Gamification: A Suitable Approach To Improve Healthcare All Over The World?

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Foreword

The Future of Health: With the world’s population forecast to continue to grow throughout the 21st century and with human beings, in developed countries, having greater than ever life expectancy, new approaches to health research and delivery will need to be developed. What roles must governments, organizations and individuals play to ensure that healthcare can be provided universally at a low or zero cost to the individual?

Sandra Carina Posern is currently an MBA candidate at Saïd Business School, University Oxford. As the winner of 2018 Typhoon Consulting – Saïd Business School essay competition, Sandra provided her insights into how gamification could be a suitable approach to improve universal healthcare and country development.

Introduction

Game-like elements have long been applied in many countries of the western world as a mean of service innovation. Underpinned by the technological and digital development, gamification seems to have appeared out-of-the blue and has now also been introduced to non-game related industries (Zichermann & Linder, 2013). The potential value of gamification is significant. Applying a game-like approach, game elements such as play, fun, challenges, rules, transparency and rewards can be addressed to almost any real-world problem in order to help people achieve their goals. Especially in health-related contexts, the application of gamification is accelerating as wellbeing and health are fostered and negative outcomes related to unhealthier behavior patterns are mitigated (Pereira et al., 2014). Similar trends were also found in medical education and practice (Bunchball, 2017).

However, only little research has been conducted into service design of gamification in relation to healthcare in developing countries (Pereira et al., 2014). As health and living standards are the strongest contributors to poverty in developing countries (Hanley, Wachner & Weiss, 2016) attitudes towards health need to evolve into “living well” in order to promote a positive idea of health in everyday life. Due to the characteristics of a gamification approach being joyful and easy to use, gamification may be the way forward to improve healthcare in countries with low educational standards and an absent healthcare system (Mechael, 2009). Accordingly, this essay will discuss how people can receive better, more accessible care by applying a gamification approach to healthcare. The following paragraphs specify the definition of gamification in the healthcare context and discuss its potential application in healthcare systems of developed and developing countries taking into account the development status of such countries.

Innovation in Service Design

Gamification and Healthcare in Developed Countries

Gamification is defined as the “application of game design elements in non-game contexts”. (Deterding et al., 2011). Hereby, gamified elements and principles are used to motivate and engage people to stick to their commitments and goals (Burke, 2014). In healthcare, gamification aims to turn patients into consumers to trigger behavioral change. In disease management for instance, healthcare gamification has helped patients with diabetes to be educated about their illness and to control it in a better way. A number of studies have confirmed the success of gamification, demonstrating that higher engagement and motivation can increase a patient’s health (Burke, 2014). Thus, many healthcare systems of the western world already recognized its added value and impact. As a consequence, health insurances, start-ups, fitness- and lifestyle companies as well as technology corporations in many developed countries are already working with gamification in the health sector. An increasing number of pharmaceutical companies develop prevention games mainly with a focus on chronic diseases, for example diabetes, in co-operation with institutes focused on medicine and biology. However, the degree of adoption of the gamification approach varies by country. Especially in the U.S., gamification is already an integral part of health insurance (Pereira et al., 2014). The American health insurance provider Humana, for instance, offers rehabilitation programs with xbox Kintect technology (Humana, 2011). The American pharma company Pfizer is evaluating the use of a mobile video game from Akili Interactive Labs to detect early signs of Alzheimer’s disease (Al Idrus, 2016). In Canada, SickKids hospital developed Pain Squad, a mobile game designed to help kids fight cancer better (SickKids, 2018). On the other hand, in some European countries such as Germany, insurances currently begin to understand the potential of gamification and start engaging in the field. Germany’s largest insurance provider Allianz, for instance, developed a health app in co-operation with Runtastic (Runtastic, 2018) and the pharmaceutical giant Bayer has developed a blood glucose meter that plugs into a Nintendo DS gaming system to reward kids for consistent testing (T-Online, 2009).

Gamification and Healthcare in Developing Countries

In developing countries only selected pioneers such as the South African based insurance company Discovery have adopted a gamification approach. Discovery’s business model revolves around incentivized behavior change and the achievement of a positive long-term impact on costs and value for employers and members. The company aims to offer innovative insurance products that emphasize the importance of behavioral change, prevention and wellness. Vitality is one such successful product from Discovery. It is a reward system that incentivizes positive behavior based on deep customer knowledge. In Vitality, users can collect points that transform to real life rewards such as rebates or coupons when they make healthy choices and get active. Apart from Discovery, gamification has not yet been widely adopted by health players in developing countries (Discovery, 2017).

Although gamification seems to be the road to success, not every gamified product is automatically successful. According to Gartner, poor design is one of the main reasons why many applications are unsuccessful (Gartner, 2012). Zichermann and Linder (2013) identified that successful gamified elements should center around three main factors: “Fun, Friends and Feedback”. The first factor, fun, is an essential element of each gamified application. Apps, games and other game-related products need be fun to use and entertaining for the consumer. The motivation to achieve reachable targets therefore needs to be manifested in a playful way. Doing fun activities is often linked to family and friends, which is the second factor. Challenging friends to playfully compete against each other encourages personal motivation to reach set targets. Moreover, the use of social media to share results with friends, family or a broader community can also enhance the accountability of reaching one’s target. The third factor, feedback, centers around documentation and consequences of user behavior. Giving patients feedback on their performance or illustrating long-term consequences of actions help consumers to influence their health towards reaching their goals.

Strategic Opportunities and Barriers for Gamification and Healthcare

The three aforementioned factors, while being a prerequisite for success and fulfilled in most developed countries, are not necessarily completely applicable in developing countries as their applicability depends on a country’s degree of development. In very poor developing countries, the majority of the population does not care whether treatment is fun, engages friends or provides feedback; in these countries, receiving treatment at all is a major challenge when no comprehensive healthcare system is available. In countries with more or less comprehensive healthcare systems and a growing middle class, having fun and engaging friends can become more and more important due to the increasing role of social media in these countries. Furthermore, the educational advice in form of feedback is inclined to find higher endorsement as middle-class citizens are more educated and can thus better understand and reflect such feedback.

Besides these three crucial factors gamified products should adhere to, there are some more general challenges that arise through gamification. Especially in healthcare, the application of gamified elements is confronted with protecting a patient’s privacy. Alongside patient privacy, data security is a challenge for healthcare players as privacy and protection policies contrast with fundamental principles of gamification: Data is always available, accessible and shared. Even consumers expressed skepticism to display their health online because they are afraid their personal data could be misused (The Center for Democracy and Technology, 2008). These more general factors have limited influence in developing countries. In such countries, data protection and patient privacy do not, as of now, have the same significance as in developed countries. Especially in marginalized countries, setting up nationwide healthcare is of higher importance than patient privacy.

While data protection is not limiting the spread of gamification in developing countries, a device on which gamified applications are accessible can potentially be a limitation for the widespread use of gamification. The comprehensive availability and usage of mobile phones in developing countries can therefore be a strategic advantage as many gamification elements work through mobile applications. Furthermore, especially in African developing countries mobile payment is a common form of payment (Duncombe & Boateng, 2009). Thus linking the receipt of rewards such as coupons to mobile payment enables convenient use of rewards. Gamification has another advantage that is particularly valuable in developing countries: Gamified products require a minimum upfront investment as they are connected to a mobile application in the majority of cases. Hence, they are well suited for government and private investments in healthcare.

Conclusion

Concluding whether gamification could be a suitable approach to improve universal healthcare, the degree of development of a country plays a crucial role. Many developed countries have already discovered the potential cost savings related to engaging patients in a healthy lifestyle and preventing diseases such as diabetes. In order to fully tap into this potential, governments should fund research in the field and support innovative organizations setting up gamification programs. Although a supportive attitude of the government is very important, a wide-spread adoption can only be reached in case private corporations cooperate to develop new technology, test devices and successfully roll them out. For developing countries, gamification can enhance healthcare provision in the long-term. While in the poor and most marginalized countries, it is still a prerequisite to institutionalize nationwide stable healthcare, in countries with a principally existing healthcare system, mostly the newly industrialized countries, gamification seems to be a suitable approach with a huge potential to improve healthcare. Examples like Discovery show, that in such countries, gamification can be used as a way to activate the population and trigger a healthier life-style. While in these countries diseases of affluence are not yet as wide-spread as in developed countries, especially the forms of gamification that aim to engage, motivate and reward fitness, sport and a healthy life-style, can have a significant impact. In these countries the widespread mobile phone availability and use of mobile payment, as well as the absence of data protection and patient privacy regulations positively stimulates the potential for gamification. Also, the three f-factors seem to play a more important role in these countries and can help to create successful health-related services. Further valuable areas for investigation could center around the analysis of Discovery’s Vitality program in the context of South Africa’s development state to determine specific success factors and other circumstances that enhance the application of gamification in developing countries.