By Ali Warner
Dr Rachel Gawley, CEO and founder of AppAttic, which specialises in creating, developing and deploying apps for the health and wellness market, shares with Ali Warner her insight on the role of gamification in healthcare.
Pokémon GO is taking the world by storm. It’s officially a phenomenon. To date, it’s been downloaded more times than dating app Tinder, and has seen children and adults taking the to the streets in droves to locate and catch virtual Pokémon. For the uninitiated, Pokémon are pocket monsters with names as out there as Pidgey, Eevee and Pikachu. Once a playground card- swapping game, it has been transformed into a mobile app with a smattering of augmented reality thrown in.
But it’s one of the game’s positive side-effects, rather than the game itself, that has led many in the medtech industry, including medtech trendspotter Paul Sonnier, to take note. And that side-effect is that once sedentary gamers are willingly leaving their sofas to walk kilometres each day in search of their Pokémon prey. And, in the process, they are also acknowledging the physical and mental health benefits that the outdoor exercise is providing. By simply making physical activity a means to a gaming-end, participants are seeing exercise as more fun and less of a chore.
This ‘side-effect’ is already getting results for medical practitioners at CS Mott Children’s Hospital in Michigan, USA. The hospital team there is using the app to encourage their young patients to connect with one another , to push themselves further in their rehabilitation exercises and to even venture out of their hospital bed.
The gamification of healthcare
So what’s the definition of gamification? It’s generally agreed to be the use of game elements in non-gaming contexts – so in the field of medtech it could be adding gaming elements to devices to encourage taking regular or correct dosages of medicine, or rewarding a patient for behaviours that improve their mental or physical health.
While gamification only really took off in 2010, the concept has existed in an analogue, yet no less effective form, since your mum first made airplane noises to encourage the toddler-you to eat an extra spoonful of greens. The principles come from psychology and behavioural science, but essentially the aim of gamification is to improve motivation and encourage productivity or behaviour change while making things fun. The key to its success, whatever the application, is clear, player-centric rules and goals.
‘While gamification only really took off in 2010, the concept has existed… since your mum first made airplane noises to encourage the toddler-you to eat an extra spoonful of greens’
‘But take note, gamification is not a silver bullet. Like most things, it needs to be assessed to make sure it’s a good fit for whatever entity you wish to apply it to. It can be used to amplify motivation, but to be successful there needs to be some intrinsic motivation already there.’
Evidence of success
But does it actually work? Here’s a list of 90 gamification case studies that are worth perusing. Notable among them are the Astra Zeneca and Galderma examples that see gamification techniques used to encourage staff to complete online training programmes; Fun Theory’s piano stairs, which encouraged 66 per cent more people to take the stairs after the steps were painted and tuned to sound like piano keys; and the research stats that saw an uplift of 18 per cent in grades when gaming elements were added to a study course.
So what’s the potential appeal of gamification for medtech and mHealth? It’s appealing because it is empowering to the user and drives behavioural change. Cost saving is also a big driver because it’s extremely inexpensive and scalable when compared to other solutions; once an idea is developed, it can be rolled out to massive audiences with relative ease. Using the fun element of gaming can potentially lead to a happier as well as healthier society; and that healthier society means funds can be redirected into more proactive activities such as research and education.
Currently the majority of health spend is on treating conditions, many of which are preventable. We’re spending a lot of money fixing things rather than making society better. With better health encouraged through long-term behavioural change, there is the potential to save billions of pounds globally, annually.
Medication non-adherence costs the NHS £500 million a year. In the US, that figure is $290 billion. Chronic conditions account for 70 per cent of the NHS’ budget (in the US, it’s 86 per cent, equivalent to close to $2.9 trillion). Add to this the cost of lost revenue/economic activity that occurs as a result of illness and stress… alongside the strain on family/friends and you’re talking a lot of money. Death after these ‘diseases’ often follows years of needless suffering, disability and, in many cases, extreme poverty (especially in the US). This is especially sad considering that at least 80 per cent of cases of heart disease, stroke and diabetes are preventable.
Medtech and gamification: what's happening now?
Gamification in medtech is a very new area, especially if you’re talking specifically about health and medicines, whereby there is a lot of legislation and costs, such as clinical trials and insurance, involved to enter the market. As a result, you will find most consumer apps are still categorised as ‘wellness’. The key to moving the industry forward is validation and clinical trials, which many people are avoiding doing so they can stay within the wellness category on their apps.
Recently, however, there has been a surge in serious games that address rehabilitation, cognitive disorders, and even medical research and analysis, such as Cancer Research UK’s Citizen Science. There’s also a great iPhone app, Pain Squad, which has seen tremendous success in encouraging children with cancer to track and record pain during their treatment. In turn this has allowed doctors to gather appropriate data to improve their young patients’ overall care.
Here at AppAttic, we are also running a clinical trial of a medicines management gamification app with the South Eastern Health and Social care Trust, in Northern Ireland. The aim is to see if a gamified mobile app can improve medicine adherence and provide useful, timely data to the clinician. We do this though an end-to-end solution that uses Fitbit data to further validate against clinical findings and feeds into a real-time insights dashboard. So, in short, the industry is moving – and it’s moving fast.
What's the future for gamification in medtech?
Gamification will certainly become more commonplace. It will be built into nearly every technology within work, education and wellness environments. But low-quality, over-gamification of meaningless activities and entities will be disregarded by the public, much like junk mail and banner ads. Simple techniques will be the norm. Soon brands will seek to move beyond gamification into more immersive experiences.
The future lies in deeper, more meaningful engagement to drive long-term behavioural change. This will use connected devices, technological advances and behavioural science. Problems that can be solved through Big Data and Open Data will be gamified to motivate public participation. Personally, I’d like to see connected devices and the Internet of Things motivating people to be healthier. For example, smart play parks, buggies, refrigerators, toothbrushes and workplaces that could gamify a more holistic lifestyle, rather than current health wearables that just encourage you to walk or go for a run.
However, gamification and connected devices ultimately involve personal data so I see privacy and security as being big factors that will come into play. The biggest barrier to widespread uptake of connected devices is that our current healthcare system and service model can’t cope with all the new technology coming through.
App developers will need to consider – and quickly – how or if they can work within the system. In the medium term, a gamified medtech future will mean that instead of wearing wearable devices, our bodies will become the hub. We will see more on-skin and under-skin sensors collecting and sending data. We will become part human, part computer. From cradle to grave, we will be a living part of the system, with all our health data feeding into predictive and precision medicine.