“People rarely succeed unless they have fun in what they are doing.” -Dale Carnegie

The Theory of Fun is an organization devoted to social experiments in fun. In one experiment, they turned a staircase next to an escalator into a piano to see whether people would still opt for the less physically challenging escalator. Not only did people choose for the fun piano staircase; they also went up and down the stairs multiple times (see the results here.) Playfulness has increasingly become incorporated into patient engagement and adherence. Additionally, creative tactics like video games that use fun, competition, and your social networks have shown positive affects on health and fitness behavior.

Paul Tarini, team leader for the Robert Wood Johnson Foundation’s Pioneer Portfolio, reported in 2010 that the collision of games and healthcare was inevitable. Featured that year at the Games for Health conference in Boston, MA, were dancing games for patients with Parkinson’s disease, or alternatives-to-smoking games on iPhones. Since, we’ve seen an unveiling of companies that develop games benefitting all sorts of conditions from anxiety and depression (SinaSprite byLitesprite) to games for kids with cancer (Re-Mission2 by Hopelab). The results have been significant and have illustrated how patients feel more inclined to accept and learn from a game about their condition than from, say, a PowerPoint or clinician. In Re-Mission2, results showed how players adhered to their treatment longer and more consistently after interacting with the game. Even more impressive, players had higher levels of chemotherapy in their body and so were literally responding to treatment better.

Michael Fergusson, founder and CEO of Ayogo Games, a social gaming production company based in Vancouver, believes games are the key to patient engagement and adherence. Practitioners, Fergusson says, “ still haven’t internalized the idea that we need to help people do the right thing. Not just by giving them the opportunity, but making them want to do it.”

Prescribed Fun: The Trick (or Science) of Adherence and Engagement

The World Health Organization (click for report) has said that people around the world will benefit more from adherence than from new therapy. Esther Dyson, an active investor in the digital health movement, has said, “It’s colossal stupidity that people aren’t healthier, because we know how to do it.” Yet, we don’t. Our own inability to do what we know we need to is the cause of many health care problems.

Perhaps social games can help. Social games are digital games played with your online social communities (like Facebook and Twitter). According to Ayogo Games: “Designing engagement into social games is largely about manipulating dopamine response. Gamifying health allows us to hack into our natural feedback loops by engineering ways for us to get more dopamine for demonstrating good behavior.”

A recent NPR article, “How Video Games Are Getting Inside Your Head – And Your Wallet”discusses how video game architects actively track children’s engagement with the game they’re playing. Inherent in any game design is research, tests, and analysis, all of which are imperative to making the game more fun, more engaging, and more likely to hold the player’s attention longer, and in some cases long enough to buy something.

The science of the brain and human behavior are integral to the success of a game. Many, especially parents trying desperately to get their kids outdoors, interacting with “real” things and “real” people, have more damning language about these studies than applauding. Indeed, most, when attributing the term “brain manipulation” to something, don’t have many nice things to say. Yet, looking at all this through a health care lens, if doing the same types of testing, tweaking and manipulation leads to positive and permanent change in health and fitness of an individual, it can’t be that bad, right?

Michael Fergusson believes this, and has created successful games where players’ health and behavior improve because of it.  One of Ayogo’s first health care games, Healthseeker, was for people living with diabetes, and the first health care game on Facebook. They had over 15,000 players. There were parts that were extremely successful, but other elements that weren’t. They reviewed the data and looked at what worked and what didn’t to see what design elements of the game brought players success in their health goals. What they found was players who consistently received incoming messages of encouragement from their online social networks had significantly greater chances of success. Putting friends and family into their application, Ayogo discovered, makes the game more meaningful. As a result, this design element has been brought forward into other game designs.

Team Fun 

“Man is most nearly himself when he achieves the seriousness of a child at play.” -Heraclitus

Outside of the digital space, Little Bit Therapeutic Riding Center provides equine facilitated therapy to children and adults with neurological, pyshological, and physiological disabilities. For the riders, working with horses provides an overwhelming sense of joy, and the therapy no longer becomes treatment-like. Instead, it’s fun and unpredictable. More, a rider’s experience of success is linked to the team supporting her efforts – her volunteers, her horse, and her instructor. Play, joy, laughter, excitement – they all have healing powers for our minds, bodies, and spirits – and the value of your community in sustaining all that cannot be underestimated, whatever the method.

“The experience of interacting with your own health can be dramatically affected,” says Fergusson. Because of this you want the design of the experience to engage as many people as possible so that embedded in the design, is an evolving conversation where people can learn together and improve the quality of life together. To this, Fergusson asks an interesting question: “There’s a question about who’s behavior you’re really trying to affect in social gaming – is it the person’s behavior or the community of that person?” Perhaps it’s both that need to change in order for engagement and adherence to really stick.