By Katrina Firlik, MD
Co-Founder and Chief Medical Officer
As a physician trying in earnest to prevent downstream complications of chronic conditions, I often resorted to scare tactics.
“Stick with your cholesterol medication or you’re at greater risk of heart attack.”
“Make sure to take your hypertension pills or you could end up with bleeding in the brain years down the line.”
My counsel felt right at the time, and may have done some good, but I’m now convinced that a lighter approach may have greater merit.
Medication nonadherence is one of the most serious challenges in healthcare – half of all patients with chronic diseases don’t take their medications as prescribed and nonadherence is directly associated with 125,000 deaths each year. We need to bring a multi-faceted approach to this multi-faceted problem.
A physician’s reminders of gloom and doom are too easy to deny when someone has an attitude of “that won’t happen to me.” For some, these warnings may even be too scary to process, or too distant in the future to resonate. Denial is easier. Plus, how often does a patient see a doctor? Perhaps too infrequently for a critical message to really take root.
I believe that, in keeping with a “treat patients like people” mantra, people are more likely to engage in activities they find pleasant, or even fun. Healthcare for the most part is unpleasant, but the relatively simple act of taking a daily medication doesn’t need to be.
At HealthPrize we recognize that human psychology is primarily to blame for medication nonadherence, rather than the commonly cited reasons of forgetfulness or cost. Part of this psychology is the negative bias that many of us have toward taking a medication, getting older, being labeled a patient with a condition, or ceding control to a healthcare system we may not fully trust.
In attempting to overcome this bias, the use of fear as a motivator can actually backfire. Instead, at HealthPrize we strive to transform that negative bias into a positive bias via the use of immediate gratification (which most chronic medications lack), gamification to make the process engaging, and education to communicate the value of the treatment plan.
Gamification is not new, of course. We encounter it all the time in consumer experiences to engender loyalty, enjoyment, and frequency of use — think Facebook, LinkedIn, Uber, airline miles programs, and customer cards at our favorite retailers. However, gamification is still relatively new in healthcare.
The idea of using game-like mechanics in the consumer world is now second nature, whereas its use in healthcare still raises an occasional eyebrow, even though it shouldn’t. Our successes at HealthPrize tell us that people with chronic conditions enjoy earning points, checking their leaderboard, and taking quizzes about their condition or treatment (for more points).
And, in contrast to their interactions with doctors, people interact with HealthPrize multiple times per week, for an average of 60 minutes a month. That allows for the repetition of important messages, giving them time to actually sink in.
Early on in the development of HealthPrize, we sought feedback from participants in an effort to troubleshoot bugs and enhance the user experience. I recall receiving feedback from one woman in particular that helped to convince me that our fun and games approach may be more compelling than my former fear-based tactics.
This woman informed us that she needed to spend a couple days in the hospital to undergo a procedure. She had made it to the top of the HealthPrize leaderboard by checking-in every day, completing every weekly quiz, and opening every Daily Tip (our short-form medical education and fun trivia). She was not worried too much about the procedure. What mattered more to her was slipping from her position on the leaderboard.