Developing a Traditional Chinese Medicine-Based Lifestyle Content Framework for Insomnia: A Modified Delphi Study

Background: Insomnia requires long-term self-management, prompting many patients to turn to Traditional Chinese Medicine-based lifestyle (TCM-L) practices for health preservation. However, a consensus-based TCM-L content framework is lacking. This study aims to develop a consensus-based TCM-L content framework using a modified Delphi method. Methods: A modified Delphi study was conducted in two phases. In phase 1, a preliminary content framework was developed based on a systematic review, TCM textbooks, and clinical guidelines, consisting of 10 initial domains and 82 subordinate items. In phase 2, 18 local Chinese medicine practitioners were purposively recruited to evaluate the framework over four iterative rounds. Items were rated on a 5-point Likert scale, with consensus defined as a mean ≥ 4.0, a coefficient of variation < 0.25, and a consensus level of agreement ≥ 80%. Iterative modifications, deletions, and additions were informed by both these numerical thresholds and qualitative expert feedback. Kendall's W was calculated to assess the coordination of consensus. Results: All 18 experts completed four rounds (100% response rate) with high authority (Cr = 0.864-0.883). The initial 10 domains and 82 subordinate items were refined to six domains and 49 subordinate items. Expert consensus was statistically significant across rounds (p < 0.01), with Kendall's W demonstrating a high concordance of 0.717 for domain importance in the final round. The prioritized sequence of the six domains in the final TCM-L framework was: (1) Domain 1: introduction to TCM-L, (2) Domain 4: sleep-wake routines, (3) Domain 3: dietary regulation, (4) Domain 2: emotional regulation, and tied at (5) Domain 5: mind-body exercise and Domain 6: acupoint massage. Conclusions: This study established a consensus-based TCM-L content framework for insomnia, providing a culturally relevant foundational structure for future lifestyle interventions, clinical education, and self-management support.