Gamification in the Healthcare Field

Games provide invaluable contribution to healthy brain stimulation, through building cognitive skills, promoting concentration, enhancing creativity, and fostering pro-social behaviours. While games are a fun-activity for children, grown-ups use games to de-stress and reboot their systems.

‘Gamification’ is an exciting concept that applies the designs and principles of ‘games’ to solve problems in non-gaming contexts. It promotes long-term engagement with users through consistent participation and better collaboration to achieve set goals, in addition to the fun element. As Canadian-American entrepreneur and gamification pioneer Gabe Zichermann rightly puts, gamification is ‘75% psychology and 25% technology’. The underlying principle of gamification is controlling our attention and stimulating us to change. Gamification can be seen as a combination of a close friend and considerate parent – providing both fun and guidance.

Gamification is gaining momentum even in the healthcare field. From counting daily steps, to measuring water consumption, and monitoring diet charts, gamification is enabling behaviour changes to improve overall wellness, making the transformation easy and fun. Gamification in healthcare is being used for self-assessment, promotion of medical information, and disease prevention. With increased popularity of smartphones, technology being available in hands for majority of public, gamification is rising as a promising way to improve health outcomes by supporting behaviour changes. Gamification induces behavioural changes (1) by uncovering the competitive inner-self. Connecting with similar groups, competing with them, monitoring own records for success, getting meaningful incentives – all of this makes change a fun event.

Gamification induces neurological effects (2) through rewards and incentives that promote reinforcement. The sense of achieving rewards stimulates neural activity, which results in better performance and a feeling of happiness. Simultaneously, the patient feels motivated upon a sense of accomplishment, which leads to achievement and maintenance of behavioural changes.

Gamification and Medication Adherence

Gamification is also being intensively explored to improve medication adherence. Poor medication adherence is a complex behavioural problem, with diverse causes. (3) Gamification attempts to address a few of them, such as lack of awareness, forgetfulness, complex regimens, and anxiety related to side-effects, by means of its persuasive architecture. Studies have shown the benefits of gamification to improve medication adherence among patients with various chronic diseases.(1,4)

There are various theories to explain how gamification improves adherence. (5) Gamification utilises the fundamental concepts of commitment and loyalty, supported by technology acting as a virtual coach, thereby instilling long-lasting behavioural changes. The motivation instilled through gamification, which leads to the behavioural change, may be as a result of concepts coming from either one’s inner self (intrinsic mechanisms), or from outside an individual (extrinsic mechanisms). (6)

  1. Intrinsic mechanisms:
    • Creating awareness: Gamification works on the principle of ‘Edutainment’ – providing medical information in easily understandable language, enabling fun while learning. Easy retrieval of medication manuals in audio-visual modes, even in regional languages, available round-the-clock makes training over complex regimens easy, promoting rapid learning. Gamification designs can make serious medical acts (e.g. taking injections) appear as fun activities, promoting self-management. Explaining the ‘what, when, why and how’ of the medication therapy can promote adherence.
    • Goal-setting and Monitoring: Gamification helps split complex regimens into smaller and clearer goals that can be easily achieved. Gamification also motivates the patients to achieve these small goals, basically empowering them to take responsibility of their care. Setting realistic goals aids in better time-management and enables finer action-planning habits, influencing behavioural changes. Through self-monitoring and tracking the outcomes, patients can boost their medication adherence.
    • Feedback and Reinforcement: The provision of giving instant feedback based on the algorithms planned according to patient’s performance provides active participation. This constant supply of feedback promotes engagement without fears, adding to better adherence. Reinforcements through repeated notifications on benefits of adherence ensures that the patient continues to maintain the commitment to improving medication adherence. Customized reminders set as per treatment plan ensure no pills are missed due to busy schedules. Gamification can help in establishing routines, for medicines and even scheduling injections. Positive reinforcement tools like rewards, incentives or badges for progression through levels of adherence promote sense of accomplishment, driving uptake and boosting positive behaviour.
    • Anxiety relief:Gamification also provides mechanisms to distract and relax by reducing stress related to treatment side-effects or impact on quality of life. Tools like virtual assistant discussions, bonding with virtual pets, or even breathing exercises recorded through microphone help in anxiety management.
  2. Extrinsic Mechanisms:
    • Compare and Compete:Comparing progress with other similar ‘users’ promotes competition and drives spirit to achieve better. Seeing others achieve better outcomes strengthens belief in treatment and encourages oneself to have similar results.
    • Story telling: Sharing one’s experience in the form of short stories, testimonials or narratives helps persuading others. Studies suggest ‘narrative persuasion theory’ as an effective way to convey information to promote positive health behaviours. (2) Readers get absorbed in the stories, relating to the characters accomplishing target goals and get motivated to practice behavioural changes.
    • Social connectivity: Combining gamification techniques with social networking mechanisms provides an edge to boost user engagement. Communicating with people in similar situations, sharing good and bad experiences, and connecting with healthcare experts promotes usage of professional services, strengthens advices to medication adherence and helps maintain continuum of care.

Games are always fun, rewards are always encouraging, and when the reward is improved health, the taste of winning is even better. Innovation in mobile technologies by adding medical benefits is a promise to tackle medication non-adherence. Gamification is the next way up in implementing new behaviour as well as maintaining the new behaviours over time, to reap long-term benefits.

REFERENCES
  1. Munro S et al. BMC Public Health. 2007 Jun; 7:1–16.
  2. Ehrler F et al. AMIA Annu Symp Proc. 2018 Dec; 2018:413-421.
  3. Radovick S et al. Multidisciplinary Scientific Journal. 2018 Aug; 1:71–80.
  4. Kleinsinger F. Perm J. 2018 Jul; 22.
  5. Lester RT et al. Lancet. 2010 Nov; 376: 1838–45.
  6. Cugelman B. JMIR Serious Games. 2013 Dec; 1(1):e3.