(by Julia Bruntsch, Kerstin Janetta and Lorenz Harst)

One of the most popular examples for the use of gamification in healthcare is the mHealth game “Pokémon GO” (Figure 1), with almost 150 million active users per month. Whether catching Pokemon with the smartphone or using other gaming activities helps increasing healthy behavior or disease self-management is discussed by two students from the Health Information Management seminar taught by members of Care4Saxony.

Game-based elements can be used in non-game contexts to achieve goals beyond fun and pleasure . Gamification shall motivate to implement and sustain healthy behaviors and contribute to rehabilitation as well as to assess the disease status .

But how can that be achieved? It is the combination of game design, behavioral economics, motivational psychology and user experience that makes gamification effective . Game-based health prevention aims to deliver relevant knowledge and shift unhealthy behavior to promote a healthier lifestyle .

Since gamification has a motivational impact, it can have a positive effect on people’s behavior and lead to a performance enhancement. But why exactly are people motivated to perform a task?

The mechanism of gamification is that people do something through external incentives that they would otherwise not or only reluctantly do . In order to guarantee long-term success, extrinsic motivation, i.e. external recognition and success, must be replaced by intrinsic motivation. The self-determination theory of Ryan and Deci states that by promoting autonomy, competence and togetherness, motivation can be increased internally . The game-mechanics introduced in the following ensure this.

Badges, achievements, trophies (Figure 2) and other concepts are used to identify and reward individual behavior . This allows a comparison with other participants and promotes competition as a form of social comparison . Leaderboards dynamically rank individual user progress and achievements compared to their peers and competitors. They can represent a user’s position relative to others and provide him/her with a sense of his/her achievements both within the game and in real-world disease management . With challenges and quests, users may be motivated to continue using a system or an application. Tasks and challenges have to be solved in a certain time. The participant gains experience from this. Game mechanisms, like joint problem-solving, motivate participants to work together, promote communication among each other and enable social contacts to be established .

One of the core elements therefore is simulation. Users can observe the consequences of certain behaviors without engaging themselves in real danger. For example, the long-term effects of smoking can be shown within hours .

The smoking prevention game ‘Rex Ronan’ puts children in the role of the doctor Rex Ronan who is able to shrink and then enter the body of a smoker (Figure 3). In steering Ronan, users can observe first-handedly the negative consequences of smoking. In addition to this pictorial representation, an attractive, anti-smoking role model, and true-false-questions about the impact of smoking are parts of the game. The study showed that the anti-smoking attitude of children is reinforced and that the knowledge of specific negative effects of smoking on the body and their interest in learning more are increased .

A well-designed game shall offer repetitive practice which allows for the formation of habits by playing the game numerous times without making the player feel bored . That means fun is another core element in health-related contexts .

Those applications are set in different domains including promoting healthy nutrition, safe sexual behavior, anti-smoking, injury prevention or heart attack early treatment. The game “Heart Sense” covers the last domain. The player is exposed to a variety of heart attack situations. The results show that the understanding of symptoms and the intention to make emergency calls without delay was increased .

Meaningful implementation can increase engagement, influence psychological and behavioral outcomes. It therefore depends highly on a precise definition of the target group and a tailoring of the game content to the needs of the individual .

Game-based health prevention is especially an attractive channel to reach children and adolescents because repetitive skill practice and behavior rehearsal are provided with fun and entertainment (Figure 4). Besides, playing electronic games is one of the most popular activities .

Gamification approaches in general can help to understand why certain treatments and medications are necessary and how they work. That will lead to more confidence and a better management of side effects . Playful applications can help staying healthy and increasing the knowledge of how to handle certain diseases. Therefore, they are an important innovation in the field of health care.

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