Gamification in healthcare: More motivation during therapy

Getting healthy by playing? Gamification offers a lot of potential, especially in the medical and healthcare context. After all, the success of therapies depends on the motivation of patients to cooperate: They need to take their medications regularly, adjust their lifestyles and keep an eye on changes by tracking data over the long term. Gamification can help keep at it and thereby increase compliance. But how exactly do playful approaches work in the therapy of serious illnesses? Which use cases are suitable? In our article, we will show you how to integrate gamification into your medical and healthcare projects.

Gamification – What is it?

The term gamification has become increasingly popular over the past decade. Many people think of colorful mobile games, badges and high scores. Others think of the boring educational games from school. But what exactly is gamification? Gamification transfers motivating elements known from games into contexts that are not related to games. They are intended to support users in a particular activity and motivate them to adopt a new behavior. Gamification, however, does not mean developing a full-fledged game. Designers are inspired by video games and use motivational strategies or elements from games. However, these approaches do not necessarily lead to quality gamification

An example of gamification

An app from Oral-B helps users to brush their teeth "in a dentist-recommended" (1) way. It tracks and shows how long users brush their teeth. Many of you are probably thinking to yourselves: "What’s the point of that?! It's totally unnecessary!" However, there are cases where it is helpful to track your tooth brushing behavior. For example, when patients receive orthodontic treatment and have to take care of their dental hygiene several times a day. The app makes use of many gamification elements. Users collect medals when they clean continuously. There are scores, progress bars and smilies for feedback. The little gimmicks make it more pleasant to use and casually motivate you to "stick with it". However, if you don’t see a benefit in using a toothbrush diary from the start, the medals and smileys won't convince you otherwise.

Gamification vs. serious games

However, there are full-fledged games that are meant to serve a purpose beyond the game itself. So-called serious games are built around a purpose. Users play these games to fulfill this purpose. These are often learning or therapy games. An example of a serious game is our research project SCRIPT. We developed interactive games for stroke patients.

Serious games vs. game-based learning

The situation is different with game-based learning: Users learn something new while playing. But they don't play primarily to learn. Learning success happens organically. When playing football, children learn how to control the ball and approach things tactically. However, they don't play because of that, but because kicking is fun for them.

Why this distinction?

Why is it important for you to be aware of these differences? Before you get started, you should be clear about what you want to design in the first place. Depending on the decision, alternative solutions are required. Game design for serious games and game-based learning games is very complex. A self-contained game – which can be experienced as such – is a complex system. It needs good balancing, exciting gameplay, good controls and much more. Integrating gamification approaches, however, is easier: You "only" take elements from the game context that you hope will motivate the users. Gamification supports existing structures and is intended to improve the user experience of the digital product through motivation.

• Epic significance: People feel motivated when they believe they are involved in something bigger than themselves. This strategy is usually introduced when users start interacting with the game or digital product. For example, most games start with a narrative that explains to the players why they should play the game. This core drive also comes into play when users have beginners’ luck. In this effect, gamers believe that they have a special gift or amazing luck that other gamers do not have.
• Development and performance: Users have the inner drive to make progress, overcome challenges and develop themselves further. Progress bars, badges or rankings are just a few game elements that support this motivational strategy.
• Self-determination to creativity and feedback: Users want to develop themselves and their skills, find creative solutions and receive feedback on the results. This core drive can motivate gamers over time and intrinsically. A motivational injection, for example, is a temporary booster that increases an ability over a period of time. The same applies to milestones that users reach and thereby unlock new quests or abilities.
• Possession and ownership: Users want to own things and be able to decide about them. The desire to increase and improve the property motivates gamers. A prime example of this engagement strategy is collection sets, as in Pokémon. They create a desire to collect all the elements and complete the set.
• Social influence and feeling connected: This core drive encompasses all the social elements that motivate people – from mentoring and camaraderie to envy and competition. For example, group quests make players feel connected to others. Or they "brag" to others about their accomplishments with brag buttons or trout flags and vie for social recognition.
• Scarcity and impatience: Users want things that are very rare, exclusive or currently unavailable. Through artificial scarcity, exclusivity or time restrictions, games suggest unique opportunities that users should not miss. For example, desired game actions are only possible in a certain time window (appointment dynamics) or only after a waiting period has elapsed (torture breaks).
• Unpredictability and curiosity: Unpredictability makes things exciting. People have the urge to find out what happens next. Unpredictable outcomes that don't follow our normal thought patterns stimulate the gamer's attention. For example, unexpected rewards or Easter eggs encourage positive engagement.
• Loss and avoidance: Users do not want to lose anything. They are therefore motivated to avoid loss and adverse events.

Black Hat vs. White Hat Gamification

Complementing the 8 core drives, Chou distinguishes between White and Black Hat Gamification. White Hat Gamification reinforces good feelings: It conveys meaning and purpose to playful people and lets them develop their creativity and skills. Black Hat Gamification, on the other hand, puts game players under pressure and triggers stress: Gamers never know what will happen next, are constantly afraid of losing something, and have to fight scarcity. Both Black and White Hat Gamification motivate; however, Black Hat Gamification leaves a bland aftertaste. Good gamification design considers all 8 core drives. It cleverly uses the core drives to motivate the user in a fair and pleasant way.

Advantages of gamification in healthcare

How do you best use gamification approaches in the medical and healthcare context? Gamification in the medical and healthcare sector helps patients to better cope with their illness and suffering. Playful elements increase compliance: They motivate and encourage patients to actively participate in their recovery. We have identified 5 possible contexts of use:

Medical staff training

Medical training doesn't always have to be boring. Whether for medical students, apprentices, specialists or therapists – gamification can make dry learning more pleasant and practical. Prepare for surgery with ease? The serious game "Underground" (4) enables this. In the process, players dig through mine shafts and experience various adventures. The kicker: The game can be played with real operation tools. Surgeons can practice their motor skills in a fun and motivating way.

Physical fitness

So many intend to exercise more. And few follow through. The reason: Jogging and other types of endurance sports do not have a clear goal. They often seem pointless. They also offer little variety. Successes are not immediately visible. Playful approaches to fitness apps can change that.

Documentation & medication planning

Whether the success of medical therapies depends to a large extent on whether patients are motivated to cooperate. Gamification encourages patients, for example, to documenttheir health values and follow their therapy or medication plan. The better the data, the better doctors can assess the course of the disease and recommend the right therapy and medication at the right time.

One successful example is the Mango Health app. It reminds users to take their medications as prescribed. The app is very useful in its primary function – reminding. Additionally, gamification approaches enhance the user experience: Progress bars, statistics and level systems support the process. They provide an overview and make the course more interesting and comprehensible. Users collect points when they take their medications regularly. Those who steadily keep at it, will experience small successes. No one will take the drugs to earn points in the app. But getting points for taking it still makes users happy. So, in this example, gamification is just an additional cog in the wheel. However, it improves compliance and the user experience, and it adds value for users.

Some studies already prove the positive effects of gamification, especially in this application context. For example, thanks to gamification, motivation to document complaints or measure data such as blood glucose increased significantly. (6) In a pain app for children with cancer, the compliance rate was 90 percent: That is, 9 out of 10 children documented their pain twice daily.

Education

Education is an important topic in the healthcare context. Especially when patients and relatives are first confronted with diseases, fears arise. Gamification approaches help to alleviate this fear, convey information vividly, and address affected individuals more personally. Take, for example, an information platform of an institute that educates about a certain disease. A charming, friendly and funny avatar can build a more personal relationship with the sufferers than the institute or the doctors who represent serious and scientific research and therapy.

Therapy and rehabilitation

Rehabilitation is a long journey. It often extends over several months. Gamification motivates sufferers over a long period of time. It divides the large, distant target into smaller, digestible morsels. The necessary exercises are usually already given and can be integrated into the game mechanics. One example is the SCRIPT UID project mentioned above. Gestures like reaching for a glass or bringing a spoon to mouth are commonplace for healthy people. For stroke patients, they are often only possible again after a long period of rehabilitation.

How to integrate gamification into your project

If you want to improve your digital product through gamification, the first step is to define your business goals: What does the app want to achieve? Does it want to remind users to take medication? Does it want to support physicians in motor training? Or encourage fitness novices to jog? You then define what behavior you want users to exhibit so that your product achieves this goal. What do the users do of their own accord? Where does he still need the right motivational boost through gamification? The next step builds on these questions: Questions what motivates the user to behave this way and what keeps them from doing so. You can use the 8 core drives to develop appropriate engagement strategies for your product.

Conclusion

Gamification is more than just rankings, scores and badges. A digital application doesn't suddenly become a motivational booster just because some common game elements have been integrated. It is much more important to recognize the psychological needs of users and to address them with suitable core drives and game mechanisms. But even then, gamification is not a miracle cure or panacea. No matter how exciting gamification approaches are, they won't get users to do something they don't like. A fitness slacker will not become a marathon runner through gamification. But gamification can significantly strengthen user experience. The right engagement strategies can make all the difference in why users not only try the app, but stay motivated and achieve more eventually. This positive user experience can become the decisive unique selling proposition (USP) of an app.

More

• Digital Health: Modern. User-centered. Safe.
• UID Buzzword Jungle: Gamification – a playful way to positive user experiences?
• UID News: Digital Health Application (DiGA): User experience for better adherence
• UID News: Human-Centered Design: Human-centered to an intuitive and safe medical device
• UID News: Prototyping for medical devices – key to successful approval and market success
• UID News: UX Design Award for HoloMed

Sources:

(1) https://apps.apple.com/de/app/oral-b/id698092608

(2) https://www.inflammania.de/de.html

(3) https://yukaichou.com/gamification-examples/octalysis-complete-gamification-framework/

(4) https://grendelgames.com/spotlight/underground/

(5) https://play.google.com/store/apps/details?id=com.sixtostart.zombiesrunclient&hl=de&gl=US

(6) http://www.informatik.uni-oldenburg.de/~iug15/ga/medizin.html