The power of games and gamification in healthcare

Gamification has many definitions but it is generally accepted as being “the application of game psychologies and mechanics within non-game scenarios”. Game mechanics and game psychologies are used to engage and motivate “players”, develop skills, build understanding and influence behavior. Being able to measure and compare is fundamental to all games and sports. Whether it is recording a golf score, winning points or scoring goals, the ability to apply measurement against a set of challenges and rules helps to engage and sustain our interest and motivation.

The process of gamification is rooted in the psychological theory of operant conditioning – producing behavioral changes by rewarding some actions and punishing others [1]. Within the context of serious games (games designed for a non-entertainment purpose), rewards for actions are preferred to negative punishments. Examples of rewards include points and leader boards [2], badges [3],progress monitoring, as progress bars or tick charts [4] and positive feedback, e.g. an encouraging message after a user has completed a task [5].

There are a variety of gamification techniques which can be combined in different ways. It is therefore important that gamification is applied in ways which are relevant and appropriate for the target participants. Successful gamification can enhance self-belief in a participant to perform a task, also known as self-efficacy [6]. Individuals with high self-efficacy towards a behavior are more motivated to complete that behavior than individuals with low self-efficacy. Health choices are dependent on self-efficacy [7].

One of the methodological approaches used to ensure effective gamification is to have a user-centered design. This design process captures the characteristics of the population for whom the system is being produced.

According to and respecting these principles and methods health/therapy support systems can be created to enable patients to conduct specially designed exercises in their own home through the use of a game-like environment that might e.g. use a specific sensor to track movement and provide feedback to both the patient and the medical practitioner. These systems can provide e.g. valuable support for patients with physical and cognitive conditions that require specialized exercise routines to support the rehabilitation process. Leveraging on the patient’s self-efficacy and stimulating motivation, a correctly designed system motivates the patient to adhere to a long-lasting therapy. This creates a potential win-win scenario in which both patient and clinician can achieve their objectives without the necessity for travel or the use of expensive rehabilitation centers.

The objective is e.g. to make the rehabilitation experience as much funny and motivating as possible, though keeping the exactness of the protocol and aiming at the maximization of patients’ compliance and adherence. In other words, the gaming dimension should be integrated into the virtual rehabilitation environment in order to act as a bridge between the real patient context and its virtual counterpart. Information collected by the sensors should be projected in the virtual environment and be used as a feedback control for games conceived in order to drive the patient through a personalized rehabilitation path made of a set of different exercises. The game rules will constrain the reactivity of the system and will be defined in accordance with the rehabilitation specialists and following suitable protocols. Within this context, what are normally defined as “serious games” (i.e. games conceived not just for entertainment purposes but also to support learning purposes) seem to be the best approach to follow for: giving to the patient information about his/her status, teaching the patient and family members how to use the solution proposed by the project, providing detailed and continuous information about the exercises execution according to the achieved performances (personalization).

[1] Skinner, B.F. (1938). The Behavior of Organisms: An Experimental Analysis. Appleton-Century-Crofts, East Norwalk.

[2] Nike Inc: Nike+ running (4.5.5 ed) (2014) [Mobile application software]. Retrieved from

[3] Foursquare Labs: Foursquare (Version 7.0.11) (2014) [Mobile application software]. Retrieved from

[4] Jozic Productions: 30 day ab challenge free (2.1st ed.) (2014) [Mobile application software]. Retrieved from

[5] Joggle Research: Joggle Brain Training (Version 2.4) (2014) [Mobile application software]. Retrieved from

[6] Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191-215.

With permission of the authors, large parts of this text are taken from “Ascolese A., Pannese L. & Wortley D. (2016). Gamified wellbeing for all ages- How technology and gamification can support physical and mental wellbeing in the ageing society, IFMBE Proceedings vol. 57, Springer.”