Gamification on the Digital Health Landscape refers to the application of games, game elements and game design techniques to encourage people to pursue a desired course of action and accomplish constructive tasks in non-game domains, such as health, education, enterprise, marketing and even governance.
Games present a set of goal-oriented activities played according to agreed-upon rules. By presenting challenges, unpredictable obstacles and equally unpredictable human opponents—games create conflict, hindering players from achieving goals and thus stoking the competitive spirit.
Both sedentary games (games which are controlled by game controllers, mouse or keyboard) and active games (games where the control scheme is based on motions of the player) use these game elements in their approaches to direct people to achieve desired goals.
Games and Health Education in Children
Since the foundations for health and a healthy lifestyle are formed early in childhood, many people have experimented with digital games to promote health education in children. With 37 percent of the US population age 9 and older playing PC games for an average of 6.4 hours per week, games are a strong medium to reach them.
Because of the inherent interactive and engaging nature of games, they provide strong opportunities for health promotion in children in a safe environment with individualized feedback. Many games have been designed, and their impact researched, with a number of health education outcomes in mind, such as:
- Physical activity promotion
- Healthier diet promotion
- Smoking prevention
- Skin cancer prevention
- Obesity prevention
- Asthma-related behavioral changes
- Diabetes-related behavioral changes
- Rehabilitation of children with special physical needs
- Improving mental health outcomes
Many studies, systematic reviews and reviews of the scientific literature provide strong evidence of the effectiveness of active video games in promoting health and health education outcomes in children.
While some gaps in knowledge exist regarding the evidence related to sedentary games—due to the relatively small amount of research in this area—even they were found to have a positive effect in improving health education in children.
Games Promote Physical Activity
Active video games have been found to increase energy expenditure in children by 222% and heart rate by 64%, thus enabling light to moderate physical activity. Energy expenditure has been found to be significantly lower for games played primarily through upper body movements than those that engage the lower body. The evidence for the long-term effectiveness of active video games in promoting physical activity is still limited.
However, another study found that energy expenditures used to play the authentic versions of activity-based video games are substantially higher than those used to play active video-console games. This proves that video games cannot substitute for real life sports and activities.
Games Promote Healthier Diets
A systematic review of nineteen studies of ‘electronic media-based health interventions in promoting behavior change in youth’ found that seventeen of them reported at least one statistically significant effect on behavior change outcomes, such as:
- Increase in fruit, juice, or vegetable consumption;
- Increase in physical activity;
- Improved asthma self-management;
- Acquisition of street and fire safety skills; and
- Sexual abstinence.
The review concludes that electronic media-based interventions such as video games have many distinct advantages over conventional methods of health education such as radio and television due to their repetitive nature, personalization of content via avatars and virtual identities, and interactive capability that provides immediate feedback.
Games Promote Smoking Prevention
Video games that graphically portray adverse physiological effects of smoking have been found to strongly increase ‘the resolve not to smoke’ in preadolescent children aged 10 to 12. After playing the games, the children were able to express a determination not to smoke and were able to use concrete and graphic examples about the harmful and damaging effects of smoking on the body.
Games Promote Skin Cancer Prevention
A study on the use of ‘interactive computer technology for skin cancer prevention targeting children’ found that the technology is an effective way to introduce health education programs directed at young children in typical classroom settings.
The intervention involved over 200 third- and fourth-grade students and was randomized into three groups: computer intervention, standard teacher-led intervention and a control group. The study found that there was a significant increase in post-intervention knowledge about skin cancer in the computer group compared to either the teacher-led or control group.
Games Promote Childhood Obesity Prevention
A systematic review of health video game interventions in childhood obesity prevention concludes that video games play a positive role in improving health and health education outcomes in children. Positive outcomes related to obesity were observed in about 40 percent of the studies included in the review, and all of them targeted overweight or obese participants.
Various other studies have also reported the positive impact of video games on outcomes related to obesity prevention such as adherence to play games, aerobic fitness, anthropometry, dietary intake, motivation to play, knowledge of obesity, perceived exertion, physical activity, physiological measurements, and reduction in sedentary behavior or screen time.
Games Promote Asthma-Related Behavioral Changes
Six research studies—five of which used computer-based asthma games and one which used a console video game—have reported the positive impact of games on behavioral change outcomes related to asthma, such as asthma self-management skills; asthma symptoms; physician visits; hospital visits; oral steroid use; school absence; and spirometric performance.
Two of those six studies reported significant improvement in asthma self-management skills in the experimental group compared to the control group. One study reported lower asthma symptom scores, lower clinical appointment return rate, and fewer hospitalizations in experimental subjects post-intervention.
Games Promote Diabetes-Related Behavioral Changes
With regard to behavioral change outcomes related to diabetes, one study reported improvement in self-efficacy ratings and levels of hemoglobin A1C levels, but the differences did not reach statistical significance.
Another review of nine studies involving 11 video games in diabetes education concludes that games using situation problem-solving methods to teach diet, exercise, self-monitored blood glucose and medication adherence have shown positive outcomes in knowledge, medication adherence, disease management, and clinical outcomes.
Games Promote Rehabilitation in Children with Special Needs
A randomized controlled trial that used Nintendo Wii along with standard physiotherapy to treat patients with cerebral palsy reported significant improvement in upper limb function compared to patients receiving standard physiotherapy alone.
Another study that used Wii-based video games reported significant improvements in motor proficiency in people with Down’s syndrome. Video games also improved manual and body coordination, ability to follow movement cues and directions, functional mobility, and length of time spent at high intensity physical activity in people with special needs.
Games Can Improve Mental Health Outcomes
Gamification is also shown to improve mental health outcomes. While concerns about the impact of video game content and its perceived effects on youth persist, researchers conclude that video games facilitate therapeutic relationships, help evaluate cognitive skills, and clarify conflicts during the therapy process.
Incorporating video games into the therapy of three children struggling with disruptive behaviors, separation anxiety and tic disorder, respectively, produced clinically significant improvements in all three patients—however, these results are limited by the small sample size of the study.
Including commercial role-playing video games in therapy for children with a history of abuse, neglect, and conduct problems has been proven to increase rapport between the patient and therapist, and improved the engagement of children in the therapy process.
As noted by the time period over which many of these studies have been conducted, the use of therapeutic gamification has been around for some time. As it grows in volume and frequency for the pediatric population, we will hopefully see a continued increased in positive health and health education-related outcomes in children.
Shiva Gopal Reddy has a Bachelor's degree in Physics and a Master's in Applied Psychology and writes frequently on the latest research, impact, happenings and trends in digital health technology.