Gamification of health, it’s something that has been discussed for years. I remember sitting in a room with former White House Chief Technology Officer Todd Park, and him saying that the potential for games to affect health is huge, but we just have to figure out the right way to do it. That conversation happened roughly 4 years ago back in 2012 and it wasn’t until two days ago that I think the true potential of applications effecting health has been tapped.
Research has shown that mobile phones are an effective medium for delivering health interventions . And what makes phones more effective than say platform or computer gaming is the ability to tap into some of the unique hardware on a phone like GPS for measuring location, accelerometer for measuring movement and orientation, and gyroscope for measuring angular rotation. And it is those features that have allowed applications like Strava, RunKeeper and Nike + Training Club to have widespread adoption.
But while those applications have seen widespread adoption, the users installing and using those applications are already active. They run, bike, hike and swim and have installed and use those applications to get a more accurate tracking of progress. So while there may be some behavior modification because of the use of the application, it isn’t changing the behavior of people who are currently not active.
So how do you get the non-active people to change their behavior? Easy, develop a game using mainstream content — which is what Niantic did when they developed Pokémon Go. As of right now, only two and a half days since launch, Pokémon Go is the number one downloaded and revenue generating app in the United States.
It should be no surprise that Niantic has developed a game that requires a user to move around and explore to advance in the game. Prior to Pokémon Go, an early iteration was a Pokémon pedometer known as the Pokéwalker, which interacted with Nintendo DS versions of Pokémon and rewarded users by giving them the opportunity to capture rare Pokémon. The problem with this is that you didn’t have to be honest in your usage of the pedometer — with a friend of mine sitting watching television for hours while shaking the pedometer. But the intent and foundation for Pokémon Go was there — encourage movement and exploration by users and reward them.
What exactly is Pokémon Go?
Pokémon Go is part mobile game, part augmented reality, part health application. That’s a lot to be in just one small mobile application, so lets break it down. Pokémon Go, is like any other Pokémon game in that you are on the quest to collect them all. In doing so you encounter gyms, different terrains, and battle others. But there is a catch here — the only way to encounter these things is by walking and exploring the world around you. Pokémon Go rewards movers and explorers.
The game is developed to track your location in a city based off the GPS in your phone, as you move around there are checkin points known as Pokéstops (which a ton of them seem to be churches near my office)
and gyms but the only way to get to them is by physically going to the location. In addition to GPS, the application uses the camera in the user’s phone to present augmented reality — so now I see Pokémon wherever I go — Cuebone in the dog park? Yup. Zubat in the neighbor’s yard? Why the hell not.
The health component of the application comes in when you are looking to advance in the game. If you want to do better, collect all the Pokémon possible and become a Pokémaster (who doesn’t) a user has to get out and explore. In fact, one of the achievements in the game is “Jogger” where the user will be rewarded once walking 10 miles. Granted, this isn’t the ultimate solution in changing behaviors when it comes to health care — review of 132 health and fitness applications found a lack of integrating important elements of behavioral theory from the app industry, which can potentially impact the efficacy of gamification apps to change behavior — it is a really really good start. And there are flaws in the game — the fact that the game board is basically an entire Google map can be perceived as overwhelming, especially in car dominant cities, where users may say why walk to the Poké Gym when I can drive? By shrinking the game board it does diminish the wow factor of the game, but possibly increases the health benefits.
And it is that factor of shrinking the game board, that I think can lead to some of the most drastic changes in health behavior — which is exactly what Nag Murty and Quantified Habits, Inc. are doing with their Move Hotspots application. The way it works is that Move Hotspots allow a user to set up their own game board in their office or home and then pings them based on their location to take a specific action — like drink more water while near the water fountain or take a walk if you have been sitting too long.
Unlike Pokémon Go, Move Hotspots isn’t GPS-based, but is bluetooth iBeacon-based; the reason being GPS isn’t precise enough for indoors. What also differentiates Move Hotspots from Pokémon Go is that it does integrate important behavioral theories from the Fogg Model of B=MAT by BJ Fogg, and the Hook Model by Nir Eval.
But like Pokémon Go, Move Hotspots rewards users the more they move.
So the questions that remain are: Do games like Pokémon Go need to integrate behavioral theories to positively effect a user’s health behavior? The short answer is no. Given the popularity and appeal of the game, it is likely to have a bigger impact on a user’s behavior than an unpopular application that has integrated behavioral theories. And like any application, the lasting effects of Pokémon Go may be limited only to how long the user finds the application entertaining but ultimately Pokémon Go is going to have a bigger effect on people’s health than not.
And when looking at Move Hotspots, does there need to be more than just a leaderboard to make a difference in a person’s health habits? Does there need to be a storytelling element — which there is a general one in Pokémon Go — to keep a user engaged with the application thus having long-term health benefits?
What I can say is this. Applications like Pokémon Go and Move Hotspots are finally changing the way nonactive people interact with health and actually giving them incentive to get up and move. The next step to be taken is the measurement of what the lasting effects are regarding healthy habit development and behavior change, but until then, gotta catch ém all.
1 King, D., Greaves, F., Exeter, C., & Darzi, A. (2013). ‘Gamification’: Influencing health behaviours with games. Jrsm, 106(3), 76–78. doi:10.1177/0141076813480996
2 Caddy, B. (2016, April 9). Here’s how your phone is tracking you right now. Retrieved July 08, 2016, from http://www.techradar.com/us/news/phone-and-communications/mobile-phones/sensory-overload-how-your-smartphone-is-becoming-part-of-you-1210244
3 Cameron Lister, Joshua H West, Ben Cannon, Tyler Sax, David Brodegard. JMIR Serious Games 2014 (Aug 04); 2(2):e9