Doing the right thing is often a bit dull. In the fight between brown bread and chips, or apple and chocolate, you’ve got to admit that chips and chocolate seem more exciting. But what if improving your health was more fun?

That’s the thinking behind the ‘gamification’ of public health: make ‘doing the right thing’ more fun, and more people will do it. Turn the stairs into a giant piano, and it turns out that people will choose stairs over escalator every time. In India, mobile phone games have successfully been used to raise awareness of HIV/AIDS and tuberculosis among young people. The idea of using fun to drive public health is catching on around the world.

The rise of gamification

Gamification, or the use of digital game elements and techniques to solve business and societal problems, has been growing in all sectors, according to a 2012 report by Gartner. Its application to health is fairly new, but probably inevitable. After all, those aged 18–27 are the group that have grown up digital, who are most used to games, and they are the group most targeted by health insurers. Why? Because they’re largely uninsured, and broadly healthy, so they’re cheap to insure.

But there’s another aspect: gamification is chiefly successful where behavioural change matters, and that’s one of the key issues in health. Whether it’s becoming more active, managing your medicine, or sticking to a treatment regime, there’s now an app to help. With wearables acting as sensors, and mobile phones to manage the data, gamification is easy.

Gamification also been adopted by the scientific community to harness the power of computer gamers across the world. Using a game called Foldit, players were challenged to complete a ‘puzzle’ to explain how a protein might fold. Within three weeks of one particular retroviral protein being placed on Foldit, its structure had been solved, a challenge which scientists had failed to complete in more than a decade of trying.


Games have also been identified as a way to help people with chronic diseases to manage their illness and maintain their drug regime. However, there are certain psychological problems with that. Yes, games are a great way to encourage people to start behavioural change. However, they tend to use extrinsic rewards for behaviour, such as moving to a new level, or scoring points. Too much extrinsic reward can reduce intrinsic motivation, the internal ‘I should do this’ drive that we all have.

Consider a child whose parents use a reward chart to encourage a certain behaviour. The behaviour starts. Great. But what about when the parents want the child to do that behaviour unrewarded, whether it’s use the potty or simply say please and thank you? It can be hard to move to the position that the behaviour is no longer rewarded, but is simply expected. A certain amount of regression is often observed, and adults are no different. Providing rewards conditions us to expect them, and reduces our ability to self-motivate.

Games are also very top-down. They leave no room for individual responsibility or improvement, which in itself is quite demotivating.

Making gamification work

Gamification does have genuine potential to drive behavioural change and address some of the key health challenges such as the rise in preventable diseases. But there are also some real challenges to making it work, not least making sure that the game both engages users, and drives the right behaviour. Many games have not been well-designed and therefore are not being used. And a game that’s not used might as well not have been created.

Some companies are getting there. For example, QStream, based in Burlington, MA, sends out short quizzes that take three to five minutes to complete, a couple of times a week. These help their users to retain information, and are being used by sales reps and clinicians in several hospitals in the US. For example, several UC Medical Centers are using QStream to improve the discharge planning process. Uptake of QStream quizzes, which are tailored to the topic and the individual, is over 90% every day, which is huge by the usual standards of online engagement processes.

Creating value, having fun

QStream’s CEO, Duncan Lennox believes that the essential feature in a game is that users get some value from it, so that they keep coming back to it. And at three to five minutes, he points out, QStream’s not a disruption. Instead, as several participants have commented, it’s fun. And that’s the key.

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