5 Lessons In Gamifying Health
I’ve been designing games and gamified apps that improve health and wellbeing for around a decade. When I first started designing in this sector, things were fuzzy and ill-defined. People were just kind of trying things and seeing what worked, often to the detriment of their users. A lot has changed since then, most notably the amount of money and attention being funneled into user-facing healthcare applications. From wellness apps to digital thereputics (DTx) to software as a medical device, health apps are big business, and almost all of them use gamification of some type to engage and retain users.
These easily accessible and highly usable apps provide untapped potential to make the world a healthier place and save our healthcare system billions of dollars. But there are rocks on that shore that must be avoided if we want our products to truly serve patients and earn their trust. Here are five of the most important lessons I’ve learned designing these kinds of applications.
1. Beware of social mechanics
It’s modern design dogma that social mechanisms are extremely motivating. We’re wired to care about what one another think, to behave altruistically, to seek validation, and to compare ourselves to others. However, when it comes to our health, most people prefer to keep things closer to the chest. Sure, you might talk about your health conditions with your family or closest friends, but most of us aren’t posting details of our chronic illnesses online for all to see. That isn’t to say that users don’t want to share their health data — they do, as long as there’s something in it for them. But out of all the game mechanics I asked about for a 2023 UX research brief, the least desirable by far were social mechanics of virtually all kinds.
It may be painful to leave this incredibly powerful motivator on the table, but if we want to serve users well, we must respect their privacy. So is there a place for social mechanics in your gamified health app? Well, it kind of depends. The users I spoke with are not necessarily your users, and in certain focus groups, specific demographics did desire social mechanics (such as the ability to share their stories and hear other experiences) very highly. But even here, they made it clear they wanted an extremely individualized and controllable social experience, so proceed with caution.
2. The people who want your product the most might need it the least
One trap designers fall into when building gamified apps is to find their super users and tailor the experience to them and their needs. But the truth is, if you really care about users’ health (not just recording minutes of engagement or points of contact per day), these are the people you need the least. The type of user in the top 5% of your user base, who steadfastly adhere to a health app, any health app, are also the ones who would probably have success on their own. They’re highly organized and motivated, love checking boxes and completing task lists, and already have good knowledge of holistic health practices.
Do you want these people on your app? Oh, definitely. They look amazing to investors and provide useful data. But if you’re after measurable improvements in health and wellbeing, it’s the sluggish users you need to focus on. These are harder to win over, but you’ll never see longterm success if you can’t capture them, and they have the most to gain when it comes to fitness.
Last, one very important word of warning. Whenever you build gamification into your app, there are people who will use your product pathologically. You may be thinking that there’s no harm in this, since everything in your app is geared toward improving health, but there are many people out there with, for example, disordered eating who have a strained relationship to food and nutrition, or with exercise. Do you want these users meticulously logging their food and exercise? They’ve been there before, and it did not serve them well. There may be an app that will provide what they need, but most likely it’s not yours unless you are designing a mental health application for users with eating disorders, specifically.
3. Don’t follow the leader
App design 101 is seeing where others have found success and taking inspiration. There are many extremely engaging apps out there for habit building, education, commerce, and more. Why reinvent the wheel?
Duolingo is probably the most successful gamified platform ever built by human engineers. It’s gamified to the gills, has been A/B tested with millions of live users, and is massively profitable. Dulingo wants to educate people in a second language. You want to educate people on better health habits. Seems like a slam dunk, right?
However, when it comes to gamifying health, you need more than education. In fact, there’s little evidence that education improves peoples health at all, at least not by itself. What you need is behavior modification: real-world action. What is the action that Duolingo needs its users to repeatedly take? Touching a smartphone screen. What is the action that a successful health app needs users to take? Changes to diet, exercise, treatment adherence, and mental health practices. These things are not apples to apples or even apples to oranges. It’s apples to hippopotamuses. This is why you can’t just copy what the leaders are doing. You need to do the hard work yourself to make these difficult practices rewarding.
4. Make progress visible
Health changes slowly. Who hasn’t swapped a salad for lunch over the course of a few days and discovered that their health hasn’t changed one bit? Walking feels great and will help you live longer, but after a walk, no specific new state of fitness is achieved.
This is why visualizing progress is the most important thing you can do on your health app. There are many ways to do this, so I won’t list them here. But what is important is that whatever system you build combines instant feedback for user behavior with a long-term progression system. Use milestones, use a legible scoring system that isn’t steeped in data and statistics, and make sure that it is relevant to the users’ health, not abstract.
Note that this is different than a streak or daily check in. These mechanics are powerful in and of themselves, but do not denote progress toward a health goal. Think less Apple Health and more Candy Crush.
5. Make them feel better, right now
Yes, it’s true, health changes slowly. But that doesn’t mean you can’t provide instant gratification, too. If your app is not providing things like meditations, breathing exercises, and mindfulness you’re sleeping on the one category of action a person can take that will really make them feel better, instantly. If your app can do this well, you’ll have not just engaged users but fans for life. This is what makes Headspace so sticky.
That said, it’s not enough to just provide meditations and breathing modules. They have to be, well, good. That might sound vague, but even a small bit of user-centered design should light the way and fill out the details. Bottom line is, your mental health features need to be simple, easy to do, delightful, and repeatable any time. Give users this, and the rest will start to follow.
Sam Liberty is a gamification expert, professor of game design at Northeastern University, and former Lead Game Designer for Sidekick Health.
