Gamification of Health - Wellness, Healthcare and more
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Encompassing a range of activities that many find disengaging or difficult to maintain, the topics of health, wellbeing, and other health-related topics are perfect for gamification. With clear behaviors to increase, gamification and the rise of smartphones have merged, meeting at an integral moment. At the same time, millennials are a growing population that not only are accustomed to the technology, but at times demand a relationship with health and healthcare facilities through a fun, dynamic, and personal interface.
As of the most recent 2011 study, more than half (52%) of adults aged 18 years or older did not meet recommendations for aerobic exercise or physical activity. Poor nutrition , lack of exercise, and risky health behavior (smoking, drinking alcohol) are all preventable behaviors that cause much of the illness, suffering, and early death related to chronic diseases and conditions, especially in the United States. The United States spends astronomically more money on healthcare than any other country in the world. Yet, many other countries boast higher life expectancies, especially Japan and the Scandinavian countries (Denmark, Switzerland, Norway, etc.). See graph to the right.
Where does the disconnect reside? A healthy lifestyle remains elusive, partially, because of how much work and time is required before perceptible results emerge. In addition, there exists an intention-behavior gap: the gap between intending to diet and saying "no" to snacking, the gap between intending to run five times a week and actually getting off the couch. Studies show that one of the ways to bridge this gap is through vivid, explicit rules. For example, instead of "I should go to bed earlier,"
one explicitly states, "I will record my shows so I can watch them earlier, thereby allowing myself enough time to get ready and sleep earlier." The latter incites action in the way that the former does not.
Gamification can provide those vivid, explicit rules. One of the keys to gamification is to identify and target quantifiable behaviors to increase. In an online community, those behaviors, or activities, can be logging in, commenting on a post, or liking a status. In health, the concept is the same. Especially with the recent ubiquity of biometric sensors, GPS, and accelerometers (movement detection) it is possible to target behaviors like walking, individual step count, and distance covered using a mere smartphone. Once those desirable behaviors have been identified, gamification uses game mechanics to reward those behaviors, reward a collection with achievements, or reward a collection of achievements with a completed mission. In this way, gamification and mobile technology explicitly outlines a step-by-step process for the user to follow, bridge the intention-behavior gap, feel rewarded, and continue towards reaching their individual health goals.
Over the past few decades, nutrition/fitness/weight-loss programs and gimmicks have surged, creating a huge market for shakes, books, videos, and foods programs. Gamification has introduced a low-cost option that is tailored to the individual's needs and focused on maintaining the motivation to persist, rather than drop off after the initial excitement has died away. With gamification, not only can one track his or her progress with immediate feedback, but that process is placed into a context with game mechanisms like points, badges, leader boards, missions, and stories. For example, Zombies, Run! is a fitness game that sends the user on 20-30 minute missions requiring the runner to avoid zombies and complete missions. Apps like this are successful for a number of reasons:
- Providing immediate feedback
- Allows the user to see progress over time
- Places activity in a context that makes users want to return
- Social element pits teams against each other, digging into competitive drives
- Mobile phones are ubiquitous and convenient
Finding the motivation to exercise is frequently a battle with oneself. Fighting psychological addiction and combating mental health issues like high anxiety, stress, worry, depression, and fear takes that battle to another level. Gamification's spread into the health field is fairly recent, with its applications to addiction and mental health even more novel, therefore their results are not yet documented. While the gamification method has potential, it is important to acknowledge the difficulty of resisting addiction. Nonetheless, apps like QuitNow! and Kwit use self-reports of cigarette use to log progress in ways like amount of money saved and time gone without smoking. Of course, the glaring weakness in these apps is the ease of which a user can cheat the system and falsify reports of cigarette use. However, as biometric sensors begin to roll out with newer mobile phone models, this will likely change in the near future.
In addition, it has been found that the most successful applications to provide information, tracking tools, life management tools, and tools for awareness and relaxation as healing support for depression employ game-like strategies or feature a playful design. With topics as sensitive as depression, addiction, anxiety, and other psychological states, researchers warn that the driving forces of social status and competition may need to be redesigned. Gamified applications have found some success, though. In a small study from the City University of New York, 78 highly trait-anxious participants were exposed to gamified attention-bias modification training. Relative to the placebo training group, the gamified training condition experienced reduced subjective anxiety and observed stress reactivity.
The rapid growth of gamification, especially in recent years, has begun to change the face of the healthcare industry and the way that consumers interact with their healthcare systems. An increasing emphasis on value-based care, the increasing role of the patient as the consumer, and the millennial generation's changing needs demand a reevaluation of existing healthcare models, especially with the rising prevalence of smartphones and tablets. With the implementation of the Patient Protection and Affordable Care Act (ACA), insurance companies are aiming to better promote interactions with customers and increase engagement.
One of the driving factors behind this change is the implementation of the ACA, which mandates a reduction in the U.S annual spending on healthcare, which is estimated to be higher than $2.5 trillion annually. Gamification is a great way to increase user engagement, especially in a traditionally dull setting such as healthcare, while also being cost-effective. In addition, the ACA mandates a move towards a "value-based" reimbursement model. This means that healthcare organizations are reimbursed based on healthy outcomes for the population of customers they serve.
Millennials, or Generation Yers, are members of the population between the ages of 18 and 27 so named for the proximity to the year 2000 turn of the millennium. They are estimated to be 7% larger than the baby-boomer population. Since millennials tend to be more health-conscious, they are less costly to insure. The generation has also grown up with gaming, and is used to interacting with companies through apps and game-based interfaces.
Currently, hospitals, insurers, and healthcare providers are bound by the Health Insurance Portability and Accountability Act (HIPAA), which requires them to conceal individually identifiable health information to protect patients. With new developments in fields like gamification, the rules are now muddied. Users typically agree to terms and conditions before using a program, rarely reading or understanding them. One of the important aspects of gamification is being able to collect data on users and analyzing it to better improve and enhance further interactions between the gamified program and the user. Another important aspect is the motivational factor of social status, publicly displaying achievements and accomplishments. San Francisco's Fitbit made users' profiles and activity public by default, to encourage social sharing and competitiveness. However, this included users' records of sexual activity, publicly exposing the sexual habits of their users to search engines Google, Yahoo, and Bing. With a changing atmosphere surrounding healthcare and technology, there is concern that privacy and private information is less attainable.
HealthMonth by Fitbit
- Players pick one or more rules from a menu of dietary, fitness, relationship, mental health, and financial health behaviors
- Or design their own, personal rules
- Follow rules for a month, "choose-your-own-adventure-style"
- Running app
- Conquer as much area in neighborhood
- Build up virtual kingdom, defend from attackers
- Gain control of area by encircling it while jogging
- Awarded with soldiers for burning calories
MeYou Health by Blue Shield
- Uses social media to make wellness fun
- Goes beyond physical exercise: improves physical, emotional, and mental wellness
- Participants earn points, badges, status, and can see progress
- Past three years, 80% of Blue Shield employees have participated
- 50% drop in smoking prevalence
Healthseeker by the Diabetes Hands Foundation/Joslin Diabetes Center
- Facebook game
- Players choose a mission
- Take small actions in daily life
- Complete levels, report achievements, earn points
- Players are active in helping friends, not only diabetics, reach goals
DIDGET by Bayer
- Blood glucose meter
- Can connect to Nintendo DS and DS Lite (does not require DS to operate)
- Helps kids manage diabetes by rewarding them for consistent testing habits
- Points to unlock new game levels and options
- Made for kids ages 4 to 14
- Online community withs core leader boards, web games, and player profile pages
- ^Centers for Disease Control and Prevention. Exercise of Physical Activity. NCHS Fast Stats Web site. http://www.cdc.gov/hchs/faststats/exercise.htm.
- ^Gigi A. Cuckler, Andrea M. Sisko, Sean P. Keehan, Sheila D. Smith, Andrew J., Madison, John A. Poisal, Christian J. Wolfe, Joseph M. Lizonitz and Devin A. Stone, National Health Expenditure Projections, 2012-22: Slow Growth Until Coverage Expands And Economy Improves, Health Affairs, no. (2013): doi: 10.1377/ hlthaff.2013.0721