What is gamification, why is it so engaging and how you can use it to improve adherence and health literacy?
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.5 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
1. Onboarding
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.
2. Goals
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 customers, educating them about what they can do for optimal health – and what your product can do to help them achieve their goals.
3. Fast Feedback
Whether positive or negative, give players and customers 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 reward, or providing advice so that they can improve.
4. Transparency
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 customer 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 customers to access new and exciting activities, badges, and rewards.

6. Leaderboards
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 customers 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 and wellness. The most effective leaderboards in a consumer context keep competition light and positive, positioning an activity as an opportunity for advancement, not as means of frustration.
7. Badges
As mentioned in the section on Fast Feedback, badges and medals are a great way to help your customers visualize how far they’ve already come. Particularly when used as a shareable graphic, badges provide player customers with a tangible congratulations and something that they can share with their online social networks.
8. Points
Every game has some way of keeping score. Points enable player customers to track their progress, feel a sense of status, or even unlock rewards like virtual or real-world goods. Points could be earned for achieving goals, leveling up, sharing, contributing, engaging, or interacting with the community in a meaningful way.
9. Collaboration
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 customers. Player customers could create teams, and tackle puzzles and challenges together.
10. Community
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.
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.
Bartle’s Player Type Diagram Visual

References
- Firlik, K, Moore T, & Chawla, S. (2016). Estimated Annual Pharmaceutical Revenue Loss Due to Medication Nonadherence. Adherence564.com. Capgemini Consulting and HealthPrize Technologies.
- 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
- Malone, T. (1980). What Makes Things Fun: A Study of Intrinsically Motivating Computer Games. Xerox, Palo Alto Research Center.
- Bunchball (2017). Gamification 101: An Introduction to the Use of Game Dynamics to Influence Behavior.
- 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
- 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.
- Van Grove, J. (2011). Gamification: How Competition Is Reinventing Business, Marketing & Everyday Life. Mashable. http://mashable.com/2011/07/28/gamification/
- Edery, D & Mollick, E. (2008). Changing the Game: How Video Games Are Transforming the Future of Business. Pearson Education, Upper Saddle River, NJ
- Sorrel, C. (2010). Swedish Speed-Camera Pays Drivers to Slow Down. Wired, https://www.wired.com/2010/12/swedish-speed-camera-pays-drivers-to-slow-down/
- Bidgely. (2016). Automated Demand Response with >30% Peak Load Shift. Bidgely, Inc.