The Impact of a Reward-and-Progression Loop on Engagement with a Mobile Breathing Training: Preliminary Findings from a 15-day Field Study

Engagement with digital health interventions (DHIs) often declines over time, with many users discontinuing use after initial adoption. Gamification has been proposed to address this challenge, yet evidence on its effectiveness remains mixed. This exploratory study examines whether a reward-and-progression loop (RPL), linking performance to daily-constrained collectible coins and unlockable visual features, is associated with differences in engagement in a mobile biofeedback breathing training (MBBT). Twenty participants were randomly assigned to a control or an RPL condition and used the application over 15 days. Engagement was operationalized using two metrics: the number of active days and median session duration per user. Participants in the RPL condition showed more active days than those in the control condition (median = 7 vs. 2). Session duration was comparable across conditions, though more variable in the RPL condition. These preliminary findings suggest that RPLs may support more frequent engagement in DHIs and warrant further investigation.