Talking about gamification has gotten me into a whole lot of “heated discussions” over the past couple of years. Sometimes it’s with the sort of ahead-of-the-curve professionals who talk at length about the intricate game-play of Call of Duty versus the simple pleasures of Angry Birds; sometimes it’s with more skeptical types who balk at buzzwords and think digital culture is an oxymoron; sometimes it’s with both at the same time.
Dubious name, solid credentials
Gamification is certainly not the most elegant invented word in digital technology; just the sound of it is enough to make some people roll their eyes. It’s the “game” part that turns off people who aren’t familiar with the principles behind it. It brings to mind old stereotypes of hard-core shoot-‘em-up gamers immersed in online mayhem – or possibly newer stereotypes of cute cats on smart phones.
But the key question hat interests us is what’s behind thethinking in gamification: What computer game designers know that gets more than half a billion (that’s over 500,000,000) people round the world voluntarily playing at least an hour a day – often so deeply engrossed that they forget to eat or sleep?
The uninformed see games as a category of activity that’s all about fun and entertainment and has nothing to do with serious things in life, such as business and healthcare. That’s way off. Some of the smartest, most serious people study games: Over the past decades games and the principles underlying them have revolutionized our understanding of how people think and behave.
The first great milestone was the publication of the classic 1944 work Theory of Games and Economic Behavior by mathematician John von Neumann and economist Oskar Morgenstern. Building on their work, eight game theorists have since won the Nobel Prize in Economics. Game theory has been applied to many other fields including philosophy, biology, artificial intelligence, military strategy, epidemiology, and politics. It all gets very complicated, but at heart game theory is about people making decisions.
Popular culture got another challenging take on games from the 1964 best-seller by psychiatrist Eric Berne: Games People Play: The Psychology of Human Relationships. Berne’s notion of games is a series of interactions that follow a predictable pattern in which one person obtains a "payoff" or "goal." In most cases, participants are not aware that they are "playing."
The success of computer gaming and its recent offspring social gaming is based on the industry’s rapidly evolving understanding of game design and game mechanics, which in turn are based on an underlying knowledge of what motivates us, how we interact, and what drives our decisions in a given moment. Gamification is about taking the underlying principles of gaming and applying them to virtually any non-game activity, including healthcare.
6 essential elements of gamification
Create a perception of play. Games typically feel like play but that doesn’t mean there’s no work involved. The crucial difference is perception. For most people, work is when they have to put time and effort into an activity they feel obliged to do for money or for duty; play is putting time and effort into something they want to do because it’s enjoyable.
Provide clear rules. Games must have rules that spell out what you can and can’t do: what you must and must not do. Rules provide an essential sense of order and logic to a game.
Show clear objectives and intermediate goals. To drive motivation games must have clear in-game small-scale tasks, such as finding hidden tokens, and the tasks must lead towards an overall longer-term goal, such as finding all the tokens within a certain time.
Build in group dynamics. A sense of competition helps to fuel participation, whether it’s playing against another individual, against a leader board, or against a personal best.
Motivate players with task-based rewards. Smart games give players a constant stream of carefully calibrated rewards as feedback and encouragement to progress: extra points, higher status, badges. These reinforce the brain’s own reward system that releases dopamine on completion of a task or goal.
Continue to challenge. Games must offer scope for improving a player’s level of skill, and for raising the level of challenge to match it. When skill and challenge levels are matched, the player feels a state of flow as described by Professor Mihaly Csikszentmihalyi in his highly influential work Flow: The Psychology of Optimal Experience.
Gamifying healthcare can improve outcomes
When people engage in anything that normally counts as a game (e.g., baseball, rock-paper-scissors, World of Warcraft), they take it for granted there’s no practical purpose beyond playing the game and enjoying it; any additional benefit is an extra.
Gamifying creates actionable steps to overcome personal challenges. When people engage in gamified activities, they understand that there’s a meaningful purpose beyond playing the game. They engage because they value the purpose but may not have the willpower or presence of mind to achieve it easily; gamifying the activity helps people to remember and motivates them to stick at it.
Gamification in healthcare can help people initiate healthier activities in any number of areas: losing weight, sleeping more, making healthier food choices, improving fitness, monitoring health metrics, and medication compliance.
The obvious place to introduces gamification has been with children and young people, who are the most likely to feel comfortable playing games and to demand fun from things they have to do.
Health insurance company Humana has been actively innovating to make fun things healthy and healthy things fun with Humana Games for Health or HG4H. In its Horsepower Challenge (HPC) targeted at school students, players wear a pedometer in their shoe; the device stores up to two weeks of data and uploads remotely via a remote access point to a website. Individuals can track how many steps they and their team have taken; the steps convert to points that can go towards purchasing accessories. The company reckons the challenge prompts a 35 percent increase in physical activities.
Bayer’s Didget blood glucose meter has been developed specifically for young diabetes patients aged 5-15 with the aim of getting them into consistent testing habits through play with a purpose. It connects directly to Nintendo DS and DS Lite platforms and gives them access to Didget World, an online password-protected secure community where users can interact with each other and compete. The meter includes the game Knock 'Em Down World's Fair, which encourages young users to upload their readings; health behavior is rewarded with tickets for prizes such as mini games, special power-ups, snacks and clothes for the user’s online avatar. The main question mark hanging over this sort of approach for youngsters is whether it risks encouraging them to stay indoors playing computer games too much.
Canada-based Hospital for Sick Children has created the Pain Squad app for the iPhone. Its purpose is to help children and teens with cancer to track how intense their pain is, how long it lasts, where it’s located, and what helps to treat it. The app enrolls users as crime-fighting characters as rookies and progresses them up through the ranks as they complete surveys.
But gamification isn’t just for kids
The newly launched Games for Health Journal features extracts of a roundtable discussion with experts who flagged up positive outcomes for games used in managing diet, physical activity, asthma, pediatric cancer, diabetes, cystic fibrosis, pain, phobias, addiction, and stroke rehabilitation, as well as cognitive functioning of older adults, social perceptual skills of autistic children, and improvements in physical activity and nutrition across a wide range of age groups.
Insurers Aetna Inc. enlisted gaming and team-based competition to promote employee health goals with its Get Active! program. The online system gets users to set goals (e.g., weight loss), track progress, compare results, team up with supporters, and take part in challenges. Aetna reports that employees that participated in Get Active! had a body mass index (BMI) reduction of 7.8 points greater compared with those who did not.
On a much shorter time span of just minutes, Cambridge Consultants has created a gamified system called T-Haler to train people to use their asthma inhaler correctly; according to the American Academy of Allergy Asthma and Immunology, around 8 percent of the U.S. population suffered an asthma attack in 2009 and globally an estimated 300 million people suffer from the condition. The T-Haler system uses as wireless training inhaler that monitors how a patient uses his or her device and provides real-time feedback via an interactive video game. In just a few minutes of training, correct usage went from the low 20 percent range up to 60 percent, and was still at 55 percent a week later.
Gamification isn’t just for patients
Stanford University has developed a game called Septris designed to educate healthcare professionals about sepsis and to gamify management of the condition. The idea is to heal all of the patients who are progressively deteriorating. If their condition gets worse, patients move toward the bottom of the screen, whereas if their condition improves they move up the screen. Reaching either screen limit will either result in death or discharge.
A popular app called Ward Round puts the user in the role of doctor to solve clinical medical mysteries against the clock. Using a quiz format, the game is to answer questions fast and correctly to progress through levels of expertise from High School Student. The game is open to anybody but is apparently a boon to aspiring medical professionals needing to sharpen up their knowledge.
As in other high-skill areas (e.g., flying) a lot of game-designers’ expertise is focused on creating compelling simulations. The U.S. Defense Advanced Research Projects Agency, spiritual home of the Internet, has put out an RFP for apps that are engaging and challenging to the user to train medical first responders.
An unlimited opportunity for healthy change
All the signs indicate there is virtually unlimited scope for gamification to help all stakeholders to improve health outcomes across the board. That’s certainly the view of Tom Baranowski, professor of Pediatrics at Baylor College of Medicine specializing in behavioral nutrition: “There are probably no limits to where we could take video games, as long as there is a behavior or psychological component to what is being done.”
For a company such as mine working at the nexus of digital, marketing, and healthcare, gamification is one of the most exciting tools we have for helping our clients get to the future first.
Larry Mickelberg is partner, chief digital officer with Havas Health.
This post originally ran on MedAdNews.
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