Game-design elements have provided a sense of motivation and encouragement to many sectors of the healthcare industry, from individual user benefit to mass-campaigning from public health organizations. The gamification of healthcare has been transformative for patient motivation, especially when considering the doctor-patient-administrator relationship. Public health campaigns utilize gamification as a powerful strategy to promote healthy habits, such as mobile programming to encourage vaccinations, as well as online games to maintain hand hygiene. Through investigating both intrinsic and extrinsic behavior, this paper explores how gamification strategies are used throughout healthcare when considering the individual, as well as a population. This paper concludes with an emphasis on the importance of ensuring protective measures are talent to maintain data privacy, as well as inclusivity within socioeconomic statuses are integral to the success of gamification strategies, in order to combat concerns about the ethical concerns that may arise.
Gamification is the leading solution to assist users and obtain their attention by simulating games and game-like experiences to foster motivation amongst users. As major public health challenges plague our world like the rise of chronic disease rates linked to modern living habits, it is simple to assume that there is one factor that can alter the outcome of these issues: the individual themself. However, finding that motivation to maintain a healthy lifestyle is not as simple as healthcare campaigns make them out to be. It requires a high level of care, maintenance, and education, all of which are factors that the common person might find difficult to obtain without a specific care plan. These plans require focus and patience, as well as the privilege to follow through without worrying about the money or time-costs that follow it. This is where the process of gamification comes in. When applying a game design element to a non-game context, especially in a healthcare setting, a public health strategy of allowing all individuals to subscribe to a “game-plan” is implemented. The gamification of healthcare will allow for a maximized patient engagement approach, as well as the ability to improve health-oriented behavior. On the administrative side, gamification adds a significant step to fostering a healthy work environment that improves the patient-doctor-administrator relationship.
This paper strives to explore how gamification plays a role in healthcare settings, public health campaigns, and administration. By analyzing the decisions that are made when implementing gamification procedures within healthcare settings, new strategies can be constructed to create a strong environment that values the different relationships within. It is important to acknowledge how these gamified systems involve a key factor: the individual. Without emphasizing the importance of self-motivation and the goal of personal health, it can be easy to forget the target in question. Since incentive is a prominent factor across health behavior theory, it can be seen that motive is a key target for behavior change (Johnson et al., 2016). Not all forms of motivation are equal, thus noting that different gamified strategies are better suited for different walks of healthcare, from an administrative standpoint to the patient themself.
The behavior surrounding healthcare is one that must be analyzed through several different factors of encouragement and motivation. Through motivational factors that allow for positive healthcare habits, an intrinsic motivation strives to perform an act for pleasure, rather than for reward, whilst an extrinsic motivation focuses on those external factors that reach outside goals. Ultimately, the end goal is driven by praise, approval, winning, receiving a prize, or more.
With both intrinsic extrinsic motivational goals come the implementation of an effective rewards-based system. In terms of healthcare, health behavior consists of behaviors, habits, and attributes that relate to health restoration, maintenance, and improvement (Kraepelin et al., 2020). Kraepelin et al. explore health behavior change theories (HBCTs) as an explanatory model to predict changes in said behavior. With this to consider, creating a rewards-based model that measures HBCTs is integral to the success of gamified structures. According to Johnson et al., extrinsically motivated activity has the potential to limit autonomy when only completing tasks for the end reward. Both social and mental well-being benefit from intrinsic motivation, as well as sustainability goals (Johnson et al., 2016). Thus, the best transitional system to create for individuals looking to improve their health behavior is to combine both forms of motivation.
Jurriaan van Rijswijk, chairman of the Games for Health Europe Foundation, states that although motivation is a key factor in behavior change, the loyalty towards the subject of change is a critical factor that many individuals do not consider (“The Top Examples,” 2024). Long-term behavioral change is important, but committing to a dramatic and expensive change requires a gradual process. Through implementing a game-design strategy to an everyday commitment, users can obtain rewards for their behavior.
For example, health insurance company Blue Cross Blue Shield introduced a “wellvolution” program, where they saw 80% of participation rates from their employees. Incidentally, an increase in regular physical activity was seen across their wellness surveys, as well as an almost 50% drop in reported smoking rates (Aon Hewitt, 2013). In their Wellness Incentive program, members of FEP Blue Standard and Basic members can earn rewards, such as earning $50 when completing a standardized company health assessment, as well as completing certain goals with a daily habit tracker, earning up to $120 (“Wellness Incentive Program,” n.d.). This reward money can be spent at official retailers or for qualified medical expenses. By measuring habits like nutrition, exercise, weight loss, hypertension and COPD prevention, employees are able to participate in these challenges and receive a beneficial reward.
Different game-design-catered strategies can enhance all forms of healthcare, from mental health to physical health, as well as positive reinforcement with healthcare professionals. The popular meditation app, Headspace, is described as a “lifelong guide to mental health, mindfulness, and meditation” on the Apple App Store. The app promotes a progress tracking component to set goals and share insights with the app’s given personal coach. By integrating a progress tracker, users can interact with the interface in a way that benefits not only their mental health by creating healthy habits, while also tracking their progress through maintaining goals. Visualization of achievements allows users to maintain a regular schedule and feel rewarded for their efforts. Meditation efforts are also constructed through a gamified lens, with illustrations portraying different progressions, such as an expanding and shrinking plant growing, to represent breathing patterns (“The Best Way,” n.d.). Although not directly a game-design feature, this interactive resource enables users to visualize their daily tasks and see their achievements.
While seen to improve physical and mental health, gamification also finds itself successful when tied to a collective online goal or challenge. With several apps that elevate the experience of conducting physical activity, this provides a small solution to the fact that physical inactivity and sedentary behavior are among the leading risk factors for global mortality (Mazeas et al., 2022). With mobile applications such as “Zombies, run! 5K Training App,” and “Mobile Kids Monster Manor,” individuals who are not particularly active are motivated through gamified elements that coordinate with external activity monitoring and wearables. Additionally, with the implementation of fully designed online training programs and challenges, inactive individuals are given the end reward of “following-through” with the game, improving their chances for success in the game and increasing their health and physical fitness. Mazeas et al. Includes different behavioral theories within their analysis, emphasizing the importance that self-determination theory brings to gamified elements, as it is ultimately based on the motivation that individuals require to complete the tasks.
Although mobile applications and external monitoring devices do emphasize the importance of gamified elements, these devices often focus on personal fitness goals and health benefits. However, gamification also plays a role in mass campaigning. As seen with vaccine campaigning through different online challenges and programs, public health organizations such as the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have also utilized gamification techniques to encourage the public to practice healthy habits.
The World Health Organization implemented the WHO Academy in 2020 to educate both adults and children about global health efforts, emphasizing the importance of free and accessible learning solutions to combat the rapid pace of scientific discoveries. As new technology advances, all healthcare workers have a responsibility to continue learning, all throughout their careers (“About Us”, n.d.). The Academy presented a new game titled, “My 5 Moments for Hand Hygiene,” emphasizing that “increased compliance with hand hygiene at the point of care could prevent millions of health care-associated infections every year and save lives” (“My 5,” n.d.). In this, players are transported to the International Alien Hospital in the year 2224, and are tasked with looking after their alien patient and keeping Earth safe by practicing hand hygiene in the right moments. Although hand hygiene seems like a practice that is given, this game specifically targets students in healthcare education and clinical health professionals. Based on specific WHO Hand Hygiene guidelines, this game presents a game-design strategy that rewards clinical health professionals for not only keeping their character safe but also bringing these practices into their career and personal life.
These strategies can also be implemented throughout different vaccine campaigns. In a study conducted by Hakim et al., various vaccination campaigns were listed based on their efficiency, all with one similar factor: gamification. Different gamification elements were measured, such as reward points, leaderboard activity, serious-gaming, and role-playing methods. Whilst the studies were mostly conducted within the United Kingdom, a diverse set of study populations were involved, thus extracting data from various sociocultural communities. Different web-based tools were used to educate population groups on vaccine-preventable diseases, COVID-19, HPV, influenza, and other diseases. With programs with game-oriented names such as “Flu’s Clues,” “Virus Fighter,” and “Help take down COVID-zilla,” individuals who are motivated by a common goal of a reward can also reward themselves through healthy habits (Hakim et al., 2024). These gamified strategies additionally improve public health outcomes through increases in vaccination rates.
While gamified strategies have been shown to be efficient in increasing motivational factors by creating a transition from extrinsic to intrinsic motivation, there are ethical concerns that arise when discussing online healthcare strategies. Patient autonomy is a critical factor in gamification and must be critically considered when creating a game-design approach to healthcare. It is integral that the user in question is driven to make health-based decisions based on their personal healthcare, rather than the rewards that are attached to a gamified strategy. Thus, it is crucial to ensure that rather than overriding autonomy, gamification supports it instead. Gamification also has the potential to lead to poor psychological outcomes, often associated with an obsession with tracking behaviors, or developing anxiety if a certain task has not been fulfilled. Additionally, concerns about data privacy are certainly prevalent, through
Navigating ethical gamification is a process that can be fulfilled, however. It is integral that these user-health interfaces emphasize the importance of transparency. Users should understand where their data is going, regardless of if it goes to the company itself, or to epidemiological monitoring practices. Thus, users can be educated and will have the opportunity to make informed decisions about their data privacy and concerns. Gamified platforms also have a responsibility to ensure that users are interacting with their platforms in a healthy manner. Whether that is through a simple reminder in the form of a pop-up notification, or a disclaimer that is shown at the beginning of every process, it is integral that responsibility is taken as an interface designed to benefit healthcare. Furthermore, accessibility is critical, and education and motivational campaigns should not be limited to those privileged to access them. Alternative options can and should be made available, in the case of a user unable to participate in digital practices.
The gamification of healthcare is a powerful tool that can be utilized to encourage all individuals to promote healthy habits and to prioritize their healthcare needs. Whether to promote physical activity amongst those who might not be as active, or to healthcare employers who want to integrate reward-based programming within the workplace, these game-design strategies are designed with the user in mind. Through vaccination and sanitation campaigns, public health organizations can also participate in forms of motivation by creating entertaining and encouraging programs and digital games in order to improve the healthcare setting and public health goals. Ultimately, it is especially important to prioritize the user first, in terms of mental and physical health, while also promoting socioeconomic accessibility and inclusivity.
