Idrees AR, Kraft R, Küchler A-M, et al. Persuasive Design in a Digital Mindfulness Intervention: A Randomized Trial of a Skill-Based Achievement System and Automated Peer Encouragement. Journal of Healthcare Informatics Research. 2025;doi:10.1007/s41666-025-00216-6
This randomized, parallel, three-arm controlled trial examined whether targeted persuasive design (PD) strategies could improve adherence to a digital mindfulness intervention targeting university students. A total of 312 participants were assigned to one of three conditions: a control group receiving the standard intervention, a gamification group emphasizing visualized skill progression, or a social support group using automated peer interaction. The primary hypothesis was that gamification or social support would significantly enhance adherence (the number of completed modules) compared to the control. The intervention, StudiCare Mindfulness, was delivered via the eSano eHealth platform, which integrates content management, automated eCoach guidance, and cross-platform participant access. The average module completion did not differ significantly across the groups: control (M = 2.52, SD = 1.92), gamification (M = 2.69, SD = 1.89), and social support (M = 2.76, SD = 2.03). Although participants in the social support group completed more daily diary entries, this increased activity did not translate into higher overall module adherence. Exploratory analyses similarly found no meaningful differences between groups in engagement or usability, suggesting that neither PD strategy altered the user experience of the platform. Assessments conducted at baseline, mid-intervention (4 weeks), post-intervention (8 weeks), and six-month follow-up revealed a steep decline in active participation during the first week, regardless of condition. This early attrition highlights a critical implementation challenge and points to the potential value of more intensive or differently timed strategies at the outset of digital mindfulness programs. Overall, the findings offer an important contribution to the growing field of implementation science, underscoring that commonly used persuasive design elements are not a universal solution; the content being implemented needs specifically tailored strategies to increase adherence.