Patient medication adherence

Humans are confusing creatures. While we’re hardwired with instincts for self-preservation, we still need to be dragged by the ear in order to making lasting health-conscious choices. Take patient medication adherence. Believe it or not, but in the US, “approximately 50% of medications for chronic disease are not taken as prescribed” (Annals of Internal Medicine).

That’s pretty bad, both in scale and severity! So if you were motivated enough to see a doctor, why are you not motivated enough to take your meds? Clearly, motivation is only one half of the picture – the other puzzle piece is habit formation. You can have all the motivation in the world, but motivation wanes over time and you a method to ensure daily adherence to the activity you want to stick to.

In these days of digital health, habit formation practices have been refined and made more effective through gamification. If you think some games are addictive, then you already know where I’m going with this post.

The Science of Habit Formation

According to BJ Fogg’s Behavior Model, behavioral change requires 3 main components, summarized by the equation B=MAT(P), wherein:

B = Behavior
M = motivation
A = Ability
T(P) = trigger (or “prompt”)

Thus, behavior is a function of how motivated we feel, our ability or ease with which we can perform a task, and whether an explicit trigger or “call to action” is present. In other words, “B” simply cannot be without any one of “M”, “A”, and “T(P)”.

Variable Metrics for Habit Formation

Let’s dive deeper by further defining the metrics for each variable. Simply put:

  • Motivation can be high or low, depending if the task provides instant gratification (avoiding pain or receiving pleasure) or delayed gratification (seeking hope or avoiding fear).
  • Ability means the ease or simplicity of the task. For example, if your doctor requires you to interrupt your routine 3x a day to take meds, your habit-formation “ability” will be lower than if the frequency were once a day. As such, the main metrics here lie on a continuum from “very easy” to “very difficult”, which can mean a lot of things. To determine your ability or task simplicity, ask yourself the following questions:


    • Will it take a lot of time? Less time is always easier than more.
    • Will it cost a lot of money? The more expensive your meds, the harder to adhere to your regimen.
    • How much physical effort must I exert? Less exhaustion is obviously easier.
    • How much mental effort (or “brain cycles”) must I exert? Are your meds clearly labeled with clear instructions? Less brain strain is evidently easier.
    • Is social deviance required? For example, are your mental health meds stigmatized? This could make the task harder… but not necessarily. I might also argue that social deviance is more a function of motivation than ability (i.e., habit-formation simplicity).
    • How about routine deviance? For example, to what degree would medication adherence disrupt your daily flow or routine? To what degree does it disrupt your tendency to not want to change existing behavior? The less you have to leave your routine, the easier you’ll perceive behavioral change to be.


  • Triggers or prompts remind people to even consider doing the action. Regardless if the task is easy (high ability) and provides instant gratification (high motivation), something needs to tell you to “Go!” I wouldn’t say triggers involve “metrics” so much as they do “trigger types”. They include:
  1. Signals, which are simple reminders for highly motivated people to perform a high ability action/behavior.
  2. Sparks are somewhat similar to signals. While they also serve as simple reminders, they are meant to “enhance motivation” in people with high ability yet low motivation.
  3. Facilitators are a great habit formation tool for those who are highly motivated to perform a low ability (difficult) action.

Gamification Design: Piecing It All Together

If you’re familiar with our 8 Core Drives, then you’ll have no problem leveraging Fogg’s Behavior Model for your gamification approach.


Starting with M for motivation, it’s clear that instant and delayed gratification play on almost all core drives. That’s because practically any white hat gamification technique relates to “gaining pleasure” and any black hat technique relates to “avoiding pain” – at the risk of gross oversimplification.

For example, white hat techniques are “feel good”, so any of the following Core Drives are relevant here, including:

Epic Meaning & Calling
Development & Accomplishment
Empowerment of Creativity & Feedback

Core Drives 1-3 are all “sweet” gamification approaches. But there’s another side related to Scarcity, Unpredictability, and Loss & Avoidance (Octalysis Core Drives 6, 7 & 8). These black hat motivators create urgency to act and obsession, some might say, even addiction.

Oh, keep in mind that the following Core Drives can be either white hat or black hat, so you can use them creatively to make people feel good or to create urgency to act:

Ownership & Possession
Social Influence & Relatedness


As for Ability (or simplicity), with all the various metrics for measuring habit-formation ease, “ability” – like Motivation – also applies to many of our core drives. For example, time deals with Scarcity & Impatience (Core Drive 6) as well as Loss & Avoidance (8), be it through a loss of physical or mental energy, or your routine. Whereas social deviance evidently relates to Core Drive 5 – Social Influence & Relatedness.


As far as habit formation and gamification goes, triggers are quite key here. I mentioned patient medication adherence, a prime example of how triggers are indispensable within gamified digital health. I also touched on 3 trigger types – signals, sparks, and facilitators.

There’s so much we can do to hardwire habits, but what you choose depends on your unique combination of Motivation and Ability. If you’re highly motivated to perform something difficult, then it’s in the name – you need a facilitator. For example, if patient medication adherence is dire but difficult for financial reasons, then you can incentivize them with discounts on the next prescription for every week they successfully stick to their regimens. As pleasant as discounts sound, they also remind people that they want to be there for many years more for their loved ones. For many elderly patients, living on for their grandchildren can be a great intrinsic motivator.

Another handy tip is to create a spark, which is basically a black hat trigger. Sparks are triggers for people with low motivation who have the ability to take the desired action. For instance, if you only needed to take one pill a day, and the consequences of non-compliance were fatal, a deadline reminder would prove quite effective.

Finally, you have what we call a signal, which is ideal for users who already have high motivation and high ability, but just aren’t leveraging them for whatever reason. In that case, it’s very easy to just have a simple prompt or trigger like, “Hey, do it.” There’s usually a high chance the user will take the desired action.

This might seem somewhat intuitive once explained. But it takes expert guidance to create human-focused design that marries prominent habit formation theories with our world leading gamification framework!

Contact us and we help you create habit magic!

So I don’t blame you if you need some support here. If you’d like to sidestep analysis paralysis, give us a shout and we’ll reach right out!