Subjective Perceived Effect of Mindfulness-Based Tai Chi Chuan versus Sleep Hygiene Education on Sleep Quality Improvement in Community-Dwelling Elderly People in Hong Kong: a qualitative study

Trial design: Insomnia is common among older adults and poses physical and psychological challenges. While pharmacological and cognitive behavioural therapies exist, their limitations underscore the need for accessible and non-pharmacological alternatives. Integrating mindfulness-based interventions (MBIs) with Tai Chi Chuan (TCC) into a combined innovative approach—Mindfulness-Based Tai Chi Chuan (MBTCC)—may yield enhanced benefits for improving sleep quality. This randomized clinical trial (RCT) compared the effects of MBTCC and Sleep Hygiene Education (SHE) on sleep disturbance in a Hong Kong community setting was reported elsewhere. Although greater benefits were hypothesized for MBTCC, quantitative results showed similar improvements in sleep quality across both groups. To further explore participants’ subjective experiences and perceptions of effectiveness, semi-structured focus group interviews for a qualitative study were conducted at the 6-month follow-up. Methods: This qualitative study was embedded within a RCT comparing the effects of MBTCC and SHE on sleep quality disturbance. Fifty participants (25 per group) were randomly selected from a pool of 137 older adults who completed a 6-month follow-up. Focus group interviews were conducted to explore perceived changes in sleep quality and mood. Data were analyzed using NVivo software. Results: Most participants in both groups reported improvements in sleep quality, including longer sleep duration, easier sleep onset, and fewer awakenings. In the MBTCC group, benefits were attributed primarily to mindfulness-based relaxation techniques, with fewer participants continuing Tai Chi Chuan practice due to barriers such as memory difficulty and lack of motivation. SHE participants reported behavioral changes related to sleep environment, relaxation methods, and lifestyle adjustment. Both groups reported enhanced emotional well-being, including increased happiness and calmness, although some participants in each group reported no significant mood changes. Conclusion: Both MBTCC and SHE were perceived as effective in improving sleep and emotional well-being among older adults. Tailored support may enhance engagement with MBTCC practices. These findings support the integration of accessible, non-pharmacological sleep interventions into community health programs for older populations. Trial registration: ClinicalTrials.gov . NCT05396092. 31 May 2022