The evidence behind mHealth gamification

A few months ago I reviewed an app created by the American Red Cross to help educate users on first aid.

One of the most captivating features of the app, outside of the tremendous useful information, was the integration of the Game Center on the iOS version of the app.

After reviewing a section of the app on how to treat an emergency situation (e.g. bleeding), the user can then test their knowledge.

Successful completion of the quiz yields a badge that can then be posted via Twitter, Facebook, and the Apple Game Center.

This app is part of a growing trend to utilize gaming in medical education. While I have heard of using gamification to increase patients utilization of apps, I had never really appreciated it.

As such, I tried to look into other potential places where gamification could be beneficial. A paper by McCallum explored the implication of games in health, while exploring challenges and possible future research [1]

Expansion of gamification to patient education apps in specific disease fields could be potentially beneficial. Caffazzo et al explored the benefits of gamification incentives to increase recording SMBGs in teenagers with type 1 diabetes [2]. Rewarding patients with iTunes music and app gift cards demonstrated increased recordings of their measurements. However, this method really boiled down to  applying a reward system to patients for increasing their measurements.

In contrast, when I was at the Medicine 2.0 Conference in Boston last year, I happened to see an interesting poster being presented on pain management. The Hospital for Sick Kids in Toronto had created an app called ‘Pain Squad’ designed to help increase measurement of cancer patients pain levels for improved therapeutic management.

Interestingly, the patient is thrust into the position as a detective who is investigating the pain they are experiencing. By being compliant, they are rewarded by increasing their rank up in the police department. Amazingly, they got a large cast of live actors from television to help encourage the patients to stay compliant! This is an amazing step and great deed.

Areas of direct gamification being explored include actual games targeted at younger crowds to increase preferable activities or discourage unhealthy practices. One group that is exploring this aspect is Truth (the group behind the anti-tobacco company movement), who put together a game called ‘Flavor Monsters.’ The aim of this game is to help deter users from smoking by bringing together a tower defense/shooter game and information on smoking and tobacco manufacturers. Whether such a tactic will actually deter users from smoking will be interesting to see in the future.

The use of gamification, if used appropriately, can be a potential boon to the education of patients on medical related topics. One issue  is that incentive based gaming will lose interest if maxed out by the user. However, with social media this could be refined through social rewards.

A study by Lin et al explored the use of social media in gamification and how it may impact health [3].  This expansion of gamification for education could also be done by increasing utilization of social media such as with Facebook and Twitter. Zynga has made great strides in decreasing our daily productivity by encouraging people to pluck virtual apples on virtual farms. That alone is not what keeps users coming back. It’s the social factor that draws in others to see and participate.

Can this mentality be expanded to education for both patients and professionals? If so how could this be done? I feel these areas will be explored further in the next few years and integration into practice may become more commonplace. One area that would be great is the incorporation of healthy lifestyles with gamification. One app that I think brings this together is Zombies, Run! I mean, what can be better than ‘running’ from zombies as you collect supplies and listen to a great story? Incorporation of an RPG (or role playing game) mechanics helps increase users desire to continue to participate. Could this be done with diet or other activities as well?

Gamification as an incentive for health may be a great feature to be studied and prudently applied in the future. This may be beneficial for increasing medication adherence, or serve as an incentive for diet and exercise. Ideally, future research should center on what factors increase patient utilization of an app and analyze objective outcomes that would be pertinent for patient healthcare. I would love to hear others thoughts on where gamification can be expanded and what possible challenges we may encounter.


  1. Mccallum S. Gamification and serious games for personalized health. Stud Health Technol Inform. 2012;177:85-96.
  2. Cafazzo JA, Casselman M, Hamming N, Katzman DK, Palmert MR. Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study. J Med Internet Res. 2012;14(3):e70.
  3. Lin RJ, Zhu X. Leveraging social media for preventive care-A gamification system and insights. Stud Health Technol Inform. 2012;180:838-42.


Timothy Aungst, PharmD

Digital Pharmacist seeking to integrate technology and mHealth into pharmacy practice and patient care. Assistant Professor by day, blogger and writer by night.

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9 Responses to The evidence behind mHealth gamification

  1. Rob Richards February 6, 2013 at 1:44 pm #

    Nice article Timothy and thanks for sharing.

    It’s a good feeling seeing the interest in promoting health and well being using the latest consumer technologies.

    HopeLabs is successfully using gamification mechanics to to fight obesity, heart disease and diabetes by incenting teens and tweens to exercise more. Kids strap on a small activity meter called a Zamzee and run around all day then upload the data to update their profiles on the Zamzee website. Points are rewarded for meeting exercise activity challenges and can be rewarded with virtual and physical rewards. You can check it out here:

    Here’s a useful blog post on Gamification best practices that are applicable at driving long-term goals and resolution successes.

    Have a great day!

  2. Portable Genomics February 13, 2013 at 12:37 pm #

    Interesting article indeed.

    As medical data and health in general turns digital, using the data as a source for gaming or creation might be included in the serious gaming approach.

    Working in the genomics space, we think that genome data is about to be the new digital data available in town. With its huge potential in preventive medicine, we need to involve users, patients into learning about their genome and start using their data.

    Playing, creating with the data is possible, even with your genome data.

    We have created the first “genomic entertainment” App, GeneGroove for iPhone, a free App that allows patients with 23andMe data, to create a unique music melody from their genome. Your genome is unique, your melody will be unique. To come, genome-based ringtones, graphics and videos. Possibility to create unique Art from your genome is endless.

    We’ll see in the next future how playing with your genome can bring consumers to start using their genome also for a better comprehension about their risks, susceptibilities and how it can engage them into prevention.

  3. Jeremy Eck February 13, 2013 at 12:59 pm #

    Nice article on gamification. As an instructional developer, it is with a great deal of skepticism that I approach lasting behaior modification. The use of “shiny objects” as incentives or rewards (whether virtual or tangible) has rarely worked for long. The underlying triggers for the behaviors has to be assessed and a long-term strategy (with an understanding of the long-term benefits) clearly understood by the users and patient populations. A simulation with a compressed timeline illustrating the inherent costs of any series of chronic health conditions or risky behaviors might do more to build a convincing argument for taking a earnest and participative approach, and much of this could acheived through gaming and simulation. Wellness and silver linings are fine, serious health challenges need a more substantial approach.

  4. Gunther Eysenbach February 13, 2013 at 8:20 pm #

    Another fascinating application is described here:

    Gotsis M, Wang H, Spruijt-Metz D, Jordan-Marsh M, Valente TW
    Wellness Partners: Design and Evaluation of a Web-Based Physical Activity Diary with Social Gaming Features for Adults
    JMIR Res Protoc 2013;2(1):e10

    Gamification is certainly an area where more research is required to find out what works and what doesn’t, and JMIR welcomes submissions on these topics (

    • Timothy Aungst, PharmD February 14, 2013 at 10:47 am #

      Thank you Gunther for bringing this paper to my attention. I think its excellent and brings a lot of good points together. Hopefully our readers and other researchers will be able to use this as an example in their own works. Gamification still has a long way to go, but further studies and trial and error will get us there.

  5. Kate Whittaker March 26, 2014 at 10:27 am #

    Thanks for this pithy article. I’d be interested in finding out if and how gamfication has been used in educating medical professionals either regarding a specific subject or, even more specifically in educating them about the value of understanding the principles of educational theory in designing their own courses. Any leads welcome.

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