Is Gamification a Healthcare Game-Changer?

In an effort to help children with cerebral palsy or spina bifida undergoing physical therapy and diagnostic testing, a group of engineering students at Rice University have constructed a videogame system consisting of Wii Balance Boards arranged between handrails and a screen.

Patients shoot approaching monsters by hitting specific spots of the boards with their feet. As they improve, the game becomes more challenging and gamers rack up points. The setup both intends to improve balance and coordinated movement, as well as incorporate feedback from the handrails into the game.

Gaming grew organically via centuries of incentive-based activity and entertainment. The term ‘gamification’ is an umbrella for a heap of loosely floating concepts that reach beyond any marketing scheme. And despite the claims of detractors, it’s also not a ploy to rein in the wild and gaudy games industry.

Let’s apply the concept to healthcare. Why wouldn’t we use gaming to help make treatments something a patient likes to do, without feeling like it’s something a doctor casually suggested? Imagine its influence on obesity rates, smoking cessation and entertainment for cancer patients.

Consider mobile apps like Nike Plus for iPhone and Massive Health’s The Eatery. Both promote fitness and health to users via engaging, purpose-driven activities. They share results with users in their social networks and earn scores based on their performance.

However, some feel their true objectives – improved health, avoiding obesity and healthcare cost reduction – are trivialized by gimmicky incentives. Part of it is because gamification has been associated with the banality of Foursquare badges and Klout scores. While both are highly successful manifestations of the idea, they highlight conflicts involved with defining gamification and overshadow its advantages.

Describing a concept in its infancy is always problematic, i.e., meaningful use. ‘Gamification’ as an expression has received significant negative backlash, dismissed as another marketing buzzword devoid of much consequence beyond the fattening of pockets. Much of the skepticism lies in the virality of its growth from rather obscure search term to 4.9 million Google search results in two years. Why the hoopla?

Mashable defines gamification as “the use of gameplay mechanics for non-game applications.” In a 2010 TED Talk, game theorist Jane McGonigal takes this one step further by discussing the urgent optimism and human optimization of gaming – simply put, gamers believe they are capable of changing virtual worlds. Her goal is to help translate that attitude into the physical world, or ‘IRL’ in gamer-speak.

In other words, if used properly, the phrase ‘epic win’ could be associated with the improvement of healthcare.

For instance, the University Orthopedic Center in Salt Lake City has used Wii Fit as a form of physical therapy to correct issues like equilibrium for years. And while the game may not correct all physical shortcomings, it’s a useful way to transition to a full-fledged exercise routine from a previously sedentary lifestyle.

PE Interactive, built for the Microsoft XNA platform by University of Utah students, uses Sony’s Move motion controller to complete challenges like building retaining walls to guard island inhabitants from a tsunami. The walls figuratively represent the patient’s immune system.

Users are also inspired to get stronger via the game’s protagonist, a superhero who becomes increasingly more powerful as he wards off his arch nemesis.

So, there’s no doubt that contests between the user and the game can be highly effective in healthcare. But how do we justify games that highlight competing against others?

California-based HopeLab hopes to decrease child obesity with Zamzee, a device students wear to track their physical activity. Developers say the game helps users be 30% more active than non-users by racking up points, winning and purchasing goods as goals are met, and competing with friends.

Some argue that social gaming, even to maximize patient benefits, is detrimental to progress. It’s true that gamification is not a friend of egalitarianism – it perpetuates incentivization, a very Western notion thought to promote efficiency. See: capitalism.

For an economic determinist, economic decisions make up the backbone of our society. So it seems natural for competition to filter down into all aspects of modern life as it has been for centuries, in a manner that parallels the evolution of games.

Gamifying industries like healthcare or education appeals to Nozick’s rebuttal of Rawls’s Difference Principle: inequalities cannot be unjust so long as they arise from voluntary exchanges. Competitive gaming is, in fact, a voluntary exchange.

Zynga has helped define consumer expectations for gamified user experiences. They masterminded the popular Facebook app Farmville, which is designed so the emotional impact of failing to act is more powerful than feelings of having benefited.

Incorporating this dynamic into mobile apps like Medullan’s, which forces quitting smokers to place a street cone in the app’s tracker that forces them back onto square one whenever they cheat, allows users attempting to improve their health to succeed in a competitive social setting and earn bragging rights.

According to McGonigal’s talk, “gamers are a human resource that we can use to do real world work, that games are a powerful platform for change.” From this angle, gamification is not only a powerful tool for personal health and industry change, but the crowdsourcing opportunities are promising.

McGonigal was part of a team that helped design Superstruct at the Institute For The Future. In the game, a supercomputer called the “Global Extinction Awareness System” predicted that humanity has 23 years left on the planet.

Lifelike news reports and videos make the user feel immersed in this “epic adventure” of sorts, and they’re tasked with brainstorming ideas for the future of energy, health, food, security and the social safety net. Eight thousand people played for eight weeks, resulting in 500 creative solutions to help avert planetary harm.

Imagine what this kind of brainpower can do for healthcare. As McGonigal herself would say, “We can make any future we want. Let the world changing games begin.”