Exploring applications of gamification for children with chronic conditions

Am I winning? Am I making progress? What level can I reach? How do I compare to others? Consciously or subconsciously, children and adults alike are constantly looking for positive feedback. The concept of gamification taps into this desire for recognition by turning daily behaviours, such as shopping, playing, waiting or exercising, into feedback intense activities through rewards, points and achievements.

Gamification is all around us, both in the physical and online world. It’s built into our fitness trackers, apps and brand loyalty programmes. While marketers have been using gamification for years to engage consumers, scientists are just starting to investigate how gamification could be used to improve patients’ adherence to treatment, reinforce positive lifestyle behaviour in order to prevent disease, and help medical practitioners to better relate to their patients.

Some descriptionThe concept of gamification and what it could mean for children with chronic conditions was explored by over 300 delegates at an interactive Ferring-sponsored symposium in Paris earlier this month as part of the 55th Annual European Society for Paediatric Endocrinology (ESPE) Meeting.

Here are some of the highlights:
Professor Sally Radovick, Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, USA, opened the symposium, noting that the innovative theme had intrigued delegates in the run-up to the symposium, inspiring them to  attend and explore how it could affect them and their patients.

Professor Marc Buelens, Emeritus Professor of Management, Vlerick Business School, Ghent, Belgium discussed the creative use of gamification by companies and brands, citing the use of games, loyalty cards, websites and programmes aimed at changing behaviour. He used the location-based augmented reality game Pokémon GO as the most topical example, pointing to its success in motivating millions of sedentary people to exercise in the pursuit of virtual creatures.

Exploring the way in which children see things differently to their parents, Professor Buelens noted that the new digital generation may well benefit from a health perspective by using the feedback and reward system that is at the heart of a game. This is especially true in long-term chronic conditions, such as growth hormone deficiency which requires young patients to take daily injections.

Explaining the neuroscience behind gamification, Professor Eli Hershkovitz, Director of the Paediatric Endocrinology Unit, Soroka Medical Centre & Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel, pointed to evidence to suggest that education in a game-based environment can help promote a deeper level of learning and reinforce positive behavioural changes through activation of a range of cognitive pathways that result in specific health benefits.  Using complex techniques and state-of-the-art scanning such as structural Magnetic Resonance Imaging (sMRI) and functional Magnetic Resonance Imaging (fMRI), changes can be seen within the reward centres in the brain in individuals involved in games. These reward centres in turn can positively affect behaviour leading to actions that can improve health and disease management.

Some descriptionThe proof of this point was provided by Professor Maged Kamel Boulos, Professor and Chair of Digital Health, University of the Highlands and Islands, Scotland, who considered the evidence on the use of games. Although gamification in health is a relatively new concept, the emerging evidence is compelling. Studies have already begun to demonstrate behavioural and clinical changes in patients enrolled in disease-specific games, with these games improving exercise outcomes in patients, calorific intake and adherence in chronic conditions such as diabetes.

In response to a question from the audience, Professor Boulos explained that while the games themselves do not have to be digital in nature, they do need to reflect the balance of feedback and reward, be directly relevant to the needs of the patient and the outcomes that clinicians want. So while a board game could achieve as much as a website, no doubt kids would want the website!

Participants asked a string of highly relevant and practical questions on how gamification could be used with patients, with a number of questions focusing on the issues of confidentiality and patient data. Professor Buelens commented that many younger patients are motivated by social interaction and are willing to share information on social media. However, he stressed that the choice to remain anonymous through pseudonyms should be respected, particularly on disease-specific websites. Professor Boulos went on to say that he felt that gamification is an exciting area which will have a role to play with patients, particularly the young.

Professor Radovick then asked the audience for feedback on their perception of the applicability of gamification in health by asking the question: “Do you believe that gamification could improve adherence to growth hormone treatment?”

The audience were asked to vote with green (yes) or red (no) cards. Professor Radovick received the gamification reward she had hoped for, with over 280 green cards and only 3 red.

Often the success of a symposium is gauged by the interest generated in the audience after the meeting has ended. Delegates followed the presenters out into the lobbies asking questions and debating issues for almost an hour afterwards. Perhaps, that was part of the game; providing feedback, rewarding the audience with stimulating information and initiating behavioural change within them for the clinical benefit of children with growth hormone deficiency.

Can We Gamify Health – YES! And we look forward to exploring this concept further.

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