Dan Lock, human factors consultant at TTP, asks where gamification can make a difference in healthcare

n a world where everyone is increasingly inundated with competing demands for

less amenable to a good gamification solution. Users of inhalers, for instance, often find it difficult to synchronise pressing the canister and inhaling. The game mechanics in many sports games require this sort of timing skill, and incorporating these ideas into an app could be one way to both engage and upskill inhaler users. Here in Cambridge, a device and app that turns the chest physiotherapy exercises of children with cystic fibrosis into a games session is an example of gamification done well. Playphysio transforms the child’s physiotherapy device into a breath- activated controller for games on their smartphone. Each physiotherapy ‘blow’ then makes their character perform an action in a game. Children say they enjoy the exercises that previously were a burden on them and on family life. In addition, prompts in the games encourage them to complete more and better physiotherapy that could make a real difference for their health. Clinical trials are ongoing, but early feedback from nurses indicates the app transforms the engagement of children with chest physiotherapy. So, here are two principles for good gamification: aim to engage the user’s intrinsic motivation rather than offering mere rewards, and target the right task or behaviour, in particular those that require skill or endurance. By doing this, and taking advantage of the decades of R&D the games industry has done into game mechanics, we can find sure- fire gamification solutions in healthcare – and beyond. For more TTP insights into product and technology development, visit

engage us to perfect skills, and reward us with the satisfaction of seeing everything slot into place, narratively or visually, when we win. But many gamification solutions adopt some of the trappings of games – points, rewards, leader boards – without any of the fun. Often this is because the task itself doesn’t provide enough to work with. External rewards for doing something boring over and over again will capture your interest for only as long as the reward appeals to you, and if there are shortcuts to game the system you can be sure people will find them. This is because external rewards do not alter how you feel and what you think about the activity in question. As the educator Alfie Kohn puts it, “A child promised a treat for learning or acting responsibly has been given every reason to stop doing so when there is no longer a reward to be gained.” Gamification is done well when a user enjoys each repetition because it has become intrinsically motivating. Several companies now use VR platforms to improve patient engagement and motivation for rehabilitation exercises. Motion detection technology places an avatar of the patient in a virtual reality where their exercises are combined with gamified activities, like lifting weights, for example. Such solutions can be tuned to recognise and track patient progress, offering another way to engage them. Creating intrinsically rewarding

their time and attention, ‘gamification’ has become a popular way to make unappealing tasks more engaging, motivating and fun. Many apps attempt to use game elements to help us form positive habits like saving money or exercising regularly. But gamification also has a place in healthcare, where it promises to improve patient engagement, treatment adherence and self-care skills. Last year, I came away from a gamification seminar in Cambridge with the impression that more or less any health-related behaviour could benefit from gamification. But if it were

that simple, why do many attempts at gamification rapidly lose their appeal? Game designers are true experts in creating experiences that players come to find intrinsically rewarding. Successful games provide just- manageable challenges,

experiences is important, but so is selecting the right problems for

gamification. If the desired behaviour does not include a repeated task that requires skill or endurance, then it will be



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