Digital Rewards and Retention in a M-health App (DIGITALRCT)

Does Engagement in a Computerized M-Health Intervention Increase With Digital Rewards?

Attrition and user engagement are two challenges that eHealth interventions struggle with. Attempts to address this have been previously made through gamification, instructional design and using different types of incentives. Overall, any type of reward, be it non-financial or monetary is better than the controls, but the latter usually produce a greater effect. It is also worth mentioning that having an affective value attached to the reward itself is also important to user retention and engagement. Given the ever-increasing interest in cryptocurrency and its current relevance, the present study - a randomized clinical trial with three arms - aims to compare cryptocurrency to non-monetary rewards regarding their effectiveness in reducing attrition and increasing engagement. In order to do this, a mental-health computerized intervention will be developed, in which the users will have to complete several modules, during which time they will be rewarded either with cryptocurrency, sweepstake rewards (e.g., vouchers), or nothing.

Study Overview

• Status: Not yet recruiting
• Conditions: Stress; Depression, Anxiety; Transdiagnostic Psychopathology; Attrition; Engagement
• Intervention / Treatment: Behavioral: Multipurpose Online Tool; Other: No intervention

Detailed Description

Albeit effective, eHealth interventions suffer from very high dropout rates. Finding novel ways in which to maximise user retention and engagement in such settings can be beneficial, and exploring cryptocurrency as a potential reward may be worthwhile, since motivation seems to increase as the reward is perceived as more meaningful by the recipient.

The design is experimental, between-subjects, with one independent variable (the type of reward offered) and mental health (e.g., depression, anxiety, stress, and transdiagnostic constructs) as well as engagement and retention outcomes. Thus, three groups will be formed: two in which participants will be enrolled in the modular MOTO intervention and will receive different rewards, and one in which they will not receive any intervention or reward but will be evaluated as part of a waitlist control group. The modular MOTO intervention involves, in addition to the mentioned assessments, the completion of six weekly modules, each focused on specific aspects of mental health and containing exercises that may improve psychological well-being. These modules are automated, requiring no interaction with others (except for communication between participants and research team). Each of these modules contains the following: psychoeducational section(s) that participants must complete; a short test of 5-10 questions after each section to assess understanding of the material; (only for the first two groups); a link where they can obtain their rewards; the exercise corresponding to that module; the evaluation corresponding to that module.

• Study Type: Interventional
• Enrollment (Estimated): 177
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Cezar Giosan, PhD; Phone Number: +40730908050; Email: giosan@outlook.com

Study Locations

• Romania
  • Bucharest, Romania
    • University of Bucharest
    • Contact: Cezar Giosan, PhD; Phone Number: +40730908050; Email: giosan@outlook.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• English speaking

Exclusion Criteria:

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Crypto reward group; The participants will be enrolled in a weekly, 6 module intervention, which will require them to read psychoeducational materials, complete quizzes regarding those materials, complete the module-specific exercise, and then get rewarded in cryptocurrency. The participants will be assessed before, during and after the intervention.	Behavioral: Multipurpose Online Tool; The intervention consists of 6 psychoeducational modules, on the Canvas teaching platform. They are automated, requiring no interaction with others (except for communication between participants and the team). Participants go through the psychoeducational modules, then do the corresponding exercise, and then access their rewards (if they belong to the experimental or comparative groups).
Active Comparator: Sweepstakes reward group; The participants will be enrolled in a weekly, 6 module intervention, which will require them to read psychoeducational materials, complete quizzes regarding those materials, complete the module-specific exercise, and then earn the chance to win vouchers for an online store. The participants will be assessed before, during and after the intervention.	Behavioral: Multipurpose Online Tool; The intervention consists of 6 psychoeducational modules, on the Canvas teaching platform. They are automated, requiring no interaction with others (except for communication between participants and the team). Participants go through the psychoeducational modules, then do the corresponding exercise, and then access their rewards (if they belong to the experimental or comparative groups).
Other: Waitlist; The participants will be enrolled on the platform, but only for completing the assessments.	Other: No intervention; The participants will be assessed but without any intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Participant retention	The numbers of participants that get to finish the entire intervention	From enrollment to the end of the 6 week intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
User Engagement Scale - Short Version (UES-SF)	Score on how engaged the users feel while participating in the intervention - how satisfied and how much they value each intervention module. Minimum value = 1 Maximum value = 5 A higher score means a better outcome (i.e., a higher user engagement).	From the first module to the last (from week 1 to 6)
The Depression, Anxiety and Stress Scale (DASS-21) - Depression	The users will be assessed to see if the intervention decreases depression symptoms. Minimum value = 0 Maximum value = 21 (raw score); please note that scores are usually doubled in order to maintain consistency with the DASS-42, which would result in a maximum of 42. Higher scores on this subscale are associated with a worse outcome (i.e. depression symptoms), and a total score can be compounded across all 3 subscales, after doubling their raw scores. This total score is a general psychological distress score.	On week 1 and week 6 of the intervention
The Depression, Anxiety and Stress Scale (DASS-21) - Anxiety	The users will be assessed to see if the intervention decreases anxiety symptoms. Minimum value = 0 Maximum value = 21(raw score); please note that scores are usually doubled in order to maintain consistency with the DASS-42, which would result in a maximum of 42. Higher scores on this subscale are associated with a worse outcome (i.e. anxiety symptoms), and a total score can be compounded across all 3 subscales, after doubling their raw scores. This total score is a general psychological distress score.	On week 1 and week 6 of the intervention
The Depression, Anxiety and Stress Scale (DASS-21) - Stress	The users will be assessed to see if the intervention decreases stress symptoms. Minimum value = 0 Maximum value = 21 (raw score); please note that scores are usually doubled in order to maintain consistency with the DASS-42, which would result in a maximum of 42. Higher scores on this subscale are associated with a worse outcome (i.e. stress symptoms), and a total score can be compounded across all 3 subscales, after doubling their raw scores. This total score is a general psychological distress score.	On week 1 and week 6 of the intervention
DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult	This is a DSM-5-TR screener for symptoms, to provide additional information beyond the other secondary measures. Minimum score = 0 Maximum score = 8 (depression, mania, somatic symptoms, psychosis, repetitive thoughts and behaviors, personality functioning); 4 (anger, suicidal ideation, sleep problems, memory, dissociation); 12 (anxiety, substance use). A rating of mild (i.e., 2) or greater on any item within a domain (except for substance use, suicidal ideation, and psychosis) may serve as a guide for additional inquiry and follow up to determine if a more detailed assessment for that domain is necessary. For substance use, suicidal ideation, and psychosis, a rating of slight (i.e., 1) or greater on any item within the domain may serve as a guide for additional inquiry and follow-up to determine if a more detailed assessment is needed. A greater score is associated with a worse outcome.	On week 1 and week 6 of the intervention
The Intolerance of Uncertainty Scale: Short Version (IUS-12)	This is a transdiagnostic mental health factor that describes an individual's distress and ability to negatively perceive uncertainty as a whole. Minimum score = 12 Maximum score = 60 A greater score is associated with a worse outcome (i.e., more intense intolerance of uncertainty)	On week 1 and week 6 of the intervention
The Difficulties in Emotion Regulation Scale: Brief Version (DERS-16)	This is a transdiagnostic factor that describes a person's management and control of emotional states. Minimum score = 16 Maximum score = 80 A greater score is associated with a worse outcome (i.e., more difficulty in reglating emotions)	On week 1 and week 6 of the intervention
Ruminative Response Scale (RRS-10)	This is a transdiagnostic factor that describes a person's tendency to continually focus on negative emotions, experiences and thoughts. Minimum score = 10 Maximum score = 40 A higher score is associated with a worse outcome (i.e., more intense ruminations)	On week 1 and week 6 of the intervention
Automatic Thoughts Questionnaire (Short Version) - ATQ -8	This is a transdiagnostic contruct that describes thoughts that occur spontaneously, triggered either by external or internal states of events. Minimum score = 8 Maximum score = 40 A higher score is associated with a worse outcome (i.e., greater frequency of negative automatic thoughts)	On week 1 and week 6 of the intervention
The Cognitive Fusion Questionnaire (CFQ-7)	This is a transdiagnostic construct that measures how much people get entangled and immersed in their thoughts and beliefs. Minimum score = 7 Maximum score = 49 A higher score is associated with a worse outcome (i.e., a stronger tendency towards cognitive fusion, becoming more entangled with one's own internal experiences and thoughts)	On week 1 and week 6 of the intervention

Collaborators and Investigators

• Sponsor: University of Bucharest

Study record dates

Study Major Dates

• Study Start (Estimated): March 15, 2025
• Primary Completion (Estimated): June 15, 2025
• Study Completion (Estimated): September 1, 2025

Study Registration Dates

• First Submitted: February 24, 2025
• First Submitted That Met QC Criteria: March 12, 2025
• First Posted (Actual): March 25, 2025

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 12, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: mHealth; CBT; attrition; NFT; crypto; digital rewards
• Additional Relevant MeSH Terms: Stomatognathic Diseases; Tooth Diseases; Tooth Wear; Tooth Attrition
• Other Study ID Numbers: DIGITALGAMINGRCT

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No