Psychiatry · Medical Literature
Web-Based Mindfulness Intervention for Reducing Perceived Stress in Health Care Professionals: Secondary Analysis of Moderators in a Stepped-Wedge Cluster Randomized Trial.
Abstract
Health care professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions using mindfulness- and acceptance-based approaches have shown promising results in improving psychological well-being in this population. The MINDxYOU program is a self-guided digital intervention designed to reduce perceived stress and enhance emotional regulation, resilience, and psychological flexibility. Although its effectiveness has been demonstrated, treatment response may vary substantially between individuals. The aims of this study are to explore the sociodemographic, occupational, and psychological moderators of the effectiveness of the digital MINDxYOU program on perceived stress among health care professionals and to identify differential response profiles. This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 health care professionals from 6 clusters allocated to 3 intervention start sequences. The intervention (MINDxYOU) is a self-guided, web-based program designed to be completed over 8 weeks, grounded in third-wave psychological approaches and incorporating mindfulness-, compassion-, and acceptance-based components. Weekly support was provided via WhatsApp Messenger (Meta Platforms Inc), phone calls, or email to promote adherence. Assessments were conducted every 8 weeks across 5 measurement waves. Linear mixed-effects models were used to evaluate moderation effects by testing condition × moderator interactions, accounting for repeated measures within participants and clustering effects. Moderation analyses showed greater reductions in perceived stress among participants with higher baseline depressive symptom scores (9-item Patient Health Questionnaire [PHQ-9]; B=-0.22, SE 0.08; P=.004) and those with higher scores in the observing facet of mindfulness (15-item Five Facet Mindfulness Questionnaire [FFMQ-15]; B=-0.86, SE 0.41; P=.04). In addition, nursing staff exhibited greater reductions in perceived stress compared with physicians (B=1.92, SE 0.81; P=.02) and other health care professionals (B=1.80, SE 0.90; P=.04). The results suggest that baseline psychological and occupational characteristics may contribute to differences in the effectiveness of the MINDxYOU program in reducing perceived stress. These findings provide preliminary evidence regarding potential response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in health care settings.
Clinical relevance
Among health care professionals enrolled in the MINDxYOU digital mindfulness program, which sociodemographic, occupational, and baseline psychological characteristics moderate the intervention's effectiveness in reducing perceived stress? __SNAPSHOT__ {"studyDesign":"Secondary moderation analysis of a stepped-wedge cluster randomized trial","setting":"Primary care centers, hospitals, and other health facilities (e.g., nursing homes) in two Spanish regions: Aragon (Zaragoza) and Andalusia (Málaga), Spain","sampleSize":"n=347 health care professionals from 6 clusters allocated to 3 intervention start sequences","population":"Employed health care professionals (physicians, nurses, psychologists, nursing assistants, and trainees) aged 18–70 years, Spanish-speaking, digitally literate, with continued employment expected for ≥6 months. Baseline mean PSS-10 score 16.88 (SD 6.33), indicating moderate perceived stress. Physicians (42.4%) and nurses (26.8%) were the most represented occupational groups.","intervention":"MINDxYOU: an 8-week self-guided, web-based program grounded in third-wave psychological approaches (mindfulness, compassion, and acceptance-based components), with weekly adherence support via WhatsApp, phone call, or email from the research team","comparator":"Waitlist control phase within the stepped-wedge design; each cluster began in the control phase before sequential crossover to the intervention phase at 8, 16, or 24 weeks","primaryOutcome":"Moderation of intervention effect on perceived stress (PSS-10), evaluated via Condition × Moderator interactions in linear mixed-effects models; moderators examined included sociodemographic, occupational, and baseline psychological variables (e.g., PHQ-9 depressive symptoms, FFMQ-15 mindfulness facets, professional role)","followUp":"Five assessment waves conducted every 8 weeks (total follow-up approximately 32 weeks from baseline)","fundingSource":"Not reported in the abstract or available preprint metadata; trial registered ClinicalTrials.gov NCT05436717"}
Key findings
This secondary analysis used linear mixed-effects models with Condition × Moderator interaction terms to identify baseline characteristics that modified the stress-reduction effect of MINDxYOU. Two psychological moderators and one occupational moderator reached statistical significance. Higher baseline depressive symptoms (PHQ-9) were associated with greater reductions in perceived stress during the intervention phase (B = −0.22; p = 0.004), indicating that participants with more pronounced baseline depression-spectrum symptoms derived larger benefit. Higher baseline scores on the 'Observing' facet of mindfulness (FFMQ-15) also moderated treatment response favorably (B = −0.86; p = 0.039), suggesting that a pre-existing tendency toward attentional awareness enhanced program effectiveness. Regarding occupational role, nurses exhibited significantly greater reductions in perceived stress compared with physicians (B = 1.92; p = 0.019) and compared with other health care professionals (B = 1.80; p = not fully reported in available abstract excerpt). Absolute effect sizes (e.g., mean PSS-10 change by moderator subgroup), number needed to treat, and confidence intervals for moderator interaction estimates were not reported in the available abstract. The parent trial (López-del-Hoyo et al., JMIR 2025) reported a significant overall PSS-10 reduction in the full sample (β = −1.08, SE 0.51; p = 0.03) and among completers (β = −1.84, SE 0.62; p = 0.003), providing contextual reference for the magnitude of the main effect within which these moderator findings are nested. Adherence was moderate: of 229 participants who initiated the program, 112 (48.9%) completed ≥3 of 4 modules. No specific adverse events attributable to the intervention were reported in the available abstract.
Practice implications
This study established that differential treatment response to the MINDxYOU digital mindfulness program is associated with at least two baseline psychological characteristics—higher depressive symptom burden and greater pre-existing mindfulness observing capacity—and with occupational role (nursing vs. physician or other HCPs). These findings suggest that health care professionals who present with mild-to-moderate depressive symptoms and some baseline mindfulness orientation may be preferential responders to this type of intervention, and that nurses as a professional group may be especially receptive. The study did NOT establish causal mechanisms for these differential effects, the clinical threshold of PSS-10 change that constitutes a meaningful patient-level benefit, or whether these moderators replicate in non-Spanish or non-public-sector health care systems. Notably, this is a secondary (exploratory) moderation analysis of a parent trial that was not specifically powered for moderator detection; therefore, all interaction findings should be considered hypothesis-generating rather than confirmatory. The analysis was conducted on the abstract only, which limits full appraisal of covariate adjustment, multiplicity correction, and handling of missing data. Sociodemographic moderators (age, sex, seniority, contract type) and occupational burden variables not found significant are not listed in available sources. Populations underrepresented include non-Spanish speakers, health professionals outside hospital and primary care contexts, professionals with severe baseline psychopathology or burnout, and those without digital access. __LIMITATIONS__ Secondary, post-hoc moderation analysis: the parent trial was not powered for interaction detection, raising risk of both false-positive and false-negative moderator findings.,Multiple statistical tests across sociodemographic, occupational, and psychological moderators without explicit correction for multiplicity (not reported in available abstract); inflated Type I error is probable.,Only an abstract and accepted-preprint excerpt were available for review; full methods (e.g., covariate adjustment, imputation strategy, moderator selection rationale) could not be evaluated.,Moderate adherence (48.9% completers among initiators), with ~34% of enrolled participants never initiating the program, introduces substantial attrition bias and limits per-protocol interpretations.,Stepped-wedge design with only 6 clusters constrains between-cluster variance estimation and statistical power for cluster-level effects; secular trends and historical confounding cannot be fully excluded.,Single-country sample (Spain, two regions) with predominantly public-sector, Spanish-speaking professionals limits generalizability to other health systems, languages, and cultures.,The intervention included weekly human contact (WhatsApp/email/phone) for adherence support, making it a minimally guided rather than fully self-guided program; this component's contribution to outcomes cannot be disaggregated.,Between-cluster heterogeneity in occupational composition (e.g., cluster 6 with very few physicians) may confound occupational role moderator findings.,Funding source was not reported, precluding assessment of potential industry influence.,Perceived stress (PSS-10) is a self-report surrogate; no functional, occupational performance, or patient safety outcomes were assessed. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This exploratory secondary analysis suggests that the MINDxYOU digital mindfulness program produces larger stress reductions among health care professionals who have higher baseline depressive symptoms, greater pre-existing observing mindfulness capacity, and who work in nursing roles; however, all findings are hypothesis-generating given the post-hoc design and the absence of multiplicity correction. The parent trial established overall efficacy of MINDxYOU for perceived stress reduction at a small-to-moderate magnitude. Clinicians and health system leaders may use these moderator profiles to inform patient selection and resource targeting for digital mindfulness programs, but prospective, adequately powered moderator trials are needed before this guidance can be operationalized with confidence.