One-size-fits-all gamification is not enough to improve patient outcomes
Around one in three of all adults suffer from multiple chronic conditions, many of which can be avoided or whose symptoms can be mitigated through diet and exercise. Medical professionals have long understood that patient engagement and adherence is the simplest solution to improving our population’s health.
Contrary to what some may believe, however, the problem isn’t that people don’t care about their health. The real problem is that telling people they need to improve their lifestyle is often not enough to produce consistent, long-term changes. The challenge is one of motivation, not interest.
Technology alone isn’t the answer
Technology has disrupted almost every industry today, and it’s had its eyes set on health for the last two decades. We all suspect technology holds one of the keys to driving greater patient engagement. But so far, no one has cracked the code on how.
One solution the industry has wrestled with the past decade are digital health trackers and reminders. Using Fitbits, pedometers, apps or other devices, these solutions use alerts and messages to give patients timely nudges for making healthier choices. And while there are now literally thousands of these apps and devices available, studies continue to show that they don’t make people healthier.
Initial attempts at gamification
Many studies, such as a 2014 report from Health Informatics Journal, have indicated that gamification is a promising way to incentivise improved patient self-management. Understanding that motivation is the key challenge to patient engagement, hundreds of apps have emerged in the past years that used rewards — the simplest of gamification strategies — to motivate users to improve their health.
- Healthy activity: Apple and Aetna recently launched a campaign that rewarded Apple Health users for maintaining a healthy, active lifestyle. MapMyRun is offering prizes to users who cover 1,020 km in 2020 in its latest challenge.
- Weight management: Several apps like HealthyWage.com and DietBet.com literally pay people to lose weight, while MyFitnessPal regularly offers challenges and the potential to win prizes for users who log consecutive meals for a number of days
- Check-ups: Start-ups like Healthereum and Clinicoin reward patients with cryptocurrency when they follow recommended health steps like regular check-ups and exercise.
These rewards-based health apps are attempts to follow the gamification success of non-health apps like Duolingo.com (for learning new languages) and ZyngaPoker.com (for online non-cash poker players).
But while these gamified health apps have had some success, their singular approaches haven’t been gamebreakers when it comes to moving the needle on population health. An article from The National Centre for Biotechnology Information reviews 19 studies on the effect of gamification on health and wellbeing with mixed results. While there is evidence that gamification can have a positive impact on health and wellbeing, several studies also reported mixed or neutral effect.
Gamification that works for all
So why hasn’t gamification worked for healthcare apps? The answer is that this single-focus approach gamification hasn’t worked for most non-health apps either.
Whether for healthcare or other industries, the key to successfully implementing gamification strategies in apps is to first understand that gamification isn’t a magic bullet. Gamification can’t overcome the limitations of an app that doesn’t deliver real value for its audience.
The second key to turning the tide is in understanding that app users are motivated by different rewards. Yes, many people are motivated by monetary rewards, but many others are motivated by other things beyond cash. In short, making health gamification more targeted and personalised to your audience segments is critical for long-term success.
To understand why, let’s look at a few reasons health gamification hasn’t made a bigger dent.
People are motivated by different game dynamics.
So far, most of our attempts to gamify health have been rudimentary and one-size-fits-all. A company might challenge its employees to a “walk-off” in which individuals or teams compete for prizes based on their step counts. A doctor might recommend an app that rewards a person with points or prizes for taking their medicine consistently.
The trouble is that not everyone is motivated by the game dynamic of goals and rewards. In fact, there are six user types when it comes to gaming:
- Players – This group is motivated by extrinsic rewards and may respond well to the standard types of health games and competitions described above.
- Socialisers – These folks are motivated by relatedness, so to grab them, games need to facilitate social connections.
- Free Spirits – The motivation for free spirits is autonomy and self-expression, requiring games that allow them to create and explore.
- Achievers – This type of individual is motivated by mastery, so it’s important their games nurture learning, acquisition of new skills, and self-improvement.
- Philanthropists – A philanthropist is motivated by purpose and meaning, so their games will need to enrich the lives of others in some way.
- Disruptors – These people enjoy finding ways to skirt the game system.
If we’re going to engage patients in long-term change, we’ll need to deploy a variety of gamification approaches that covers this spectrum.
The gaming “high” is subject to diminishing returns.
Moreover, we need to understand how to keep our health games interesting over time. As most of us know, when a person has a goal or prize to work toward, it can trigger a dopamine release in his or her brain. Dopamine can be a powerful motivator, but it’s subject to the law of diminishing returns, meaning it takes more and more of the game stimulus to produce the same effect in our brain.
Professional game makers seek to avoid this effect by ramping up the intensity or difficulty of gameplay and/or incorporating several different types of challenges throughout the experience. If health games fail to account for diminishing returns, it doesn’t take long before the dopamine reward for meeting a game goal is outweighed by the dopamine reward for smoking a cigarette, for instance.
Time is precious.
Even people who can be motivated by a financial reward or prize can begin to lose interest if they feel the amount of time they’re putting in isn’t worth the reward at the end. Putting in time — e.g. time toward exercising or cooking healthier food – is one of the most difficult commitments to make on a long-term basis, so the more time is being required of the patient, the better tailored and more exciting the game needs to be.
How to engineer health gamification that works
Gamifying healthy decision making in a way that drives meaningful long-term engagement will not be easy. But there are a few things we can expect to be part of the solution:
We’ll need to employ a variety of game styles to meet the different motivational needs of individuals. For example, Achievers might benefit from games that teach them about their illness, with rewards tied to completing learning modules. Socialisers may do well with games where they face off against other patients in a supportive, collaborative digital environment.
We’ll need to design health gamification to have the same addictive qualities as video and mobile games by incorporating increasing levels of difficulty, multiple long- and short-term goals, and numerous types of challenges. So for a diabetic, one week’s challenge may be completing an exercise routine, where the next week’s might be cooking a healthy recipe.
Finally, we’ll need to incorporate artificial intelligence in order to recognise when patients are beginning to disengage so it can recalibrate the person’s gaming style or mix up the challenges in a way that reignites interest. Otherwise, people will stop choosing to spend their precious time engaging with something other than their health.
Chronic health conditions are an epidemic-level concern, which is why it’s more than worthwhile to invest time and resources into cracking the code of gamifying healthcare. Gamification has the potential to help us turn this ship around, but only if we approach it with a strong understanding of how the best games work and why one-size-fits-all doesn’t.