mHealth Games Offer a ‘Fun’ Way to Boost Patient Engagement

mHealth games and gaming technology have the potential to improve patient engagement and boost clinical outcomes – if only people would take them seriously.

“The word ‘game’ has always been a serious barrier,” says Beth Bryant, of Games for Health, a Portland, Me.-based group acquired by the Personal Connected Health Alliance and HIMSS in 2014. “For a long, long time, people have tried to call it ‘serious play’ or used other words to get around it.”

Yet it is serious business. Several payers and pharma companies have invested in games and gaming platforms to push the needle on patient engagement efforts like medication adherence. Even Express Scripts, the nation’s largest pharmacy benefit management organization, recently turned to Mango Health’s gaming platform in an effort to boost compliance.

"Our experience has taught us that when patients are active participants in their health, they achieve better health outcomes,” Glen Stettin, Express Scripts’ senior vice president and chief innovation officer, said in a press release. “Mango Health's success in keeping patients engaged in their care through fun, user-friendly mobile applications is a natural extension of the care our pharmacists provide to our members. We look forward to bringing together our unique capabilities to motivate patients and encourage positive and healthy behaviors.”

But “fun” and “friendly” aren’t words typically associated with healthcare. And those within the mHealth and digital health gaming ecosystem say that’s what’s keeping the industry down.

Bryant, who has seen the once-sizeable Games for Health pavilion dwindle away at each year’s mHealth Summit, says the market is struggling to find an, ahem, game plan.

“There are lots of smart, bright people” in the industry, she says. “It’s a very competitive market, but they haven’t been able to get it going.”


To be clear, mHealth games and gaming technology are two separate concepts.

The first deals with games that promote health and wellness or seek to improve care management or clinical outcomes.

The second – also called gamification - refers to technology that promotes engagement by feeding that natural human desire to play a game, compete with others and receive rewards.

And that, experts say, can be tricky. You have to know your target audience, your goals and – most importantly – what engages your audience. It’s very easy to do this wrong.

"Bribery is not a game,” Michael Fergusson, CEO of the mHealth gaming company Ayogo, famously said at the 2012 mHealth Summit. “It’s not enough just to give people rewards for doing the right thing. Points and badges are to games what page heading and chapter numbers are to books. I can put page numbers and chapter headings on my VCR manual, but that doesn’t make it War and Peace.”

Some see mHealth gaming as an effort to appeal to emotion over reason. To compel true patient engagement, they say, one has to play to the passions.

“We in healthcare have for too long been overly targeting the rational mind,” says Tryggvi Thorgeirsson, MD, MPH, a physician at the National University Hospital of Iceland and a researcher of behavioral economics at the Harvard School of Public Health. “Most digital health solutions are reason-based,” whereas efforts to change patients’ behaviors should focus more on “finding meaningful ways of giving you instant gratification and rewards.”

Last year, Thorgeirsson – also called “Thor” - and Saemundur “Sam” Oddsson, MD, launched SideKickHealth, a Silicon Valley-based company that uses gamified services and apps to target behavior change for lifestyle-related conditions. The company’s first product is targeted at vulnerable populations at increased risk of developing Type 2 diabetes.

“We collaborated with SidekickHealth because it makes our program scalable, allowing us to provide more diabetes prevention programs to those in need,” says Marlayna Bollinger, founder and executive director of the Skinny Gene Project, a San Diego-based non-profit organization whose Diabetes Prevention Program has been recognized by the Centers for Disease Control and Prevention (CDC) with helping to prevent or delay type 2 diabetes.

“With SidekickHealth, we can maintain the high-touch relationships that are especially important to low-income participants,” she said in a press release issued by SideKickHealth.  “We can modify the program to make it culturally relevant and ensure information is not just received; it's understood.  In groups that are at high risk for diabetes, like Hispanics and Native Americans, SidekickHealth has been especially effective in helping people lower their risk for diabetes.”

Thorgeirsson says games and gaming technology appeal to the “reptile brain,” or the part of the brain focused on emotion. It ties together emotional triggers – rewards, social gratification, the thrill of winning a contest – with decision-making skills, targeting the idea that people are far more apt to change their behaviors and adopt a healthier lifestyle if they’re emotionally invested in it.

Thorgeirsson knows he’s dealing with serious issues – some 68 percent of deaths worldwide can actually be traced back to lifestyle diseases – but that doesn’t mean games should be cast aside for more weighty concepts.

“I prefer that my users don’t take it overly seriously,” he says. “I don’t want them to feel that this is a clinical solution. I want them to enjoy playing it every day.”

by Eric Wicklund,