Gamification for Device Makers: Lead With Fun and Health Will Follow

Can a game be more than a distraction? Can you use gaming to create real clinical outcomes and behavior change in patients? You can, according to HopeLab, an organization dedicated to using technology to motivate and sustain behavior change. But what should device makers be on the lookout for? 

One of HopeLab's latest developments, Zamzee (name of product and company), is showing promise in using gamification - implementing gaming principles and concepts toward problem solving – to increase physical activity and improve health in children and adolescents.

Zamzee consists of a small accelerometer-based activity tracker that clips to a child's clothes and connects to a computer and Web site via USB to report on kids' activity and movement, allow them participate in game-based challenges for rewards, and share their progress with family and friends via the site's social functionality.

Research done by HopeLab, with support from the Robert Wood Johnson Foundation, with 448 kid, ages 9-15, sover a series of 12 randomized controlled trials found that kids who used Zamzee were 59% more active than a control group. Obese kids were 27% more active.

The company works with healthcare providers, schools, community groups, and families to teach parents and kids about healthy habits and encourage more physical activity. In October the company also released Zamzee for Groups, a powerful data collection tool that allows doctors, clinicians, and other program leaders to motivate, measure and manage physical activity in real time.

While Zamzee focuse on fitness in children and adolescents, Dan Botwinick, VP of marketing and program development, and the rest of the team at Zamzee, believe that the principles of gamification can apply to a variety of medical and healthcare situations to improve outcomes. “I think gamification is widely relevant and applicable but needs to be thought through for each application,” says Botwinick who will be speaking on the subject at Wireless Medical Devices West in San Jose, CA.

Understand Your Audience's Challenges

Deeply understand your audience and what moves them. What challenges do they face? “As part of developing Zamzee, we conducted deep levels of human factors research to really understand the root causes of sedentary behavior,” Botwinick says. “People assume it's just TV and video games driving sedentary behavior, but it's much more complex than that. Kids have responsibilities: Maybe they live in an unsafe neighborhood, or they must care for siblings. There are also kids who have tried sports but feel dejected or rejected by them.When you understand the root causes of the behavior you're trying to affect you can build an intervention that has a more nuanced understanding of what those causes are.”

One of HopeLab's earlier projects was a game called Re-Mission (followed in true video game fashion by Re-Mission 2) designed to educate kids being treated for cancer on their treatment. “One challenge in a pediatric population among middle-aged kids is they really have trouble sticking to their treatment regimes,” Botwinick explains. “So the game engages them in that process and gives them control over it. It had a really positive outcome on treatment adherence.

“If you can create an experience using game design principles that make people feel empowered and in control and deeply connected to whatever it is they're going through, that's a huge, huge boost to everyone involved. It makes the experience not a cold, scientific but one they can connect to emotionally and psychologically.”

Understand What Moves and Motivates Your Audience

Zamzee's core design principle is to use extrinsic motivation to kickstart behavioral change – make the experience fun and rewarding, and the desired behavior will follow. In its research, the company has found that extrinsic motivation is powerful among its target group. In other words, kids love the almighty dollar. Zamzee allows kids to earn real life rewards, like a $5 gift certificate from Amazon, Target, or Walmart reasonably fast (in one to two weeks). But Botwinick cautions, “Extrinsic motivators experience diminishing returns over time, so it's not as effective in sustaining behavior change over the long term.”

He stresses that while intrinsic factors like badges, levels, and Xbox or Playstation-style achievements, are a good starting point, “What's really important is creating that context that helps people care about the badges and levels. For us we really focus on creating a sense of purpose, goals, a sense of connection, and a sense of control - where they can have control over the outcome and control over whether they improve or not.”

Zamzee's reward system is based on an algorithm that recognizes behavior that predicts long-term engagement. Kids are rewarded for improving over their average, not for gross performance. “We know that if a kid uploads movement data every day, for example, they're more likely to stay active in the long term. So we try to encourage that behavior,” Botwinick says. Systems like providing bonus points for daily goal setting and achievement and narrative-driven challenges (I.e A player is trapped on a pirate ship and has 15 minutes to swim a certain distance) help drive this behavior.

Understand How Much to Compete

As any avid video gamer (or a parent to one) can likely tell you. November will see the release of the Playstation 4 (PS4) and XBox One, two highly-anticipated, next-generation gaming consoles. And while both consoles, and others like the Nintendo Wii, have functions that are very much geared toward creating more active, physical participation, the big, money-making blockbuster games don't yet fall into this category. A 2008 University of Minnesota study confirmed much of HopeLab's ideas on motivation and found that Wii Fit, an exercise-based game for Nintendo Wii, had no significant effect on physical fitness, particularly for adults, mainly due to drastic declines in participation for users after only six weeks. Children showed an effect, but for adults there is simply no motivation to encourage long-term behavior change.

So the question remains, how do device makers looking to use gamification to create active patients with improved outcomes compete with a billion-dollar industry whose products are very much geared toward keeping potential patients (kids in particular) glued to their couches?

“That's something we think about a lot,” Botwinick says. “[But] our goal is not necessarily to replace Call of Duty time with Zamzee time, but rather to get kids enjoying being active more so they're maybe replacing 20-30% of their Call of Duty time with outdoor fun and active fun, and they just happen to be carrying their Zamzee while doing that.”

For smaller companies and healthcare companies the goal shouldn't be total, overnight takeover, but just a habit integration done over time. “[Zamzee's] reason for being is the kid who's active six minutes then goes to 10, 16, or 22 minutes a week,” Botwinick says. “That 's the kind of slow, steady behavior change we try to encourage.”

-Chris Wiltz, Associate Editor, MD+DI
[email protected]