Theoretical perspectives on meaning in life emphasize its central role in psychological well-being, with empirical evidence showing that individuals who perceive their lives as meaningful tend to report higher levels of hope and life satisfaction (Eagleton, 2007; Dissanayake et al., 2017; Schippers and Ziegler, 2019). Within this framework, hope is conceptualized as a motivational resource that supports adaptive functioning and is positively associated with meaning in life (Hedayati and Khazaei, 2014; Snyder et al., 2002; Yalçın and Malkoç, 2015). Moreover, mindfulness has consistently been associated with an enhanced sense of meaning in life by fostering present-moment awareness, reducing maladaptive cognitive patterns, and increasing self-compassion. These psychological processes, in turn, contribute to higher levels of life satisfaction and hope by reinforcing adaptive cognitive and emotional functioning (Bloch et al., 2017; Evans et al., 2018; Viskovich and De George-Walker, 2019; Aldbyani et al., 2025; Hanner, 2024).

This study targets medical students, a population particularly vulnerable to persistent academic stress, high performance demands, and limited access to structured psychological support. Investigating the effects of a brief mindfulness intervention in this context can provide practical evidence for scalable mental health strategies in higher education. Based on this framework, it is hypothesized that students who participate in the mindfulness intervention will show significant improvements in mindfulness, hope, life satisfaction, and meaning in life compared with the control group.

A total of 130 medical students from Shandong Xiehe University, China, participated in the study on a voluntarily basis and were assigned to either the experimental group (n = 65) or the control group (n = 65). The intervention was conducted from September 2024 to December 2024. All participants provided informed consent, and the confidentiality of their data was maintained. Participants were aged between 18 and 22 years. None of the participants reported prior exposure to mindfulness training or engagement in related practices, including Tai Chi, Qigong, or yoga. Eligibility criteria required voluntary participation and no previous experience with meditation or similar practices. Additional demographic and lifestyle characteristics, including family income, family structure, living arrangements, health-related behaviors, and physical activity, was not collected in this study. This limitation is acknowledged and will be considered in future research. During the intervention period, some students were absent, resulting in a final sample of 58 participants in the experimental group and 60 in the control group, reflecting attrition of 7 and 5 students, respectively, from the initial allocation.

A Consolidated Standards of Reporting Trials (CONSORT)-style flow diagram was created to illustrate participant allocation, follow-up, and analysis. Of the 130 students initially assigned to the two groups, 12 participants did not complete the post-test assessment (7 from the experimental group and 5 from the control group). The final analytic sample consisted of 58 participants in the experimental group and 60 in the control group. Fig. 1 presents the participant flow diagram, adapted for the quasi-experimental design.

Fig. 1.

Participant flow diagram. n, number of samples.

Baseline demographic and outcome variables were examined to assess group comparability prior to the intervention. Standardized mean differences (SMD) were calculated for age, gender distribution, and pre-test scores for all outcome measures, including mindfulness, hope, life satisfaction, and meaning in life. SMDs were small across baseline variables ($|$SMD$|$ $\le$0.05). See Table 1.

The study began with administering the questionnaires to two classes after obtaining informed consent and ensuring the confidentiality of responses. One class was assigned to the experimental group (n = 65), and the other served as the control group (n = 65). Participants in the experimental group engaged in an eight-week mindfulness intervention that consisted of weekly sessions combining conceptual instruction, group discussions, and 30-minute breathing-based meditation practice, complemented by assigned home exercises. The control group did not experience any form of training or intervention during this period. Attendance in the experimental group was monitored throughout the program. Upon completion of the intervention, both groups completed the post-test questionnaire. Due to participant absences during post-testing, the final sample included 58 individuals in the experimental group and 60 in the control group.

In this study, validated Chinese versions of standardized psychological scales were used to measure mindfulness, hope, life satisfaction, and meaning in life. These instruments have demonstrated satisfactory reliability and validity in previous research conducted in China; however, additional evaluation of their cultural applicability to the Chinese medical students remains necessary.

Mindfulness: The Chinese version of the Mindful Attention Awareness Scale (MAAS) was used to measure mindfulness, consisting of 15 items (Creswell, 2017). This scale has demonstrated good reliability and validity in the Chinese context (Chen et al., 2012). Participants rated each item on a 6-point Likert scale, where 1 represented “Almost always” and 6 represented “Almost never”. The internal consistency of the scale in this study was acceptable, with a Cronbach’s alpha of 0.79. Negatively worded items were reverse-scored to ensure that higher scores reflected higher levels of mindfulness.

Hope: The Chinese version of the Adult Hope Scale (AHS) was used to measure hope, consisting 12 items (Snyder, 1995). This scale has demonstrated good reliability and validity in the Chinese context (Sun et al., 2012). Each item was rated on 4-point Likert scale, ranging from 1 (“Definitely false”) to 4 (“Definitely true”). The Cronbach’s alpha for this scale was 0.90, indicating high internal consistency.

Life Satisfaction: The Chinese version of the Satisfaction with Life Scale (SWLS) was used to measure life satisfaction, consisting of five items (Diener et al., 1985). This scale has demonstrated good reliability and validity in the Chinese context (Xiong and Xu, 2009). Participants rated each item on a 7-point Likert scale, with 1 indicating “Strongly disagree” and 7 indicating “Strongly agree”. In this study, the Cronbach’s alpha for the SWLS in this study was 0.86, indicating good internal consistency.

Meaning in Life: The Chinese version of the Meaning of Life Questionnaire (MLQ) was used to assess meaning in life, consisting of ten items (Martela and Steger, 2016). This scale has demonstrated good reliability and validity in the Chinese context (Liu and Gan, 2010). Participants rated each item on a 7-point Likert scale, where 1 represented “Absolutely Untrue” and 7 represented “Absolutely True”. The Cronbach’s alpha for the MLQ in this study was 0.88, indicating good internal consistency.

To ensure comparability across instruments with different score ranges, all descriptive statistics and analyses were based on mean item scores rather than total scores.

The mindfulness training program was specifically developed for this study, drawing on the core principles of Mindfulness-Based Stress Reduction (MBSR) and integrating a novel, structured coloring meditation technique. The intervention consisted of an eight-week structured program delivered during regular class hours. Each weekly session lasted 30 minutes and included a breathing-based coloring practice accompanied by brief instruction and discussion. All sessions were conducted face-to-face in a classroom setting, with participants attending in groups.

A central and unique component of the in-class practice was the structured coloring meditation, which used a coloring booklet specifically designed by the researcher for this study. As illustrated in Fig. 2, the booklet contained a series of numbered, wavy shapes. Participants were guided to synchronize their breathing with the coloring movements: inhaling slowly for 4 seconds while coloring an ascending line, pausing for 2 seconds at the turning point, and exhaling slowly for 4 seconds while coloring the descending line. This exercise was designed to anchor attention in the present moment by combining breath awareness with a simple sensory-motor task.

Fig. 2.

Example of the mindfulness breathing and coloring booklet.

Session Content: All sessions focused on structured coloring meditation, which was introduced in the first week and remained the core in-class activity throughout the eight-week program. Session 1 provided an introduction to mindfulness and basic breathing techniques, integrated with guided coloring meditation. Sessions 2 to 7 progressively developed participants’ awareness, attention, and emotional regulation through coloring meditation synchronized with breathing. Session 8 focused on reviewing and consolidating all skills acquired during the program. Additional mindfulness techniques (e.g., breathing exercises, body scan, mindful walking, and mindful eating) were introduced as optional homework exercises and monitored weekly to support independent practice. The weekly structure of the mindfulness intervention is summarized in Table 2, which outlines the session focus, core in-class activity, and monitored homework practices.

Instructor Qualifications and Program Fidelity: The program was implemented by the first author, an associate professor holding a PhD in positive psychology and with extensive experience in mindfulness research and practice, including a doctoral dissertation and subsequent research focused on mindfulness interventions. He has conducted multiple mindfulness-based training programs for students both within and outside China. Intervention fidelity was ensured by following a detailed session manual. The instructor completed a fidelity checklist after each session, and a trained observer verified delivery for 25% of the sessions to confirm adherence to the protocol.

Home Practice and Adherence: In addition to in-class training, participants were instructed to engage in daily home practice (10–20 minutes, five days per week), which included breathing exercises, body scanning, mindful walking, and mindful eating. Participants were provided with printed materials and guided audio instructions to support independent practice. Adherence was monitored through attendance records and weekly logs of home practice duration. Average attendance across all sessions was 91%, and participants reported an average of 15 minutes of home practice per day.

Control Group: The control group was a waitlist group and did not receive any intervention during the study period. This design may introduce expectancy and attention effects, which are acknowledged as a limitation of the study.

Statistical analyses were performed using SPSS (version 23; IBM Corp., Armonk, NY, USA). Before the analyses, descriptive statistics [means (M) and SDs] were calculated for all study variables at pre-test and post-test. Baseline comparability between both the experimental and the control groups was examined using SMDs for demographic variables and pre-test outcome measures (mindfulness, hope, life satisfaction, and meaning in life).

The primary hypothesis was tested using linear mixed models (LMM) to examine the Group $\times$ Time interaction effect for each outcome variable. This approach allows for the evaluation of changes over time while accounting for differences between groups. Time (pre-test versus post-test), group (experimental versus control), and their interaction were included as fixed effects. Allocation was conducted at the class level using two intact classes; individual randomization was not performed. Analyses were conducted at the individual level, with this limitation properly acknowledged.

Shapiro–Wilk and Levene’s tests were used to evaluate the assumptions of normality and homogeneity of variances before inferential analyses. All tests were non-significant (p $>$ 0.05), indicating that the data met the assumptions required for the selected analyses. Effect sizes were reported as partial $\eta$², calculated from the F statistics of the fixed effects.

In addition to significance testing, Cohen’s d was calculated to estimate the magnitude of change from pre-test to post-test within each group, providing an indicator of practical significance.

Several limitations should be acknowledged. First, the generalizability of the results is limited, as the sample consisted exclusively of medical students from a single university. Expanding the sample to include participants from different academic levels, disciplines, and institutions would strengthen external validity. Second, the study relied entirely on self-report measures, which may introduce response bias. Future research should consider incorporating additional assessment methods, such as behavioral indicators, physiological measures, or external evaluations, to improve measurement accuracy.

Third, although the measures used have demonstrated acceptable psychometric properties in previous research, further validation within Chinese medical student populations would be beneficial to ensure cultural and contextual appropriateness. Fourth, the study focused on a limited set of psychological constructs—mindfulness, hope, life satisfaction, and meaning in life—without examining other potentially relevant variables, such as personality traits, resilience, or emotion regulation. Including such variables in future research would provide a more comprehensive understanding of the intervention’s impact.

Finally, the intervention period was limited to eight weeks, which does not allow conclusions about the long-term sustainability of the observed effects. Longitudinal studies with extended follow-up periods are needed to determine whether these effects persist over time. The study also did not include subgroup analyses (e.g., comparisons by gender) due to sample size constraints. Addressing these limitations in future work would improve both the internal and external validity of the findings.