What is gamification, why is it so engaging and how you can use it to improve medication adherence and health outcomes?
When you log in to your LinkedIn account after being notified that someone has looked at your profile, or when you check your Facebook feed multiple times a day to see what new updates your friends have posted, or when you instantly rate an Uber driver, your behavior has been affected by gamification.
Today, gamification, the practice of incorporating game-like elements into non-game settings, can be found everywhere consumers are, whether in a brick-and-mortar storefront or on a corporate social media profile.
And it’s not just for consumer goods and apps. Gamification can be used to attract and retain customers in any industry, including healthcare.
By using core tactics of gamification in its engagement programs for chronic disease patients, healthcare marketers can tap into the psychological aspects of game mechanics to create high-value interactions with these patients. Gamification can encourage and reinforce improved habits and behaviors such as taking one’s medication as prescribed and refilling prescriptions on time.
As we’ll explore throughout this playbook, gamification applied more broadly can be a vital key to addressing the problem of medication nonadherence, a key driver of negative health outcomes.
This playbook will cover multiple aspects of gamification and how they apply to healthcare marketing, including:
- Basic facts and definitions
- The science behind why gamification works
- 10 game mechanics that we can apply to patient behavior
- A look at how HealthPrize incorporates gamification into our platform
To be clear, gamification and games are not synonymous. The practice of gamification involves extracting the elements of gameplay that people find compelling and using them to drive actions and behaviors outside of a game context.
If we can isolate the active ingredients that make games addictive, we can incorporate those ingredients into digital technologies to help drive healthier behavior. “For instance,” says digital behavior scientist Brian Cugelman, PhD,1 “We can make a routine non-game activity, such as taking medication, into a game that is fun and engaging by adding game elements, such as earning points for taking medications.”
Not only can gamification be applied broadly, it’s remarkably effective when done correctly. A 2014 literature review by Hamari and colleagues concluded that gamification provides positive outcomes, though it stressed the importance of context.
Gameplay elements alone don’t automatically deliver results; they must be incorporated carefully into an initiative from its inception.2 Game designers have mastered the art of providing the perfect mix of challenge and reward. They rely on game mechanics, a set of basic actions, processes, and control mechanisms that make gameplay challenging, rewarding, fun, and satisfying.
Game mechanics are at the core of how designers create an experience that hooks users into a digital experience. These very same mechanics can help marketers draw customers in, keep them engaged, and motivate them to take their medications as prescribed.
As this playbook’s co-author Gabe Zichermann has said before:
“Gamification can make the process of adherence more fun and enjoyable because even in the landscape of multiple things competing for people’s attention, we can use gamification to make taking your medicine more pleasurable.”
Juho Hamari, PhD
Professor of Gamification
Tampere University of Technology, Finland
The best video games teach you how to play the moment you pick up the controller. By starting off with simple tasks like exploring your application or logging their vital statistics for the first time, gamification eases your player customers into the process, building confidence and satisfaction with every achievement.
Clear, concrete goals keep player customers on track, focusing them on the end result and motivating them to get there. Many games are guided by one main goal, but each step along the way is another, smaller goal. These micro-goals keep players engaged with puzzles, challenges, and tasks.
When gamifying your digital experiences, remember that each micro-goal should tie back into the main mission. See each step as an opportunity to interact purposefully with your patients, educating them about what they can do for optimal health – and how taking control of their treatment plan can help them achieve their goals.
3. Fast Feedback
Whether positive or negative, give players and patients feedback instantly. With on-screen notifications, text messages, or emails, gamification allows you to speak directly with patients, encouraging them to reach their goals, congratulating them on their latest milestone, or providing advice so that they can improve.
In games, a person always knows where he or she stands. A key feature of many gamification programs is showing individuals and teams their metrics and progress in real-time, so everyone knows exactly where they are and what skills they need to improve. Status trackers, levels, badges, and point totals tell players where they are within the game itself.
5. Leveling Up
Like badges, leveling up shows how far a player patient has come. While everyone starts out at square one, in any community there is a sense of achievement and status to reaching a higher “level.” Along with level increases, missions and challenges should increase in complexity or difficulty, allowing player patients to access new and exciting activities, badges, and milestones.
Ranking oneself against others can be a great motivator, whether those rankings are between people known in real life or real people made anonymous by screen names. As such, your gamified product should be able to answer when your player patients ask themselves: “Where do I rank? How can I do better?”
Leaderboards naturally encourage people and teams to compete against one another for the top slot, which can create big changes in individual health. The most effective leaderboards in a consumer context keep competition light and positive, positioning an activity as an opportunity for advancement, not as a means of frustration.
As mentioned in the section on Fast Feedback, badges and medals are a great way to help your patients visualize how far they’ve already come. Particularly when used as a shareable graphic, badges provide player patients with a tangible congratulations and something that they can share with their online social networks.
Every game has some way of keeping score. Points enable player patients to track their progress, feel a sense of status, and get rewarded for their efforts. Points could be earned for achieving goals, leveling up, sharing, contributing, engaging, or interacting with the community in a meaningful way.
Games don’t have to be a solo endeavor. It can be more effective to bring an entire community together to foster collaboration as well as help encourage, motivate, and congratulate player patients. Player patients could create teams, and tackle puzzles and challenges together.
Truly effective games bring people together, even if the main gameplay is solo. Through collaboration, sharing achievements, showing badges, and conversation, a community is built around common participation. This not only helps maintain interest in the game for the individual, but also helps the game spread to new people.
There are six broad categories of human desires that games are especially good at satisfying: reward, status, achievement, self-expression, competition, and altruism. In the chart on the following page, each desire is matched with the game mechanic that directly addresses the desire.
Take achievement, for example.
Everyone wants to feel like they have accomplished something. Completing challenging goals brings with it a rush of energy and happiness hormones that keep players coming back. Once they’ve succeeded once, they want to keep moving forward, chipping away at each goal for the satisfaction that comes from achieving.
The chart above illustrates the interaction between basic human desires and game play. The green dots signify the primary desire a particular game mechanic fulfills, and the blue dots show the additional areas that if affects.
Like gamification, dopamine, the chemical at the center of our brain’s pleasure system, represents more than just fun and games. Dopamine has also been linked to the process of learning. Human beings are simply more likely to learn, retain, and re-apply information and skills that were taught in a way that released dopamine in their brains.3
Now, healthcare marketers can harness the power of dopamine through gamification to help educate patients about their condition, their medication, and the benefits of remaining adherent.
While powerful, gamification is not a magic bullet for modifying patient behavior. It takes time and careful planning to implement an effective gamification strategy. For the strategy to succeed, healthcare marketers must fully integrate game mechanics into the product, website, or application from inception. SCVNGR founder Seth Priebatsch put it best when he said:
“I see a real difference between utilizing game mechanics to improve a core experience from the ground up, and what I call ‘bolt-on gamification,’ where you basically just tack a badge on to something and call it a day. That doesn’t really work in my opinion.”5
Instead, game mechanics must be implemented in a way that makes them meaningful to users. Just because you have a badge-based or points-based system doesn’t mean those badges or points will automatically mean something to the users. Earning a badge must truly feel like accomplishing a goal or besting a challenge. Otherwise, the system will feel arbitrary and boring.
Bartle’s Player Type Diagram Visual
Buying and taking medication can be a source of dread for patients. It’s far too easy to forget, especially for those experiencing long-term illness, that these medications and therapies are helping and valuable. Treatments for chronic disease tend to benefit patients slowly over time. Such benefits are difficult to appreciate in the moment when decisions such as refilling a medication are made. Because there is little in the way of instant gratification (or, to use the terminology of game mechanics, fast feedback), this is one of the reasons nonadherence rates remain so high for medications for chronic disease. Behavioral economists call this phenomenon “present bias” – the concept that we make value short-term benefits over long-term outcomes.
There are a lot of other things in life that get in the way of health. People spend time on TikTok, taking care of their children, and working to make money. They aren’t spending all day thinking about taking their medications. But gamification makes the process of adherence more fun and makes the option of taking a medication more enjoyable.
The goal of gamification in healthcare marketing is to turn routine tasks associated with medication into something that brings a moment of joy to the person – treating them as an active participant in their health, rather than a passive patient. HealthPrize’s platform has been designed from the ground up with these objectives in mind.
Many of the arguments against gamification center on the idea that it impacts extrinsic motivation only. Extrinsic motivations are driven by external rewards, such as earning points or moving up a leaderboard. These types of motivations can deliver quick changes in behavior, but as the novelty of the game elements wears off, player patients may revert to their original habits.
HealthPrize, though, uses gamification to help establish healthy habits in the first place, combined with education to enhance intrinsic motivation so that patients maintain their healthy behaviors in the long term, even once no longer enrolled in a HealthPrize program.
John Ragland, Chief Strategy Officer at HealthPrize, puts it this way:
“We blend in gamification to start to reinforce positive health messages so that we shift the action of taking the medication from something they do to get an external reward into something they want to do internally. The personalized educational components of the member experience are what ultimately drive treatment persistence.”
When just a 10% increase in medication adherence could result in substantial improvements in health outcomes and reductions in overall healthcare costs, results like HealthPrize’s 50+% mean increase in adherence are no small matter.
- Cugelman, B. (2013). Gamification: What It Is and Why It Matters to Digital Health Behavior Change Developers. JMIR Serious Games, 1(1), e3. http://doi.org/10.2196/games.3139
- Hamari, J., Koivisto, J., & Sarsa, H. (2014). Does Gamification Work? – A Literature Review of Empirical Studies on Gamification. In Proceedings of the 47th Annual Hawaii International Conference on System Sciences, Hawaii, USA.
- Burns, M (2012). Dopamine and Learning: What the Brain’s Reward Center Can Teach Educators. Scientific Learning Fast ForWord. http://www.scilearn.com/blog/dopamine-learning-brains-reward-center-teach-educators
- Bunchball (2017). Gamification 101: An Introduction to the Use of Game Dynamics to Influence Behavior.
- Van Grove, J. (2011). Gamification: How Competition Is Reinventing Business, Marketing & Everyday Life. Mashable. http://mashable.com/2011/07/28/gamification/