Perhaps the greatest challenge designers face when creating new products intended to improve a person’s health is ensuring proper use and adherence. A user may adopt the product initially with optimism or even enthusiasm, but over time, we often see waning engagement and inconsistent use. This is a big problem when the efficacy of the product depends on long-term use.
One strategy used to address this challenge in the recent past is gamification—using the features and mechanics of games to keep users interested. Few engagement models are as potent as a game. Themes like competition, rewards, and discovery connect with users at a basic, and even sub-conscious level. When applied to health, gamification can transform typical chores, such as regular exercise, glucose monitoring, and a healthy diet into something more fun. However, designers should be aware of the various pitfalls involved when using this approach for health-related products and services.
In my experience as a product designer, I’ve explored gamification in various applications, especially for healthcare products. While there were some moments of success, I’ve run into numerous pitfalls – these have become the lessons that shape my current approach to healthcare design. Below are four problem areas I’ve learned to avoid.
In gaming, the opportunity to win is a primary motivator for play. People start most games with an understanding of the goals and constraints and then unleash their competitive spirit for the thrill of victory.
Many healthcare products, particularly quantified-self wearables, have adopted a similar goal oriented model to drive engagement. The Fitbit Flex that I currently use gave me a goal of 10,000 steps per day. When I reach that total, the device buzzes and dances in celebration – like I won the game. The first few times it was fun, but the excitement is wearing off. The device continues to reward me in the same way for the same accomplishment, and I find the thrill of “winning” is diminishing in value. This may help explain why one-third of American consumers who have owned a wearable product stopped using it within six months.
I’ve encountered the same problem when designing other healthcare products around this basic game theme of winning. The challenge is that long-term health is hard to distill into achievable, near term goals. Unless the Fitbit device can define new ways of winning, or provide more insight into how to improve my behavior, I expect it will spend more time in the drawer than on my wrist.
Hundreds of video games, especially action-oriented games, use some kind of score to represent how a player is doing. Users quickly figure out what factors in the game influence their score and tune their game behaviors accordingly.
In a similar way, many health-tracking devices distill the data they collect down to a simple metric. The Nike Fuel band translates physical activity into Fuel Points for instance. Blood glucose meters use a simple metric to represent the status of the user’s diabetes. For most of these devices, the metric becomes the only representation of what is often complex data. This can become a problem when users only connect to the metric and not the data that informs the metric. I’ve talked to people who’ve abandoned blood glucose meters because their glucose number fluctuates dramatically between tests they’ve conducted back to back. In other cases, they don’t see a direct connection between their activities and their measured results – they eat a healthy meal and still have a high number. The worst fear, especially for health care providers, is when patients base their behavior on false assumptions. I’ve observed diabetic patients who see a normal blood glucose reading and use it to justify indulging in an un-healthy meal.
While there are obvious reasons to distill complex data into simple, understandable metrics, designers need to ensure users know how to properly interpret results. Unlike a video game character, a real person’s health is hard to represent with a simple metric.
It doesn’t take long for players of a game to exploit any weaknesses in the structure, rules or components of the game. Most great games have evolved over time in response to this exploitation. Baseball has seen hundreds of rule changes since the National League was formed in 1876.
When using game mechanics as a design tool, the same challenge must be addressed, and room for evolution should be considered. The use of “steps” as a metric for health can be valuable, but it can be easily gamed with the current accelerometers in wearable devices. I’ve spoken to people who twirl their Jawbone Up around their finger at the end of the day if they haven’t reached their steps goal. As devices become more sophisticated, blending data from different sources like GPS and heart rate, designers will have more ways to defend against gaming the game.
While fear of losing a game can motivate players, it can also be a powerful de-motivator. Many people will not play a game if they think they will lose, which is a disaster if the game is your health.
When designing a blood glucose meter, my team tested UI concepts that employed rewards and a score to provide positive and negative feedback on glucose results over time. When we tested the concepts, several research participants indicated that if they knew their glucose level was high, they wouldn’t use the meter – to avoid influencing their score. This reaction, the threat of not using the device, was the opposite of what we were striving for with the design so we quickly shifted direction.
When it comes to health, maintaining a good routine is much more important than losing a game. Designers must be sensitive to this issue when considering health oriented products, and ensure the experience always motivates and encourages users.
With the rise of chronic and lifestyle related diseases like diabetes, the availability of wearable technologies, and various other emerging market forces, health engagement is set to be a hot topic in the coming decade. Product designers will play a substantial role in shaping the health landscape by defining and developing the engagement models that truly drive behavior change. Gamification will continue to provide inspiration in this space but as discussed above, designers should be wary of the many pitfalls it creates as an experience strategy.
Feel free to share your experiences with gamification below.