The Gamification Playbook for Pharmaceutical Marketers

DEEP DIVE

What is gamification, why is it so engaging and how you can use it to improve adherence and health literacy?

Introduction

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 brand’s 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 the pharmaceutical industry.

By using core tactics of gamification in its digital engagement programs, pharmaceutical marketers and brand managers can tap into the psychological aspects of game mechanics to create high-value interactions with patients. Gamification can encourage and reinforce improved habits and behaviors such as taking one’s medication as prescribed or 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 non-adherence, the issue that cost the pharmaceutical industry $637 billion in 2015 alone.

This playbook will cover multiple aspects of gamification and how they apply to pharmaceutical marketing, including:

Basic facts and definitions
The science behind why gamification works
10 game mechanics that we can apply to patient behavior
3 gamification success stories
A look at how HealthPrize incorporates gamification into our platform

“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.”

— Brian Cugelman, PhD

Origins of Gamification

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,² “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.”

Exploring the Science of Gamification

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

What Every Game Designer Knows

There are ten fundamental game mechanics, but they don’t necessarily all have to be used together in order to be effective. Instead, think about what you want your “player customers” to feel and what behaviors you want to encourage or teach when choosing which mechanics to employ.

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.

Desire, Dopamine and Gamification

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.⁶

Now, marketers can harness the power of dopamine through gamification to help educate patients about their condition, their medication, and the benefits of remaining adherent.

“The addition of game mechanics to a site or application allows you to layer more compelling user experiences into existing activities. These gamified activities address and satisfy basic human desires, creating the addictive experiences that motivate users to take specific actions, and to return more frequently.”

— Bunchball³

Misconceptions and Pitfalls

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, 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.”⁶

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 reward 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

The Goal of Gamification

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 on time 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 Instagram, taking care of their children, and working to make money. They aren’t spending all day thinking about taking your medication. But gamification makes the process of adherence more fun and makes the option of taking a medication more enjoyable.

The goal of gamification in the pharmaceutical industry 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.

Extrinsic vs. Intrinsic Motivation

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, players or 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 education component of the platform – the surveys, quizzes, and daily tips – is what ultimately drives 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.

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.