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The primary purpose of this randomized controlled trial is to evaluate the efficacy of a 12-week gamified blended mindfulness intervention in reducing academic burnout, perceived stress, and anxiety among first-year nursing students. Nursing students frequently face high academic and clinical demands that deplete their psychological resources, leading to high levels of stress and emotional exhaustion during their training. While mindfulness interventions can mitigate these negative effects, adherence to standard digital programs often remains a challenge.
To address this, the study investigates the impact of incorporating gamification elements into a mindfulness program. Participants are randomly assigned to one of three groups: a minimal-treatment control group, a standard blended mindfulness group, or a gamified blended mindfulness group. The intervention spans 12 weeks and consists of 24 guided meditation sessions (16 online and 8 in-person).
The central hypothesis is that the gamified architecture will act as a behavioral reinforcement mechanism, improving student adherence to the program. Consequently, researchers hypothesize that participants in the gamified group will exhibit significantly lower post-intervention levels of emotional exhaustion, perceived stress, and anxiety compared to those in both the standard mindfulness intervention and the control group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control Group | Active Comparator | Participants in this control cohort (CG) receive a single-session minimal psychoeducational intervention rather than a structured multi-week mindfulness program. |
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| Intervention Group 1 | Active Comparator | Participants in this group (IG1) receive a structured 12-week blended mindfulness-based stress-reduction program without any gamification elements. |
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| Intervention Group 2 | Experimental | articipants in this group (IG2) receive the standard 12-week blended mindfulness program enhanced with a structured gamified architecture designed to increase adherence and engagement. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Psychoeducation and Free App Recommendation | Behavioral | Participants receive baseline information regarding the definition and health effects of meditation, alongside advice on how to independently practice it using free sessions available on a mobile application. |
| Measure | Description | Time Frame |
|---|---|---|
| Academic Burnout: Emotional Exhaustion | Assessed using the Emotional Exhaustion subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). This subscale consists of 5 items rated on a 7-point frequency scale ranging from 0 (never) to 6 (daily). Higher scores indicate higher levels of emotional exhaustion. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Measure | Description | Time Frame |
|---|---|---|
| Academic Burnout: Cynicism | Assessed using the Cynicism subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). It consists of 4 items rated on a 7-point scale (0 = never to 6 = daily). Higher scores indicate higher levels of cynicism toward studies. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ceuta | Ceuta | Ceuta | 51005 | Spain |
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| Standard Blended Mindfulness Program | Behavioral | A 12-week program consisting of 24 guided meditation sessions (16 online and 8 in-person). Sessions are led by a mindfulness expert, last between 15 and 30 minutes, and focus on breathing techniques and guided meditation practices. |
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| Gamified Blended Mindfulness Program | Behavioral | A 12-week, 24-session blended mindfulness program (15-30 minutes per session) integrated with gamification elements. Participants earn one point per completed session to enter a draw for a premium nursing training app subscription. The system also provides weekly automated score updates and a final anonymized leaderboard. |
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| Academic Burnout: Academic Efficacy |
ssessed using the Academic Efficacy subscale of the Maslach Burnout Inventory-Student Survey (MBI-SS). It consists of 6 items rated on a 7-point scale (0 = never to 6 = daily). Higher scores indicate higher levels of academic efficacy (considered a protective factor against burnout). |
| Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Perceived Stress | Assessed using the 10-item Perceived Stress Scale (PSS). Higher total scores indicate higher levels of perceived stress. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Anxiety | Assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS). This subscale consists of 7 items, each scored from 0 to 3, with subscale totals ranging from 0 to 21. Higher scores indicate higher levels of anxiety symptomatology. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Depression | Assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS). This subscale consists of 7 items, each scored from 0 to 3, with subscale totals ranging from 0 to 21. Higher scores indicate higher levels of depressive symptomatology. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Student Engagement | Evaluated using the 9-item short version of the Utrecht Work Engagement Scale for Students (UWES-9). All items use a 0-6 frequency scale. Higher scores indicate higher levels of academic work engagement. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| Dispositional Mindfulness | Measured by the Mindful Attention Awareness Scale (MAAS). This is a 15-item instrument designed to assess core characteristics of dispositional mindfulness, specifically open awareness and attention to the present moment. Higher scores denote greater mindfulness. | Baseline (T0) and immediately following the 12-week intervention period (T1). |
| ID | Term |
|---|---|
| D000077062 | Burnout, Psychological |
| D013315 | Stress, Psychological |
| D001008 | Anxiety Disorders |
| ID | Term |
|---|---|
| D001526 | Behavioral Symptoms |
| D001519 | Behavior |
| D001523 | Mental Disorders |
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