the serious strategy behind social health games

September 30, 2011

in cohealth,health games

on september 21, the #co_health tweet chat welcomed trapper markelz, head of product at meyouhealth. we spoke about why social health games work (and why they don’t), and we left a few unanswered questions, which trapper’s addressed here. during our chat, we also announced the opportunity to participate in a cohealth pilot of meyou health’s product, the daily challenge. this is your chance to test a soon-to-be-released enterprise solution and give feedback on it. don’t miss out. sign up now.

q: many of us were confused by the idea that a game should have no goal. could you help us better understand your position?

tm: this is a hard one. it isn’t that games should have no goal, but more that games don’t need a goal. based on what i’ve learned in the last two years, there’s something immediately disingenuous (from the perspective of the player) about a health game. if i need to lose weight, the fact that you’ll make a game that successfully tricks me into eating differently and running around more is absurd. equally absurd is the idea that if i need to lose 40 pounds, your game is the intervention i need. it might be for some tiny fraction of the population, but people are far too complex—and, thus, so is behavior change.

before most people can tackle weight loss, they may need to change jobs so they decrease their two-hour commute. or they may need to repair an abusive relationship with a parent or spouse. they may need to find long-term care for their parent with dementia to reduce their stress. or become mindful of their food-buying habits. and so on. i’ve personally become overwhelmed by the complexity of people as we dove into this design challenge at meyou health.

so far, i believe the best we can do is create a supportive, educational environment that guides people toward some small epiphany. gamification can help with this. we can create a context where interacting with people is deemed required. essentially, we generate a reason to reach out and form support networks—even with people you’ve never connected with before. and we can impose constraints so that the entire spectrum of behavior change isn’t the focus. instead, the focus is these seemingly arbitrary small actions that generate momentum.

the product doesn’t need to be a game at all. it doesn’t need to be about abstractions. it can be about real people, and it can be about real small changes that you make in your real life. in such a product, there is no “goal.” that doesn’t mean that people don’t create their own goals as they have their own epiphanies, but the game doesn’t create that; the participants do.

q. what works best to prompt engagement long term?

tm: long-term engagement is all about relevance. if a product continues to be relevant (therefore valuable) to someone’s daily life, he or she will continue to pay attention to it. gamification can help with this because it can create permission for a product to reach out and, therefore, remain relevant. for example, with daily challenge, participants agree to receive a daily email invitation. they receive a daily challenge in a method that’s comfortable, non-intrusive and convenient. we have a reason to contact someone and remain relevant—and we have permission to do so.

q. are there any studies that show that games help people make long-term changes?

tm: as far as i’m aware, there are no studies that show that long-term behavior changes were made specifically from a game. and even if there were, my bet is that it would probably cite a social dynamic rather than the game itself.

for instance, competition is a social dynamic that arises out of a game mechanic like a leader board. the game could be something simple, like collect the most coins in 30 seconds. i might keep playing the game every day—not because collecting coins is particularly fun, but because my friends have collected more and i’m trying to beat their record.

that said, there are plenty of studies showing that long-term behavior change was accomplished using social interventions. what we’re trying to do at meyou health is make social more relevant to someone for a longer period of time by setting up specific interactions that come through a gamified product.

q. picking up from my recap of our #co_health chat, “what is it that makes some games accomplish this [social interaction] while others don’t. how else can we evaluate a game?

tm: if everyone knew this, then every game would be a hit, right?

a game is a complex mix of dynamics that lets you know what you’re supposed to do and when to do it, mechanics that let you know where you’ve come from and what you can achieve in the future, and aesthetics that deliver on your tactile and emotional connection to the content. all of this produces an extended journey of ups and downs that culminates in some form of peak-end ( judgment over what you experienced.

the way we evaluate our products at meyou health is to ask ourselves: do people keep using our products? if you don’t have engagement, you can’t possibly have effect. if you don’t have effect, you can’t possibly generate a measurable health outcome. to people in product development, that sounds pretty normal (first, we need people to use it!), but i’ve learned that in the health space, it’s normally, “let’s prove this intervention is effective, and then let’s hope we can get people to use it!”

q. will games make health programs more personal? if yes, how?

tm: i think they really can. if you use game elements, you can create a reason for people to interact. you can create scenarios where social taboos fall away. games can truly bring people together because they can immediately share a common context. if you see a guy sitting on the street, how likely are you to go up to him and start talking? if that same guy is sitting on the street with a chess board in front of him (assuming you’re somewhat confident in your chess-playing ability and you have the time for a game), you’re far more likely to stop and interact.

q. how could a game help someone train for a 5k run, for example?

tm: there are two scenarios where i’ve heard gaming applied to this question:

1. how can a game motivate someone to run a 5k?
2. how can a game help someone (who is already motivated) train (and complete the training) for a 5k?

there’s confusion between products that motivate you to do something and products that take advantage of your motivation. doing #2, working with existing motivation, is a lot easier and ultimately where a lot of health games end up shaking out (in my opinion).

creating motivation is much harder. i believe you can only approach it indirectly, as there are just too many reasons why someone chooses not to do something. i don’t have a good answer for how you create motivation at scale. at meyou health, we hope that by encouraging people to complete daily, small actions and to have conversations with their support network about these actions, we’ll create the personal epiphanies necessary for behavior change to take hold from within.

q. do things like sports leagues fit into the discussion someplace? or are electronic games more personal?

tm: sports leagues are successful because they add that social element. for team sports, it’s obvious. for golf leagues, bowling leagues, fantasy football, etc., they’re fun because of the social interaction (in the form of cooperation, competition, comparison, knowledge sharing, etc). how fun would a sports league be if you went every week and no one talked to you? if no one knew your name and you didn’t interact with anyone? you probably wouldn’t play in that league for very long.

the use of gamification is really about figuring out a reason for people to be social. we all want support and someone to share our experiences with so we don’t feel alone in our health struggles—and so that we have people on our side when we try to change.

from the beginning of time, games have been an equalizer. it didn’t matter who we were, or where we came from—when we sat across from each other at a board game, we felt comfortable interacting. the rules and constraints provided the comfort we needed to be human with one another. in health games, i’m curious to find the same thing. what combination of dynamics, mechanics and aesthetics produces the highest quality interactions that move the needle on personal well-being? if we can figure that out, the world truly can be a healthier place.


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