the UK","volume":"11","author":"Vasudevan","journal-title":"Digit Health"},{"issue":"4","key":"R39","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1001\/jamainternmed.2014.8081","article-title":"Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances: a randomized clinical trial","volume":"175","author":"Black","journal-title":"JAMA Intern Med"},{"issue":"22","key":"R40","doi-asserted-by":"publisher","first-page":"2218","DOI":"10.1001\/jama.2022.21680","article-title":"Effects of mindfulness training and exercise on cognitive function in older adults: a randomized clinical trial","volume":"328","author":"Lenze","journal-title":"JAMA"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2020.00358","article-title":"Long-term physical exercise and mindfulness practice in an aging population","volume":"11","author":"Tang","journal-title":"Front Psychol"},{"issue":"6","key":"R42","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1097\/PSY.0000000000000900","article-title":"The effects of mindfulness and meditation on vagally mediated heart rate variability: a meta-analysis","volume":"83","author":"Brown","journal-title":"Psychosom Med"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2025.1515334","article-title":"Effects of a mindfulness intervention on emotion differentiation and heart rate variability","volume":"19","author":"Guendelman","journal-title":"Front Hum Neurosci"},{"key":"R44","unstructured":"Social and Family Affairs Administration . 2021 project on analyzing demand, resource integration, and service utilization in elderly welfare. URL: https:\/\/www.sfaa.gov.tw\/sfaa\/list\/detail\/5eZ\/5PA"}],"container-title":["JMIR Human Factors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e84161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T18:18:18Z","timestamp":1782843498000},"score":1,"resource":{"primary":{"URL":"https:\/\/humanfactors.jmir.org\/2026\/1\/e84161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":44,"URL":"https:\/\/doi.org\/10.2196\/84161","relation":{},"ISSN":["2292-9495"],"issn-type":[{"value":"2292-9495","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"article-number":"v13i1e84161"}}