The word Gamification can have one too many connotations for people, industries and situations encountered with this term. For some, PBL (Points, Badges & Leaderboards) may just be the best description of gamification. Gamification is NOT Games.
General rules of gamification (used anywhere) prescribe the following commandments:
- There is always progression, with increasing levels & challenges.
- Gamification is about cause-and-effect, it can go both upward and downward.
- Gamification is essentially a scaffolding over a central concept, to inculcate game-based learning.
When it comes to healthcare, gamification is a new concept that goes leaps and bounds beyond user characterization or rewarding users at measured intervals. In personalized healthcare, gamification may just be the tipping point for users pushing towards making lifestyle choices in the achievements of health objectives. Effecting behavior changes, that too in maintaining clear and healthy lifestyle is one of the most challenging premise for personalized healthcare applications.
While doing research across multiple products for gamification in healthcare, I came across the following feedback from end users:
- Applications becoming “Over-Powering” (aka Pushy) towards the achievement of fitness, or health management objectives. People do not like pushed towards something.
- One-route applications, people get bored with a single way of doing things, becoming monotonous and predictable. This is usually a fixed set of repeatable objectives, selected for a fixed period and achieved or missed; this pattern usually stays the same across the apps.
- Missing daily health indicators. Although most personalized healthcare apps share tons of statistics with the users after every achievement, people still find it difficult to relate on a personal level.
One of the factors most important while doing gamification in the healthcare is finding the right balance between positive (and sometimes negative) reinforcements in effecting changes in users. Generally, when implementing gamification, negative reinforcement can be done through some light punitive measures, or down scoring. That is entirely NOT the case in healthcare.
Researchers believe that any sort of negative reinforcement may cause users to stop using the application altogether, so teams working on gamification in healthcare industry must keep in mind that changes in user’s habits can be sometimes painstakingly slow. There may be sporadic, non-continuous uses of the app, depending on multiple factors, intrinsic and extrinsic.
Some of the factors in making gamification to work in personalized healthcare solutions are:
- Flexibility – Users should have multiple ways and means to achieve a goal or outcome. Rigid solutions do not motivate people to walk the extra mile. For example, even though step-tracker apps like Endomondo® or Fitbit® provide a multitude of exercise options to select from, in my opinion, the eventual goal of the person is to burncalories or gain fitness/power, something that can be achieved differently. Applications should be proactive in helping users by asking questions about the difficulty of the goal, providing them alternates to reach to their ultimate goal, i.e. burn calories.
- Patience – Users may start slow, but through constant motivation, may pick up pace later. Systems or solutions must be ‘patient’ enough to keep motivating in smaller chunks even when the achievement is not so significant, and on actual, when users are on the right path. Introspection (described below) helps in this. An example of this is MyFitnessPal® that keeps on reminding you each day when you have stopped logging goals, for a number of days after which it stops. Suggestions can vary, ranging from showing characterized stall of progress to the user, and keep on asking users what problems are they facing in achieving their goals.
- Introspection – Application teams involved in gamification should keep a continuous check on data coming in from users. Data is the sole indicator that can provide insights into changing habits, perceptions, behaviors etc.
- Surprise – People love being surprised. Sudden and variable rewards are found to increase dopamine and endorphin levels, making people feel-good about themselves, especially when they are using the application lesser than expected. Anticipation of rewards is all that matters here.
- Relate-Ability (aka Characterization) – Avatars or characters animated for the users, and reflective of the user’s daily achievements are great indicators of where the user is headed. People tend to accept personalized feedback if visible from appearance, but not ‘told’.