Almost everything you ever wanted to know about gamification

Almost everything you ever wanted to know about gamification

(by Lisa Aschenbrenner, Lena Otto and Lorenz Harst)

This is a science blog post of one of our students from the Health Information Management seminar taught by members of Care4Saxony. In this article, the concept of gamification and its use in the digitalized health care are investigated.

Gamifi-what…? What is this article actually about?

Gamification can be described as the application of game elements in a non-gaming environment and can therefore change behaviour and increase user engagement through positive feedback and rewards . Game-based features, such as points, levels and leaderboards, satisfy the human need for competition and social interaction and use multiple behavioural change approaches . Besides gamification itself, “mHealth” is also mentioned frequently in the literature, meaning that health-related services are provided by mobile or portable devices .

Talking about using mobile devices… what’s the benefit for me?

Mobile applications are particularly promising because they appear more affordable, less invasive and faster intervening than classical medical procedures, while providing direct feedback and a personal, traceable record of activities . Another reason for mHealth use is that the disruption of normal life is a factor in how stressful a patient considers his or her medical condition . Taking this into consideration, it can be further interpreted that a mobile application on a patient’s own device interferes less with privacy than medical consultations and thus has positive effects.

Through which kind of wizardry or sorcery are the mentioned applications doing all this?

According to a study, the most important techniques for changing behaviour in smartphone applications are feedback and monitoring, comparison of behaviour as well as reward and threat . Certain theories of behavioural change are used in the gamification context. These include the Health Belief Model, which is used for health promotion, the Transtheoretical model, which is used in connection with addictive behaviour, and the Theory of planned behaviour, which is reflected in fitness interventions. In order to stimulate changes in behaviour, a multitheory approach is recommended throughout the literature .

I heard about Pokémon Go, that’s pretty much what this is all about, right?

Pokémon Go was in the limelight a few years ago, motivating users to become physically active. But the health potential of apps goes far beyond lifestyle applications, namely when specific diseases are addressed. According to the WHO, chronic diseases are the main driver of mortality, accounting for about 60% of all deaths worldwide . For this reason chronic diseases are an established field of application for mHealth apps and gamification.

Tell me more…

Diabetes is nowadays the most widespread chronic disease worldwide. For people with diabetes it is important to understand and adhere to their medication and to practice a careful self-management. Self-management means that patients are able to cope with the treatment, symptoms and psychosocial consequences of diseases . Since not everyone has equal access to medical care, apps that support self-management have become increasingly important in recent years .

I suppose, as so often in literature, there is a framework to better understand all this?

The “Model for Motivational Mobile-health Design for Chronic Conditions” states that three important features play an essential role in mHealth app design, namely condition specific, motivation related, and technology based components . Using self-management, socializing, self-representation, fun, esteem, motivation, sustainability and growth factors, apps can be developed that provide users suffering from chronic illnesses with reliable self-management support .

Okay, enough with the theory… Give me more examples!

Breast cancer is the most common cancer among women worldwide and for all those suffering from this disease self-management applications can likewise be beneficial. Here, the focus within existing apps is particularly on treating the symptoms and side effects of chemotherapy, informing about breast health, recording sleep patterns and motivating people to adopt a healthier and more active lifestyle . A well-known example of gamification in the field of cancer is the game “Re-Mission” where the player flies through the body of virtual patients and fights against tumour cells and side effects of the disease and thus gets motivated to fight the condition .

The game “Re-Mission”, in which cancer patients fight against tumours (, 26.01.2020)

Is it possible to use the gamification approach preventively, to help before any harm is done?…That would be great!

Clever storytelling can close gaps in knowledge about medical content by guiding users of such applications through a narrative storyline with example patients, thus introducing them to disease prevention measures. Such applications are used, for example, for HIV education in less developed countries .

Screenshots of “Battle in the Blood” – a HIV-prevention game [Hemingway, 2019]

Another example can be found in the field of addiction prevention, such as the so-called “Drink & Drive” game in which increasing alcohol levels and delayed reactions can be experienced in a racing game. This can be used to point out wrong behaviour patterns in a safe environment but with certain visual and mental stimulus .

“Drink & Drive” – experiencing alcohol induced impairments in a gamified setting [Gaibler et al., 2015]

You have answered almost all my questions! I just wonder what the future has to offer me anymore?

The mentioned diseases and associated gamification applications are only a tiny fragment of what is possible. Just as large as the multitude of diseases is probably the potential that can still be found in gamification. A look into the future promises a combination of gamification with virtual and augmented reality as well as artificial intelligence .


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