Healthcare x Gaming

Earlier this year, we wrote about gaming’s role in education and how applying gaming principles can be a means to motivate users toward practical outcomes (i.e., learning a skill or saving money). This week, we want to propose a better framework for play-driven human behavior and apply it in the context of healthcare and gaming.

The framework

Introducing “play” to applications that are not traditional games should enhance or fundamentally alter human behavior. We believe that game mechanics can be evaluated on two criteria:

1. Push vs Pull: Is the feature driving the user to take an action (push) or are they incentivizing a user to take an action (pull)? Push features make a user feel like they have to take action. A player-vs-player (PvP) mode or storyline-based progression systems are examples of push features. Pull features can best be described as “dangling a carrot” to encourage a user to reach a goal, such as a cosmetic badge achievement system.
2. Level of influence on human behavior: On one end of the scale, features of an application can cause users to take actions that they otherwise would not (i.e., learn a new language). On the other end, the action might have been one that the user would do anyway, but the game-like mechanics are a “nice-to-have”, like rewarding “karma” points for contributing to forums that the user would have likely still posted on anyway. Between these two extremes are features that enhance. This is driven by making a user’s experience more fun, sustainable, and/or effective. Streaks are an example of this.

It is important to note that where a feature falls on each scale may not be the same across all users. For example, one user may want to complete a mini-quest because it helps them unlock new content, while another may complete the same mini-quest for the reward. Ideally, every application that introduces game-like features takes this into consideration and ensures that their feature set has enough diversity to appeal to the full spectrum of users.

Keeping this in mind, we have mapped a set of consumer applications by where their most notable features fall within these two criteria:

The importance of fun: Enjoyment directly impacts the effectiveness of a given mechanic. The amount of fun required to get a user to download and use the app depends on where the primary feature set falls on the ”level of influence on human behavior” scale. The closer a feature set gets to either extremity, the more fun they must be to be effective:

• If the app is supposed to lead a user to take an action that they would not normally do, then fun is needed for a user to want to download and experience the app for the first time. For example, the user experience of Duolingo is appealing to users that are not actively seeking to learn a language in more traditional, offline mediums (classroom learning, private tutoring, reading vocabulary and grammar books).
• On the other hand, if the user would have taken the action agnostic of any extrinsic nudges, then a feature needs to be fun in order to give the user a reason to use the app in tandem. For example, the average US adult drinks 5.5 cups of water per day unprompted (CDC), but Plant Nanny is a fun way to ensure that a user is hydrating enough.

Applying the framework to healthcare apps

While any application ideally has multiple features that apply to different areas of this matrix in order to gain broad appeal, some industries including consumer-focused healthcare naturally tend to fall within a certain region.

• Fitbit - Paired with a wearable tracker, the app functions as a personal fitness monitor. The user can earn badges by completing certain activities, compete with their friends in sports-related competitions, and engage in location-specific challenges in their cities.
• MySugr - Diabetes management app that depicts diabetes as a monster (digital companion) that should be tamed by keeping track of eating habits and sugar levels.
• Zoe - Personalized nutrition app that helps users track the food they eat and measures the corresponding changes in blood sugar and fat. The app then creates a predictive model of the user’s metabolism and a personalized menu of foods and meals the user should eat. The app also includes challenges based on user goals such as hitting a certain level of daily vegetable consumption.
• Mango Health (acquired by and incorporated into Trial Card in 2019) - Application that reminds users when to take their medication and records each dose. The app incentivizes users with both real-life rewards or in-app currency that users can earn for taking their medicine on time. The app also has social features (comparison of medication adherence against patients with similar conditions).

Nuances within Healthcare x Gaming

The competition: There are >400,000 Health and Wellness apps on the Apple and Google app stores with ~250 new additions each day (The Economist). While trends show that users are actively seeking apps to fulfill these particular needs (5m app downloads per day), apps today are falling short of consumers’ expectations (95% of downloads are deleted within 24 hours). The shortcomings are primarily related to privacy, user experience, and evidence of effectiveness.

Factoring in game-like mechanics introduces even more complexity. There are 3 gaming best-practices that Health and Wellness developers should consider implementing:

1. Prioritize behavioral science like game developers: Game developers often have a strong understanding of each of their user cohorts by player archetype (the social gamer, the PvP competitor, lone wolf farmer, etc) yet can still build a cohesive game that caters across them. Non-game applications are at a disadvantage because they seek to decouple individual features from the story and disperse them across their apps. Health and Wellness applications in particular fall short in designing a logic-based approach rooted in human behavior. As a result they often do not connect measurement and knowledge to action. Cultural anthropologist, Natasha Schüll, has noted that health-tech products are often limited to “a pinch or two of positive psychology thrown in with the infrastructure of a punitive Skinner box, thrown in with some other notion of the brain” ending up as “a hotch-potch of ad-hoc things that was not that studied or scientific” (The Economist). Both game and Health and Wellness developers can even take it a step further by leveraging tools like Solsten (a Konvoy portfolio company) to understand user psychology.
2. Personalization: Taking an individualized approach is especially important in Health and Wellness - users need a product that is tailored to their body and their needs. Health is not a one-size-fits-all industry. Game developers are adept at introducing a variety of behavioral nudges across different areas of the matrix to ensure that the game can engage a wider breadth of players. Health and Wellness developers should follow suit - for example, introducing a role playing game class system based on your current state and setting users down a particular storyline or quest progression that is tailored to their goals.
3. Make it fun!: Managing one’s well-being and building sustainable habits for a healthy lifestyle is mentally, emotionally, and physically strenuous. In some cases, there is an additional stigma when it comes to certain fields (e.g. menstrual health, sexual health, elderly care, and mental health). Play-driven features can be a way to encourage education, reduce stigma, and promote healthier habits around areas of health that traditionally seem hard or uncomfortable to the user.