Successful long-term disease management definitely implies care consistency. It assumes that both caregivers and patients know the rules and follow them: a provider is aware of an individual's current health status and is timely notified about any disturbing changes, while a patient is in charge of their treatment plan, medication intake and vitals tracking.
From our point of view, achieving care consistency is possible only with the help of technologies, when a patient uses a personalized and gamified mHealth app to input their health data and share them with a caregiver. Why an app and how does it help? To explain this, we've come up with our tech-run chronic disease management model.
The model ensures inbound and outbound information flows between patients and caregivers. This two-sided awareness and teamwork make it possible to achieve reduced readmissions, prevent complications and improve health outcomes. Yet there's a serious challenge to overcome.
Patients get sick and tired of their daily routine
Of course, nobody is their own enemy. Chronic patients don't want to develop complications and spend their best days in a hospital bed. However, long-term diseases involve complex treatments and medications with multiple side effects, affecting individuals' ability to make rational decisions and keep the self-discipline level high.
Some days patients may feel too tired to even hold a pen, and this is when they can disregard any journalizing, mistreat their symptoms and break the idea of systematic care. Of course, some data gaps are inevitable, as this is no perfect world we live in. Yet it's important to get patients accustomed to recording their measurements on a regular basis. It should become their habit similar to brushing teeth.
Another challenge here is that simply saying to a patient "you have to do it, period" won't help. Here's where gamification can handle it.
Gamification triggers motivation
Gamification is a form of human-focused design, translating fun and addictive elements that can be initially found in games into different environments.
It is called 'gamification' simply because the gaming industry was the first to excel at human-focused design.
Still, as health is certainly not a toy to play with, there's a lot of skepticism on whether it's a good idea to apply gamification to any patient-related activities.
However, this form of human-focused design has a solid background rooted in neuroscience, behavioral economics and motivational psychology.
Core Drives of motivation and engagement
Human motivation is initiated by 8 Core Drives which are bound to the Big Five of neurotransmitters – Dopamine, Oxytocin, Serotonin, Adrenaline and Endorphin. The CDs of motivation are the following:
• Epic Meaning & Calling (Adrenaline)
• Development & Accomplishment (Dopamine, Serotonin, Endorphin)
• Empowerment of Creativity & Feedback (Dopamine, Endorphin)
• Ownership & Possession (Endorphin)
• Social Influence & Relatedness (Oxytocin)
• Scarcity & Impatience (Adrenaline)
• Unpredictability & Curiosity (Dopamine)
• Loss & Avoidance (Serotonin, Adrenaline)
Popular games are that addictive because they combine different CDs and balance extrinsic motivation with intrinsic one, which makes players' brains produce neurotransmitters so that they'll feel strong emotions and act accordingly.
And as game designers have spent decades on mastering engagement and motivation, and different industries learnt from their experience, this form of human-focused designed is called 'gamification'.
Now let's see real-world examples of its successful implementation in life sciences and healthcare.
Real-world gamification examples
Games + science = breakthrough
For 15 years in a row, lots of top PhD scientists around the globe were trying to decipher a crystal structure of one of the AIDS-causing viruses – the Mason-Pfizer monkey virus.
Then the University of Washington's Center for Game Science and Biochemistry department together created FoldIt, an online puzzle game about protein folding. After 15 years of fruitless research, this game helped to decipher the M-PMV's structure just in 10 days!
Now FoldIt is used to help researching not only for HIV / AIDS, but also for cancer and Alzheimer's.
Take your pills and win a gift card
MangoHealth is a mobile application empowering patients to adopt new healthy habits, such as taking pills on time, losing some weight and hydrating more. To help individuals achieve their goals, the application allows setting reminders as well as offers education materials and alerts on possible safety issues.
Once a patient takes their medication or completes other activity beneficial for accomplishing some goal, they get points. Over time, these points are accumulated, which unlocks the chance to win a $5-10 gift card or dollar donation to a charity organization.
If we break down these incentives according to the Core Drives, they target epic meaning & calling (charity), ownership & possession plus development & accomplishment (taking meds, getting healthier and winning points).
Reduced readmissions via engaging physical rehabilitation routine
Respond Well is a digital health company providing caregivers with telerehabilitation solutions. They know that patients tend to underestimate the importance of regular physical activities to successfully pass rehabilitation cycles for different conditions, such as pulmonary and orthopedic diseases, a post-stroke condition and more. To help individuals work out continuously, they've created a solution based on a motion sensor technology (Microsoft's Kinect) and the set of 650 different exercises.
An engaging rehabilitation starts after a patient visits their physician and completes an initial assessment. A health specialist then prescribes a personalized training program according to the assessment results. The Kinect-based software watches and evaluates a patient's performance, granting points for proper movements and providing a feedback to correct improper exercising. Patients are able to choose their virtual trainer, workout music and 3D environment.
Performance data is collected and analyzed to detect certain trends and patterns in the patient's behavior and rehabilitation progress. Then it is securely synchronized with the individual's health record to help their physician make data-driven decisions on the rehabilitation plan and timely alter it in case of need.
Breaking down this program according to the Core Drives, the development & accomplishment one is in the center, as patients can track their progress by getting points for good performance. Moreover, ownership & possession plus empowerment of creativity & feedback are also applied (choosing the trainer, music and environment to exercise).
Applying gamification to chronic disease management
The easy part of gamification is that there's a plethora of ready-made elements that can be extracted from games and applied to any other reality, such as the PBL formula (points, badges and leaderboards, primitive game elements).
The hard part, however, is that this copy-pasting most likely wouldn't work. Why? Because applying entertaining things in their initial form means adopting mechanics, not meaning. In other words, by mimicking something industries wrongfully put a question of "what and how we should do" instead of asking "why we should do it and how it would make customers feel".
Engaging patients from the start
To enrich a mobile tool for chronic disease management with gamification, caregivers first need to get acquainted with 4 phases of a player's journey: Discovery, Onboarding, Scaffolding and Mastery. These stages can give a lot of hints and tips on how to interact with a patient to keep them motivated in entering the app and journalizing their progress regularly.
Good news: when it's an official app issued by a caregiver, the Discovery stage is short and includes only notifying a patient about this new tool to control their disease and installing it on a patient's device.
All onboard
The Onboarding phase starts after the app appears on an individual's smartphone. At this stage, a patient needs to be carefully introduced to all the functionality, so that he or she would understand how to use the app, what it does and how it will help them to stay healthy. For this goal, the following elements can be introduced:
• A video tutorial for newbies upon the very first app opening.
• Tooltips for the essential app screens – PGHD provision, therapeutic education, nutrition status support, a physiotherapy guide and more.
• Awarding a patient with the very first badge after opening the app, then it can be another one for passing the tutorial stage.
• Preliminary customizing – setting up an avatar and / or a totem animal, changing the color scheme of the background and more.
• Deciding on goals and milestones to reach – it would be better to do this during an appointment with a physician.
The most important Core Drive during the Onboarding process is Core Drive #2 –development & accomplishment, so caregivers can be generous with those virtual 'pats on the back'. As long as patients figure out the functionality, they will need to feel the growth while their habits start forming and they get on their way to improving health. It's not likely anyone will be happy just taking measurements, reading another article and filling in some fields and forms.
Empowering and improving a patient's skills
This is where Onboarding transforms into Scaffolding. To make patients see the difference and feel empowered, caregivers should show them results. The following elements can help with that:
• Giving points for recording measurements, inputting nutrition data, watching exercise videos, listening to meditation podcasts – for everything a patient does
• Then these points can fill in the progress bar and level up a patient, rewarding him or her with new ranks and badges.
• Depending on an app, caregivers might implement a few mini-games, for example, a totem animal or a mystic creature from the Discovery stage can evolve when a patient gains their 5th, 10th and higher levels. Of course, this is not a must, but for younger patients this feature can be very engaging.
• Social influence & relatedness is a very strong motivator, thus caregivers can introduce a patient to a community of other patients with the same disease through this app. While support group meetings are held once or twice a week or even less often, with the app a patient will feel connected to other people 24/7. The type of connection can vary – it might be just a news feed with rankings and levels of other 'players' to encourage a healthy competition. There also can be a random teaming up to beat up other groups of patients in mastering the control over a disease.
• It's also possible to trigger epic meaning & calling via notifications and warnings such as "You haven't recorded your blood glucose for 1 day. Catch up! Your team needs your disease mastery! / Your physician is worried / Your pet is almost evolved". When a patient knows his or her team / physician / pet depends on their data, they feel connected to a community, so they wouldn't want to let anyone down.
Mastering chronic disease management
When a patient develops a few new habits, starts to use an app intuitively, measures and inputs the data more or less regularly, this is when the Mastery stage begins. The boredom and routine might strike down a patient and all the efforts can vanish. An individual might think like "well, how much of my data they really need? Maybe I can stop right now and nothing will change?" In games, yes, a player can leave for good, forget about the game and be happy with what they've achieved.
But long-term disease management doesn't work that way. In most cases, patients will need to continue using their mobile tool to input their vitals and keep the condition under control for the rest of their lives. Of course, nobody can't guarantee that, but it is achievable with human-focused design, as a patient's brain can get used to the app as a simple habit triggering happy emotions and bringing certainty. For this goal, the following elements can be implemented:
• Small daily challenges, which will be a complete surprise until the next day (unpredictability and curiosity).
• Accomplishing of a challenge unlocks rare badges or grants a patient with access to a weekly lottery with different benefits depending on a particular app functionality – unique avatar and / or totem customization options, discounts on some wellness procedures (like massage or balneotherapy) and more.
• Mentor level – when a patient is recognized as a master, he or she can share their tips on how to manage the disease, which can be enabled via a chat option, for example.
Why so serious? Or patients had enough of poker faces
Engagement and encouragement should take the place of uncertainty and anxiety in chronic patients' life. Even if there are some strict frames like the necessity to measure blood glucose or take certain medications in fixed periods, patients shouldn't feel like they're imprisoned in a cage forever.
Caregivers need to help patients see the positive sides, find the options to stay active and keep up with the treatment plan by combining intrinsic and extrinsic motivation techniques. What is most important, this should be a positive motivation, as the condition itself brings up a handful of negative one.
Whether caregivers decide to create a full-fledged game for chronic patients, or choose to go for adding only a few engaging elements to spice up things, it will be a drastic change for individuals who are used to strict dos and don'ts.
With 5 years of writing on business and technology, Lola is a Healthcare Industry Analyst at ScienceSoft, a software development and consulting company headquartered in McKinney, Texas. Being a HIMSS member, she focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Lola's articles explore chronic disease management, mHealth, healthcare data analytics, value-based care delivery, CMS regulations and more.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.