Digital health solutions are increasingly merging with aspects of gaming in subtle or less subtle ways. Here are 4 examples and what they mean for the future of health.
1. Gamifying health
If you have used a recent app, you might be familiar with the concept of gamification; even if you haven’t heard of the term before. It refers to incorporating aspects of game playing such as a point/progression system, motivational challenges or rewards aimed at boosting user engagement. Popular apps like Duolingo, Waze or even Tinder incorporate such aspects to entice users.
Of course, developers of health apps also made use of gamified features to help users better tend to their health. An excellent example is that of mySugr’s approach for diabetes management. Via its app, the startup reimagined diabetes as a tamagotchi-like monster that can be tamed. By completing challenges, earning points and receiving personalized insights, the app incentivizes patients to keep their glucose level at a desirable one.
Pharma giant Roche even saw the potential in this approach and acquired mySugr in 2017. The company went on to pair the app with its existing Accu-Chek Guide glucose meter to create the mySugr Bundle; thereby augmenting diabetics’ management of their condition. Insurance companies also favour such an approach, as exemplified by the five German insurers that offer the mySugr Bundle since 2018.
For a wider audience, health trackers like Fitbit or the Apple Watch come with gamified features like social components and challenges to motivate users to stick to their workout, compare with their friends and work on improving results. A recent report even found that more than 70% of young people use such digital wellbeing services/devices. The researchers behind the study are advocating for schools to better educate the younger generation about the use of these services.
2. Finding treatments by playing video games
The unique engagement that video games offer has also been leveraged to help researchers in developing vaccines. This is the idea behind Foldit, an online computer game where players, without any prior biochemistry knowledge, compete to solve puzzles by folding protein structures so that they best fit a target. Think Tetris, but multiplayer, and with a laudable aim.
The best solutions to Foldit puzzles are further analyzed as they could offer new insights into diseases like AIDS or COVID-19 and thereby find related therapies. In their latest report, researchers at the University of Washington Institute for Protein Design in Seattle tested 100 anti-inflammatory Foldit designs related to the novel coronavirus. However, the designs did not yield promising results. This only means that new puzzles will become available to allow players to find other potential solutions from different angles.
3. Prescription video game
As over-the-top as the above heading might sound, it is actually true: video games are now medicine. In June 2020, the FDA made these combinations of words hold true by approving of the first video game to be legally marketed and prescribed as a medicine in the U.S.
Developed by Akili Interactive, EndeavorRX can be prescribed by doctors for children aged 8-12 with ADHD. The developers designed it to challenge a child's brain by encouraging them to focus on multiple tasks simultaneously while playing.
Before its approval, EndeavorRX underwent 7 years of clinical trials, which included over 600 participating children. Published in The Lancet Digital Health, a recent study found the game's potential to "improve objectively measured inattention in pediatric patients with ADHD, while presenting minimal adverse events.”
More than just offering an engaging way for children with ADHD to manage their condition, it offers a drug-free alternative complying with caregiver preferences or concerns about abuse and misuse.
4. Playing to improve health outcomes
While the EndeavorRX’s case as an approved medicine is unique (for now), instances of employing games to improve health outcomes are increasing. From education through stress relief to digital alternatives, games are lending a novel, yet digital, helping hand to patients and clinicians alike.
A systematic review published in the American Journal of Preventive Medicine found that video game interventions improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes and 46% of clinician skills outcomes. The latter aspect is in line with what we previously suggested. By engaging in cooperative games - board games rather than video games - healthcare professionals can relieve stress, promote teamwork and improve healthcare processes and outcomes for patients and themselves.
For patients, Re-Mission 2 develops games aimed at improving cancer treatment adherence and self-efficacy. Studies showed improved behavioural outcomes with video game intervention among younger cancer patients, and this is what Re-Mission 2 based itself on to develop its games. Six are already freely-available online, putting the player inside the human body with a range of weapons and powers to combat cancer. The parallels the games draw from real-world chemotherapeutic strategies also help inform users about the treatments and their functioning.
Virtual reality (VR), a technology mostly used to offer gamers immersive environments, also shows great promise for medical purposes. In particular, it is a potent drug-free alternative for pain relief. Earlier this year, we interviewed researchers investigating the benefits of VR for pain reduction in labour and delivery. They found a statistically significant reduction in pain among women who used VR during labour. Other researchers found that after VR therapy, children with cerebral palsy experienced a significant improvement in their mobility. The authors further called for adding this method to conventional rehabilitation techniques so as to improve outcomes.
Even if you aren’t among the estimated 2.7 billion gamers across the globe, you are probably familiar with the phenomenon. The interactive media has been entertaining people across all age groups for decades. However, you might also be familiar with the negative portrayal of video games. While in the past our mothers would tell us to stop playing as it will damage our eyesight, nowadays the medium is being blamed for being a cause of violent and aggressive behaviour among its adopters. Last year, the President of the United States even suggested that video games are to blame for mass shootings.
Another criticized aspect of games is the length. Playtimes vary from a couple of minutes to several dozens of hours. Some of the most popular games are quite time-consuming. For instance, The Witcher III can take up to 100 hours to beat. Even a delivery simulator like Death Stranding clocks at around 50 hours.
The WHO even went ahead and included gaming disorder as a behavioural addiction in the 11th revision of its International Statistical Classification of Diseases (ICD). This can be a real issue for a significant minority whose behavioural and social abilities will be impaired. Proper therapy and followup will be required for those affected.
... Or Game On?
However, for 90% of gamers, no harmful effects or negative long-term consequences can be found. This is what the longest study ever done on video game addiction, published in March 2020, concluded.
Additionally, year, after year, after year, separate studies showed that there is no link between video games and aggressive behaviour. “There's absolutely no causal evidence that violent video game play leads to aggression in the real world,” said Andrew Przybylski, an Oxford University researcher, who has been studying the psychological effects of video games for over a decade and co-authored a 2019 study on the matter.
Video games are definitely a controversial medium whose aspects will be the subject of debates for years to come. However, some of those very aspects from video games and gaming in general can and are incorporated in healthcare. With the engagement and benefits we highlighted in this article, we are likely to see more examples arising from digital health in the near future.