Digital Health Gamification

If there’s anything we’ve learned from COVID-19, it’s the importance of healthcare. COVID has further emphasized the prevalent and indispensable role of technology in our lives. From traditional classes to online learning, and eating in restaurants to food delivery apps, it’s no wonder that digital healthcare is on the rise! Even Amazon has jumped on the bandwagon with Amazon Pharmacy, a now formidable rival to America’s largest pharmacy chain, Walgreens.

That said, you’re probably wondering where gamification comes into play. For starters, it can be downright tedious to get people to think proactively about their health, even when it comes to taking their prescription meds. According to Annals of Internal Medicine, “Studies have consistently shown that 20% to 30% of medication prescriptions are never filled and that approximately 50% of medications for chronic disease are not taken as prescribed.”

These are quite dismal numbers. So what’s the problem? Do these people have a death wish or something? Perhaps they do in some cases. But in most cases, the problem lies with the lack of human motivational design. Like getting a child to eat his/her veggies, you need to make it fun! Put otherwise, you can revamp your digital healthcare strategy by heeding a few gamification principles that are bound to inspire intrinsic motivation!

Gamification Definition

At the outset, the term gamification might seem like a fancy, pseudoscientific word for some science of “turning things into games”. That’s actually not too far off. Founded on the tenets of both behavioural and educational psychology, gamification can be defined as the application of game mechanics to real-world, non-game contexts. By incorporating the fun and addictive elements of game-playing, you can induce intrinsic motivation in your patients/customers.
In the context of digital healthcare, this means that getting people to make smart health and lifestyle decisions won’t feel like pulling teeth. After all, gamification (when designed well) is all about mirroring the way we, as humans, are uniquely wired to learn as a species – through social learning and experience. It includes any number or combination of players, points, power-ups, levels, lives, leaderboards, badges, storylines/narratives, role play, virtual (3D) environments, etc.

However, these game elements are a very surface part of the process. Thus, it’s best to view the features and functions of game mechanics as mere tools for the overarching purpose of inspiring human motivation using the 8 core drives of The Octalysis’ Framework. We’ll cover these core drives in the context of digital healthcare apps and keeping users committed to their prescribed medication regimens.

How to Make Digital Healthcare Human-Focused

When it comes to engaging users of mHealth or digital healthcare apps, even big-fish players like Apple, Facebook, and Google are struggling to find their footing. But we’re here to place the gamification process into context by showing which gaming concepts to selectively apply, and why.

Have Clear Goals

While this tip might seem obvious, it’s indispensable when it comes to gamification. Imagine running a race without a finish line, or playing chess without the “checkmate”. First, both can be considered games. Second, what unifies them as games is the fact that they have clearly-defined goals; otherwise, they would not only be pointless, but never-ending. As such, SMART goal setting is “endemic” (har har!) to gamification.

When it comes to digital healthcare, you might think that improving a user’s health is a goal, but that’s actually more of a vision, which is abstract. In contrast, goals are more concrete and thus measurable. For example, taking your prescription medicine every day for one week is more measurable, like a milestone. Once the week is over, the user will feel “accomplished” (Octalysis Core Drive 2) and thus intrinsically motivated to continue with the regimen.

Get Really PersonalGamification Digital Health

Setting clear goals becomes a lot easier when you personalize them. For example, digital healthcare apps like Noom hook its users in right away by asking them a series of personal questions. Their responses are then used to build a profile of their respective goals. This technique is not only crucial for fostering a feeling of ownership & possession (Core Drive 4). It also helps instil a sense of epic meaning and calling (Core Drive 1).

Just like there’s no one-size-fits-all approach to prescribing medicine, there’s no one-size-fits-all approach to gamification. Therefore, intimate familiarity with each users’ unique health goals or medication regimen will make them feel special, like they’ve been specifically “chosen” to accomplish their goals for a higher purpose. It might even help to build audience profiles that palatably emphasize what they might lose or are trying to avoid, which brings us to our next tip…

Highlight Possible Losses

In digital healthcare, highlighting what users stand to lose or avoid from, well… avoiding their medication, might seem morbid. But from a gamification perspective, it’s an absolute must! People are constantly acting against their own self-interest, be it by smoking, sedentary lifestyles, obesity, non-adherence to prescription regimens, etc. And you wonder why cigarette cartons contain graphic images of tarred lungs! Though loss and avoidance (Core Drive 8) are negative reinforcers (i.e., Black Hat gamification), they are also powerful forces of intrinsic motivation.

Another Black Hat technique involves scarcity and impatience (Core Drive 6), which nicely pairs with loss and avoidance. For example, if you’re using a digital healthcare app to fit into your dream dress before a big wedding, then periodic reminders like “10 days before the big day! Have you exercised yet?” or “It’s been a week? How’s the dress fitting?” are not only personalized, but inspiring!

Reinforce Good Habits

That said, don’t go overboard with Black Hat gamification. While it’s intrinsically motivating, too much of it can leave a bad taste in people’s mouths. Particularly with digital healthcare, people are already down on themselves and looking for a solution. This search for a solution should be rewarded with positive reinforcement.

For example, countless studies have shown that positive reinforcement is more effective in reducing criminal recidivism than negative reinforcement, especially if the ex-convict is genuinely motivated to change. And ultimately, what we’re trying to do here is change behaviours and thus habits.

Habits are repetitive behaviours, actions, or responses that occur – under certain conditions – with little to no conscious thought/effort. Like the classically-conditioned (Pavlovian) dog who automatically salivated upon hearing a bell sound, whenever our successes are celebrated, it breeds positive feelings that intrinsically motivate us to repeat the actions that yielded them.

By empowering users through creativity and regular feedback (Core Drive 3), they not only get guidance and insight into their progress, but they will be able to leverage their creative freedom (also Core Drive 3) to adjust accordingly. For example, if your digital healthcare app pings you that you’re falling behind on your weight loss goals, then you can explore different options by perhaps perusing its list of various diets and meal plans.

Let’s say that the feedback you receive causes you to change “course” (tee hee!). For example, you’ve chosen a different meal plan and experienced rapid results! Not only will you feel proud and accomplished (Core Drive 2) for creatively figuring things out, but it enhances the feeling of accomplishment (again, Core Drive 2). Note that points, badges, and especially gift cards are effective game mechanics for this purpose.

Clearly, Octalysis Core Drives 2 & 3 pair well together. One might consider them a “positive reinforcement” feedback loop!

Show How Well Others Are Doing

As humans, we’re wired to learn through social influence & relatedness (Core Drive 5). Not only does social influence inspire the spirit of competition, which at times is fuelled by envy, but it also aligns with how we’ve always learned – that is, by mimicry, feedback, and observation in group settings.

So, while providing feedback is invaluable on its own, placing it into context by showing how others (with related goals) are progressing can make a world of a difference! However, following a similar line of logic as Black Hat gamification, it’s better to focus on techniques that elicit positive versus negative feelings, however effective the latter is. Fortunately, because social influence & relatedness is so inherent to how we live and learn, it’s easy to implement within digital healthcare apps.

For example, game mechanics like leaderboards, where users are ranked on a communal board based on their progress, can breed inspiration, envy, or competitiveness (whatever works!). But the main emphasis of social influence is cooperation and collaboration. In this way, you might opt for a chat forum or messaging feature so users can motivate and share ideas with each other.

Get Users to Invest

The term “sunk cost” comes to mind here. That is, the more resources (time, money, and effort) someone puts into something, the more he/she is likely to keep with it. Of course, this doesn’t mean overcharging for digital healthcare or locking customers into long-term payment plans. We all know how well that works (ahem, it doesn’t!). Instead, your gamification design should stagger the steps for goal achievement. Simply put, start small then up the ante.

Like relationships, the more time and effort you put into someone, the more you’re likely to keep with it, especially when these efforts are rewarded along the way (re: positive reinforcement/celebrating successes)! For example, if you’re courting someone who isn’t reciprocating, then unless you’re a glutton for punishment, you’re likely to quit/feel discouraged. Furthermore, if you succeed too quickly, you’ll likely take it for granted. Evidently, there’s something to be said about unpredictability and curiosity (Core Drive 7).

Same goes for digital healthcare. Even in rare cases of rapid results, users might devalue (or worse, return!) the app, attributing their success to external factors. However, when you carefully plan each phase or “milestone”, not only do your goals feel more within reach. But by weaving in positive and constructive feedback along the way, you empower users to stay committed, all while making the journey pleasurable throughout.

It’s like going to the gym after years (or only months!) of a sedentary lifestyle. You don’t just jump in, guns blazing, 5 days per week. That’s how you burnout and bail. But when you stagger the process in steps, users won’t feel the mental and physical stresses of staying on course.

Let’s bring it back to the low rate of patients adhering to their medication regimens. People tend to think of themselves as unique, not mere statistics. As such, despite all the positive studies and reviews, they’re still likely to face uncertainty about their prescribed regimens. But by introducing the lifestyle-changing process as a series of small steps, you breed curiosity about the outcome (i.e., What will happen in the next phase?). This is especially true at the beginning of any habit-changing endeavour, when the efficacy of the medication can’t yet speak for itself.

Changing Behaviour to Change Lives

In places like the US, where healthcare is mostly privatized, staying on course with your medication regimen not only positively impacts your health, but your eligibility for health insurance. As such, health insurance companies and patients have a lot to gain from gamified digital healthcare. What’s more, if people aren’t taking their meds, or interacting with their “products” as “prescribed”, then how can pharmaceutical companies gauge the efficacy of their treatments?

It’s futile to speculate now, but in theory, if everyone was motivated to keep pace with healthy diets, fitness, and personal prescription plans, then perhaps COVID-19 wouldn’t have ravaged the world to the same extent. There are tons of digital healthcare companies with the right idea, wrong strategy. Whether it’s apps like FitBit for exercise, Noom for dieting and weight loss, or Sidekick Health for lifestyle-related illnesses, all their function-focused bells and whistles are for naught when delivered without deliberation – that is, without human-focused design.

And, not to be crass, but the financial cost of healthcare due to poor lifestyle choices – especially choices that fly in the face of doctors’ recommendations – is immense, to put it lightly. Whether it’s a crippling condition or deadly disease, the individual and society at large have much to gain.

Final Thoughts

It’s humorously hard to motivate people to make sound decisions. These efforts alone might make you wonder whether we’re even wired for self-preservation. Either way, COVID’s done quite a fine job of shaking and waking the world up to the importance of preventative health, as well as the myriad indispensable ways that digital healthcare can keep us on track.

However, a great idea is not enough on its own; the execution counts just as much! Even tech giants like Google and Amazon have yet to get it right. But the right gamification approach will not only motivate and engage patients/customers. It will also help them lead healthier lifestyles, overall!

Speaking of sound decisions, what are you waiting for? Contact us and find out how to implement a custom gamification solution!