A Personalised and Gamified Digital Decision Aid for Colorectal Cancer Screening: A Randomised Controlled Pilot Study

BACKGROUND: Colorectal cancer (CRC) is the second leading cause of tumour-related mortality worldwide, accounting for approximately 903,000 deaths annually. Despite the proven effectiveness of population-based screening in reducing mortality, participation rates remain suboptimal, hindered by cognitive, psychological, and socioeconomic barriers. OBJECTIVE: This study assessed the effectiveness of the PREVenGO smartphone application, a digital decision aid (DA) incorporating personalisation and gamification elements, in supporting informed decision-making and adherence to CRC screening. METHODS: DA-CRC is a two-arm randomised controlled pilot trial. Individuals born in 1973-1974 and invited for the first time to the CRC screening programme by the Local Health Authority of Brescia (Northern Italy) were eligible. Invitation letters included instructions to download the PREVenGO app, which randomised participants into intervention or control arms. The intervention app integrated questionnaires on family history, prevention knowledge, and locus of control (LoC), together with gamified features and rewards, while the control version provided static educational material. Both groups received follow-up notifications at 3 (T1) and 6 months (T2). RESULTS: Among those invited, 1% (n = 248) downloaded the app and completed onboarding. Follow-up retention was limited: only 18 participants (7.3%) completed the 3-month questionnaire (T1) and 1 (0.4%) the 6-month assessment (T2). The overall faecal occult blood test (FOBT) screening uptake was 86.7% (n = 215), with comparable rates in both arms (control: 84.3%, n = 102; intervention: 89.0%, n = 113; p = 0.278). Only 17% (n = 43) of participants met all Marteau framework criteria for informed choice, with critical knowledge gaps, particularly regarding overdiagnosis, false positives, and absolute screening benefit. CONCLUSIONS: Preliminary findings suggest that a digital DA with personalised and gamified content may enhance CRC screening uptake and partially support informed choice. Larger, multisite studies are warranted to evaluate scalability, inclusivity, and long-term effectiveness in population-based cancer prevention. CLINICAL REGISTRATION: ClinicalTrials.gov RCT n. NCT07269028. (https://clinicaltrials.gov/study/NCT07269028?term=NCT07269028&rank=1).