Gamification Rules

| August 20, 2014 | 0 Comments

By Annie Ryu

Annie Ryu is Co-founder and CSO of LifeGuard Games, a company building edugame apps to teach and motivate kids to manage chronic conditions. Prior to launching LifeGuard Games, she co-founded, directed, and implemented a maternal and child health SMS-based venture in rural southern India.

Since the 1980s, public discourse on video games’ influences has typically revolved around games’ suspected contributions to violent thought and behavior, sedentary lifestyles and obesity, and distraction from school and work.1 Within the last few years, however, hype around e-health (electronic health), m-health (mobile health), and health technology has impelled a new vision for gaming in healthcare.2 Healthcare providers and insurers are increasingly viewing games as a powerful mechanism to facilitate positive behavior change:3 leveraging the popularity and influence of gaming at a population level in healthcare may lead to dramatically reduced costs and improved health.


Yet, the question remains: how much confidence, effort, and money should society logically invest in the field of games for health? This is a difficult question to answer, given that the promises of e-health and m-health largely remain to be realized. Benefits from e-health and m-health have been hampered by challenges in technology design, implementation, and scaling, and poor research study design has contributed to a lack of conclusive data on impact.4-5


Still, some say we should be investing a great deal. The most well-known contemporary proponent of games’ potential positive influence is Jane McGonigal, professional game designer, TED speaker, and New York Times bestselling author of Reality if Broken: Why Games Make Us Better and How They Can Change the World. After a traumatic brain injury in 2009, she invented SuperBetter to help heal herself.6 This therapeutic game—a pioneer in the field of games for health—worked for Jane, succeeding where traditional therapy had failed her.5 If she has her wish, a game designer will be nominated for a Nobel Prize during her lifetime.7


Why place so much hope in games? Dozens of research studies can be marshaled to demonstrate games’ capacity to increase self-efficacy, motivation, determination, resilience, and creativity, to promote social relationships and cooperation, and to treat clinical anxiety, depression, and stress.8 Globally, three billion hours a week are spent gaming, and in the United States alone, $15.5 billion was spent on videogames in 2010.9


While games for health is a recently popularized concept, games for health have already been developed focusing on health education, health risk prevention, behavioral intervention, disease self-management, pain relief, medical training, and more.10-11 In 2009, researchers from Michigan State University published a review of 20 years of electronic games for health.11 Among noteworthy empirical results was a 70% reduction in urgent visits for diabetes recorded in 1997 in a randomized controlled field experiment with Packy & Marlon, a game in which players help two adolescent elephants monitor blood glucose, take proper amounts of insulin, and find appropriate food.12 Similarly, a game called Bronkie the Bronchiasaurus tasks players with guiding an asthmatic dinosaur away from asthma triggers; an empirical study in 2001 found that less than one hour of game play led to significant improvements in a player’s asthma knowledge, self-efficacy for asthma self-management, and self-efficacy for discussing asthma with friends.13


Results like these beg the question of why games for health haven’t penetrated further into our lives. One reason is that many teams developing games have often focused on narrow target audiences as well as ignored games’ capacity to appeal to adults.14 Another reason is that games have failed to garner the attention among healthcare providers and insurers seeking already established evidence of impact. A 2012 systematic review of video games’ role in improving health-related outcomes found that study quality was “generally poor”: only 11% of studies had blinded researchers, and only 33% of studies had follow-up periods that were longer than 3 months.15 A systematic review focused on gaming’s potential as a tool for training healthcare professionals found “a paucity of studies showing the conclusive clinical benefit of serious gaming.”16


But there’s often a more fundamental problem with scaling up the games made for healthcare: poor game design. Gartner technology research firm predicts that by 2014, 80% of today’s gamified apps will fail to meet business objectives because of the apps’ poor design.17 The healthcare community has been quick to use the term “gamification” to describe loyalty programs that lack the design elements needed to make games deeply motivating.18-19 Many of the games that have failed have relied too heavily on simple “pointification,” the awarding of points and trophies to players. To facilitate behavior changes for real health improvements, games likely need to be “sticky,” captivating for players over long periods of time.19


In order to reach massive audiences, games for health must truly be fun.20 Design teams must be interdisciplinary: behavioral psychologists and healthcare professionals can guide the overarching goals of the games, but experienced game designers must be involved in the planning as well as the construction of the games.


Will the costs to develop truly fun games justify the benefits? Time will tell, as games for health continues to gather momentum—and players.21 Minnetonka, MN-based UnitedHealth Group has launched the app Optumize Me to foster fitness-related contests among friends.19 Kea, a gamified workplace social network platform, has been adopted by over a dozen organizations, including St. Lawrence College, Pandora, and Pfizer.22 To date, the majority of commercially successful games for health have focused on fitness, appealing to an extremely broad adult population. But, as the healthcare market and recognition of games’ potential continue to drive the proliferation of games for health, truly fun games for specific health conditions are almost certainly on their way.

1. Wikipedia. “Video Game Controversies.” Web. 21 Jul. 2013 <>.

2. King, Dominic, et al. “’Gamification’: Influencing Health Behaviors with Games.” Journal of the Royal Society of Medicine 106 (2013): 76-78.

3. Kleman, Margo. “Gamifying Healthcare: A New Trend.” Technology Advice 6 May 2013. Web. 21 July. 2013 <>.

4. de Jongh, T. et al. “Mobile Phone Messaging for Facilitating Self-Management of Long-Term Illnesses.” Cochrane Database of Systematic Reviews 12 (2012).

5. Free, C. et al. “The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis.” PLoS Med 10.1 (2013).

6. Kolodny, Lora. “Gamer Heal Thyself with Jane McGonigal’s SuperBetter.” Fast Company 7 Sept. 2011. Web. 20 Jul. 2013 <>.

7. McGonigal, Jane. “Achievements: Unlocked.” JaneMcGonigal 23 Dec. 2010. Web. 21 Jul. 2013 <>.

8. McGonigal, Jane. “Show Me the Science! Resilience, Games, Post-Traumatic Growth, and More.” SuperBetterBlog 4 Jun. 2012. Web. 21 Jul. 2013 <>.

9. McGonigal, Jane. “Be a Gamer, Save the World.” The Wall Street Journal. 22 Jan. 2011. Web. 21 Jul. 2013 <>.

10. Gallagher, Danny. “7 Health Benefits of Playing Video Games.” The Week 10 Mar. 2013: n. pag. Web. 21 July 2013 <>.

11. Peng, Wei, and Ming Liu. “Chapter XXIII: An Overview of Using Electronic Games for Health Purposes.” Effective Electronic Gaming in Education. Hershey: IGI Global, 2009. 388-401. Web. <>.

12. Brown, S. et al. “Educational Video Game for Juvenile Diabetes: Results of a Controlled Trial.“ Medical Informatics 22 (1997): 77-89.

13. Lieberman, Debra. “Management of Chronic Pediatric Diseases with Interactive Health Games: Theory and Research Findings.” Journal of Ambulatory Care Management 24 (2001): 26-38.

14. DeShazo, Jonathan, Lynne Harris, and Wanda Pratt. “Effective Intervention or Child’s Play? A Review of Video Games for Diabetes Education.” Diabetes Technology & Therapeutics 12.10 (2010): 815-822.

15. Primack, Brian, et al. “Role of Video Games in Improving Health-Related Outcomes.”  American Journal of Preventive Medicine 42.6 (2012): 630-638.

16. de Wit-Zuurendonk, L, and SG Oei. “Serious Gaming in Women’s Health Care.” BJOG Suppl. 3 (2011) 17-21.

17. Gartner. “Gartner Says by 2014, 80 Percent of Current Gamified Applications Will Fail to Meet Business Objectives Primarily Due to Poor Design.” Gartner 27 Nov. 2012. Web. 21 July 2013 <>.

18. Werbach, Kevin, and Dan Hunter. For the Win: How Game Thinking Can Revolutionize Your Business. Philadelphia: Wharton Digital Press, 2012.

19. Knowledge@Wharton. “How Companies are Using Gamification to Transform Health Care.” Business Insider 18 Jan. 2013. Web. 21 July 2013 <>.

20. Thompson, Debbe. “Designing Serious Video Games for Health Behavior Change: Current Status and Future Directions.” Journal of Diabetes Science and Technology 6.4 (2012): 807-811.

21. Doyle, Kathryn. “Do We Have a Winner? Gamification in Healthcare.” Healthbiz Decoded 13 May 2013. Web. 21 July 2013. <>.

22. Keas. “The Power of Play: The Wellness Program that Works.” Keas. Web. 21 July 2013 <>.



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