Currently submitted to: JMIR Nursing
Date Submitted: Apr 17, 2026
Open Peer Review Period: Apr 20, 2026 - Jun 15, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Moderators of the Effectiveness of a Web-Based Mindfulness Intervention (MINDxYOU) on Perceived Stress in Healthcare Professionals: Secondary Analysis of a Stepped-Wedge Cluster Randomized Trial
ABSTRACT
Background:
Healthcare professionals are exposed to high levels of occupational stress, emotional exhaustion, and anxiety-depressive symptoms. Digital interventions based on 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.
Objective:
To analyze the moderating factors influencing the effectiveness of the digital MINDxYOU program on perceived stress among healthcare professionals and identify differential response profiles.
Methods:
This study is a secondary analysis of a stepped-wedge cluster randomized trial including 347 healthcare professionals from six clusters allocated to three 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, phone calls, or email to promote adherence. Assessments were conducted every eight weeks across five 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
Results:
Moderation analyses showed that the program was more effective among participants with higher baseline depressive symptoms (PHQ-9; B= -0.22; p= 0.004) and those with higher scores in the “Observing” facet of mindfulness (FFMQ-15; B= -0.86; p= 0.039). In addition, nursing exhibited greater reductions in perceived stress compared with physicians (B= 1.92; p= 0.019) and other healthcare professionals (B= 1.80, p= 0.044).
Conclusions:
The effectiveness of the MINDxYOU program in reducing perceived stress is influenced by baseline psychological and occupational characteristics. These findings highlight the relevance of identifying individual response profiles in digital mental health interventions and support the development of more personalized and targeted approaches to stress management in healthcare settings. Clinical Trial: Clinical Trial registration. ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/ct2/show/NCT05436717
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