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This randomized controlled trial investigated whether user adherence could be enhanced by two specific persuasive design strategies: a gamification approach focused on visualizing skill progression, and a social support approach based on automated interaction between supportive partners. University students were recruited and assigned to a control, gamification, or social support group. The control group received the standard intervention without persuasive strategies, whereas the gamification group utilized skill-based progression systems and infographics. In the social support group, participants were paired into teams. Participants were encouraged to motivate teammates to complete daily diary entries, with mutual completion triggering a congratulatory email. Average module completions were: control (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$\\varvec{M = 2.52}$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mi>M<\/mml:mi>\n                            <mml:mo>=<\/mml:mo>\n                            <mml:mn>2.52<\/mml:mn>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ,\n                    <jats:italic>SD<\/jats:italic>\n                    = 1.92), gamification (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$\\varvec{M = 2.69}$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mi>M<\/mml:mi>\n                            <mml:mo>=<\/mml:mo>\n                            <mml:mn>2.69<\/mml:mn>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ,\n                    <jats:italic>SD<\/jats:italic>\n                    = 1.89), and social support (\n                    <jats:inline-formula>\n                      <jats:alternatives>\n                        <jats:tex-math>$$\\varvec{M = 2.76}$$<\/jats:tex-math>\n                        <mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                          <mml:mrow>\n                            <mml:mi>M<\/mml:mi>\n                            <mml:mo>=<\/mml:mo>\n                            <mml:mn>2.76<\/mml:mn>\n                          <\/mml:mrow>\n                        <\/mml:math>\n                      <\/jats:alternatives>\n                    <\/jats:inline-formula>\n                    ,\n                    <jats:italic>SD<\/jats:italic>\n                    = 2.03). Neither the gamification components nor the automated peer support system improved adherence compared to the control. Although the peer support strategy in the social support group recorded more diary entries, this did not translate to improved module adherence. User experience ratings were comparable in all groups, indicating that the strategies did not affect usability. The smaller-than-planned sample size and higher attrition rates warrant cautious interpretation of these findings. These results contribute to healthcare informatics by demonstrating the limitations of generic persuasive strategies and highlighting the need for more adaptive, context-aware engagement mechanisms in digital interventions.\n                  <\/jats:p>","DOI":"10.1007\/s41666-025-00216-6","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T15:17:36Z","timestamp":1761751056000},"page":"154-176","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persuasive Design in a Digital Mindfulness Intervention: A Randomized Trial of a Skill-Based Achievement System and Automated Peer Encouragement"],"prefix":"10.1007","volume":"10","author":[{"given":"Abdul Rahman","family":"Idrees","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robin","family":"Kraft","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann-Marie","family":"K\u00fcchler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leandra","family":"Bantleon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harald","family":"Baumeister","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Reichert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanny","family":"K\u00e4hlke","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David Daniel","family":"Ebert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R\u00fcdiger","family":"Pryss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"issue":"1","key":"216_CR1","doi-asserted-by":"publisher","first-page":"1879551","DOI":"10.1080\/20008198.2021.1879551","volume":"12","author":"L Steubl","year":"2021","unstructured":"Steubl L, Sachser C, Baumeister H, Domhardt M (2021) Mechanisms of change in internet-and mobile-based interventions for PTSD: a systematic review and meta-analysis. 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The study adhered to the CONSORT Guidelines [\n                      \n                      ]. All participants provided informed consent to participate.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"Not applicable. This work does not include any personally identifiable information or images requiring specific consent for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for Publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}