Gamification: Profiles, points, stories

Gamification continues to be a hot topic in health tech. Everyone wants to design applications and devices that are fun and engaging to use, but it doesn’t seem to be easy. (Well, neither is game development. I read a couple of years ago that less than one in ten games actually produces net profits to developers.)

Sebastian Deterding’s excellent presentation about user experience design and game mechanics covers several challenges in gamification. One challenge is that fun is usually something that we’re not obliged to do and that doesn’t have a serious consequence. When health comes into a picture, boom! There’s our serious consequence. Maintaining a healthy lifestyle can be fun (seriously, it can!), but circumstances can often make it too difficult or too boring, disrupting the flow experience.

Just adding points doesn’t work in long-term and it definitely doesn’t work for everyone, since motivations differ. The earliest player profiling was done by Dr. Richard Bartle based on the early MUDs (multi-user dungeons, sort of what World of Warcraft is nowadays, although MUDders would probably skin me for saying that). He distinguished four profiles: Achiever, Socializer, Explorer, and Killer. Achievers are the ones who want to collect points and achievements, whereas Socializers like to hang around and chat. Explorers head out to the game world with the goal of discovering every location and turning every stone to see wondrous sights. And Killers, well, just enjoy killing. Especially other players.

Might not come as a surprise that my primary type is an Explorer. I tend to think in terms of narratives, stories, and wonders of the world when considering what is an engaging experience for me. (Games are not different from books and movies in that regard… or from real life.) But people certainly have very different mentalities and reasons for playing games – immersion is just one facet. Others include e.g. taking a small break during lunch, winding down after work, challenging one’s brain, or having fun together.

Achieve your goals, learn new things, share experiences with friends. That’s what everyone basically wants, and that’s what we can practice with games and game-like applications.

It’s a bit hollow if we just want to hook people into using our applications by stuffing them with addictive features. Ideally, the purpose should be to increase people’s awareness and help them learn skills. Thus, this post about Madden NFL game is pretty interesting. The game educates players about the seriousness of concussions through gameplay: players benefit from modifying their behavior (playing style) to avoid head injuries. A good example of nudging towards a healthier attitude without being preachy, and actually simulating the consequences of unhealthy behavior. I could imagine that many games could subtly do something similar, if they were designed with health promotion ideas in mind. And perhaps player profiling could be applied in wellness applications to determine users’ motivators to offer right kind of content.

Went exploring recently, found a new favorite place.

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Healthy mind in healthy body

I’ve been going to this improvisation class every Saturday for the last four weeks. It’s been a fun and liberating experience, and I’d recommend it to anyone who sometimes struggles with being too much inside their heads and not being present in this moment. Blurting out the first thing that comes to my mind isn’t something that I usually do, but it’s something that I should do more. Heck, if I reveal my stupidity that way, at least I’m being honest about it.

Another great thing with improv is its physicality – moving around, expressing yourself with your body, interacting with imaginary objects, being a puppet for a puppeteer. I chatted with this white-haired, wise, sarcastic man who’s a social worker in his other life and feels that improv is everything he needs in his work: listening, accepting, being there, having energy. He gave me a great piece of advice: “Any time you feel you’re not present in this moment, do something physical.”

One of the big problems with the work that most people do nowadays is that it is very far from physical. And the problem with exercising after work is that for many people it’s a chore instead of fun. (I sometimes feel that way too, but right now I’d give a whole lot to be able to just run outside and go as far as my body can carry me. Bloody stress fracture.)

So, the last thing I want to do is to develop applications that would encourage people to spend yet more time with their computers or mobile phones. I’d love to encourage people to take a moment to relax, go to spend time with other people, go out and enjoy nature, be aware of their surroundings, and do something good for the sake of doing good. And try not to destroy this beautiful planet.

The planet is really beautiful.

We often talk about saving time. We eat fast food and ready-made meals, drive cars instead of waiting for a bus, shorten words in emails, fly instead of taking a train, make up excuses to end conversations. But what are we saving that time for? Everyone’s still busier than ever – trying to make more money to keep up with the Joneses. Fargo, the excellent (albeit gory) film by Coen brothers is an extreme example of the horrid things people can end up doing just to get more money. Shallow Grave is another one, on a smaller scale.

But I digress. It’s becoming a bad habit. I was going to talk about mental well-being, which in a nutshell is composed of three things: feeling that you’re doing what you want to do (and knowing what that is), being supported by other people, and feeling confident and satisfied with yourself. (Some may recognize the similarities to the three basic needs in Self-Determination Theory – it’s not a coincidence.) I think that if people feel good about themselves, then it doesn’t matter if their physical health isn’t super-fantastic.

Mental health predicts physical health in teens, according to this study.

Depression and anxiety are starting to be as serious problems as obesity in terms of societal burden. Also, they are linked to obesity: depressed people are 60% more likely and anxious people 30% more likely to be obese than those without either of the disorders. Reasons? Common socioeconomic and perhaps hereditary risk factors, topped with physical inactivity and emotional eating triggered by loneliness and low mood.

Depression and anxiety are relatively easy to treat, I’ve heard. That’s why they should be screened out among obese people. Nutrition counselling and exercise programs won’t help if you don’t believe in your ability to achieve results, if you don’t see any reason to try, or if you don’t have anyone who cares.Online interventions for depression and anxiety could help enormously with this population, but I don’t know if they’re used in such a way yet. Anyway, some programs that are in real clinical use include:

• FearFighter (anxiety, phobia, panic attacks). Used in UK since 2006, recently launched in Denmark and the Netherlands.
• Beating the Blues (depression). UK since 2006.
• CRUfADclinic (depression, anxiety). Australia.

And probably more, but can’t think of them right now. These require a clinician’s referral. In Australia (and in the whole world, actually) there’s also eCouch which is open for anyone. They have modules for depression, anxiety, social anxiety, relationship breakdown, and loss & grief. That’s a pretty good selection already.

So. I said I don’t want to encourage people to spend more time with their computers, but going through programs like these can be a great help and a good first step for people with depression or anxiety. Unwarping warped thinking requires some guidance and processing.

Now, why don’t we have programs like that in Finland yet?