Mobile Health Apps and Gamification – Who is Playing Who?

mobile health

There is a fantastic console game which borrows the time-honored video game tradition of having a narrator/ sidekick guide you through learning how to play the game.  Once the player is familiar with the basic controls, the narrator drives much of the game’s action. They direct the player to tasks which will help both the player and the narrator/sidekick to defeat the “big boss.”  But, once this goal is about to be realized, the “big boss” dramatically informs the player  “A man chooses, a slave obeys”. Then he reveals that the narrator whom the player thought was helping him is the real evil mastermind. The shocked player realizes that they’ve been “played.”

Gamification is Here for Mobile Health

Over the past five years, gamification – and its application in healthcare – has really begun to take off. There’s great promise in mobile health. It’s being unlocked by the rapid advances in sensors, low-cost computing, increasingly higher available bandwidth, and a generation of creative folks who have grown up playing games.

I have no doubt that the future of healthcare has a place for effectively applying gaming concepts to help patients habituate healthy behaviors. That said, we’re still in the infancy of this new emerging trend. While there are success stories, there are also opportunities for improvement. Apply gamification improperly, and you may end up with a game playing you. 


For example, take the brilliantly conceived Nexercise App. If you are not familiar with the app, here’s how it works:  Anytime you do any kind of exercise, you go into the app and journal what activity you’ve done. The app makes use of the GPS and accelerometer to “keep you honest.” I was told by the company there are algorithms to ensure you are not faking it by riding around in your car or setting your phone on the washing machine. Each time you exercise you gain points. You get extra points for behaviors more likely to habituate sustainable patterns (like exercising when it’s cold, when it’s a Monday, or when it’s early in the morning). There’s a social component. You can “compete” on a leaderboard with friends and nudge them when they haven’t exercised in a while.

These features are cool, but they have been done before in other health and wellness apps. What’s unique about Nexercise is that it uses mPoints. mPoints are virtual currency you can use to purchase real-life rewards like gift cards for Amazon, iTunes, BestBuy, etc.

I have no doubt that the future of healthcare has a place for effectively applying gaming concepts to help patients habituate healthy behaviors.

SessionM is the company which runs mPoints. It acts as a conduit between advertisers, app developers, and app users to market products. Here’s how it works. Amazon (and other retailers) pay SessionM in money and trade (in this case gift cards) to advertise. SessionM then reaches out to developers to develop apps which implement mPoints. In so doing, the developers put in place a channel for SessionM’s advertisers to show you ads for their products and services. Developers get ad revenue (based on how often the ads play) in exchange for implementing mPoints. When using an mPoints App, users see ads but also get mPoints which you can exchange for gift cards. The gift cards are actually advertisements themselves, as they typically fall well below what you spend in total for the advertiser’s wares.

It’s a clever setup. When I first learned of it last December, I decided to give it a go. My sites were set on a $10 Amazon gift card and got cracking on the treadmill, P90X videos, and rowing among other things. It was intriguing. I was “getting paid” to exercise.

Then more ads started showing up for bonus mPoints – so I watched them. And by watched them, I mean I hit the play button and let them run without paying attention to them so I could collect the mPoints. I did not really focus on the message – an approach which I would guess is not uncommon. Then I realized that you earn points for every 15 minutes of exercise. So if I was doing a 40 minute run on the treadmill, I would leave the clock running while I walked around to “cool down” and capture the mPoints. Was I cheating? Maybe a little. But I was definitely letting the game play me.

Nike Plus Kinect

In contrast, I’ve also recently taken up using Nike’s Nike Plus Kinect for the Xbox360. There is a point system and a social component. However, unlike with Nexercise, it’s measuring how often I’m exercising and how good my form is. If I don’t show correct form, I don’t get credit for the rep. It’s acknowledging progress by keeping track of how many reps I’ve done and having my trainer congratulate me when I beat my personal best.  It’s pushing me to exercise longer – while maintaining form – and challenging me with more difficult exercises. In short, it is doing what it is designed to do – help me improve my exercise and fitness level.

How to Identify Mobile Health Apps that Work

These differences underscore key elements which will distinguish excellent applications of gamification to improving health and healthcare:

Focus on intrinsic rewards – Make it easy for users/patients to turn a little health engagement into a full blown healthy habit.  Offering rewards may work some of the time. However, it opens the door to providing an incentive to the wrong behaviors.

Make progress a rich experience – Badges and leaderboards are nice. But they are increasingly becoming a meme and losing their effect.  Acknowledge progress when it happens and provide a simple framework to enable the user to make a decision to do better.  “Real” people (like Nike Plus Kinect’s virtual trainer and star athletes) create a rich narrative around progress. Badges pale in comparison.

High fidelity, objective measurement – Rapid advances in integrated sensors continue to create new possibilities for designing gamified health systems. The more accurate these sensors are, the better feedback they will give to ensure they affect targeted behavior.

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