For hundreds and thousands of years, knowledge was available to limited groups of people only. Getting access to information was the main struggle one faced if they wanted to learn something. Today, we live in the world of information. Everything there is to learn is easily accessible. So much so that it is a wonder how come every single person doesn’t speak multiple languages, doesn’t cite Shakespeare on dates, and can’t explain the principles of STEM cell research to a five-year-old. Or is it? Sure, information is everywhere. What is lacking is human capabilities. According to neuroscience, in order to learn something we need to pay attention, engage in active learning, and still have the time to rest so that our brain can process and consolidate new information. Learning requires periods of intense concentration and periods of rest. It requires motivation, active involvement, repetition, and feedback. So what’s the best recipe to complete all these stages? Games.
I am sure you have been expecting this. Games are everywhere. Millennials are expected to learn nothing unless they are entertained in the process. Since the late nineties we have had edutainment ― a mix of education and entertainment: video games, television programmes, apps, and other material intended to be both educational and enjoyable. But it isn’t just joy that fosters learning. Games, interactive in their nature, lead the player through all the stages required for effective learning. Later in the article we’ll see how they do that.
Gamification in health technology
In every industry, successful apps involve gamification elements, such as points, timers, badges, and leaderboards. Uber, DuoLingo and even Tinder all make their niches feel like a game. You’ve got to complete tasks, and earn points. You get to watch your progress and feel like a winner every time you find a passenger or learn a new word.
Healthcare apps have also recognized the benefits of gamification. For example, mySugr, a diabetes management app, reimagines diabetes as tamagotchi. The diabetes device nudges users to keep the correct level of glucose by offering them challenges, rewards and personalized insights. Health and lifestyle apps and activity trackers such as Fitbit and MyFitnessPal add challenges and social elements to encourage users to exercise more.
But the symbiosis of IT and healthcare went even further than gamification.They introduced proper games called “serious” games (although this remains to be a questionable name) to help patients deal with their health conditions, help undiagnosed people carry out a healthier lifestyle, and help medical students learn medicine. As soon as healthcare professionals figured out the usefulness of games, they took this approach very seriously. Now, the industry has large conferences that focus specifically on the role of games in the healthcare ecosystem. These are, for example, “Games for Health” in the USA and Europe and Serious Play Conference.
What are “serious” games?
Serious games are defined by researchers as “interactive computer application, with or without significant hardware component, that has a challenging goal, is fun to play and engaging, incorporates some scoring mechanism, and supplies the user with skills, knowledge, or attitudes useful in reality.” They can be used for very different purposes: for example, Elinext developed a game that trains people to quickly evacuate the building (see case study to learn more). In healthcare, games are used in patient and professional health education.
Serious games are based on classic pedagogical principles: user-centred approach, interactivity, repetition, and continuous feedback. This, combined with their motivational effect, makes serious games a great tool for education. Alertness, necessary for effective learning, comes from the graphic and sound environment of the game (studies showed that the better these factors are, the more attentive is the player) and the challenge the game proposes. For both knowledge acquisition and behavioural change, active learning is much more effective than passive listening, although the latter is more common in education. In games, learners have to discover or construct essential information for themselves with the help of instruction and feedback. Games are based on interaction: you can’t complete one without being involved. Finally, most games, and all serious games, require repetition: you can’t get really good at it with a one-time action.
How are interactive games used in healthcare?
As we’ve mentioned before, in the healthcare ecosystem, games are used for patient and professional health education. But what does that mean exactly?
For patients, serious health conditions often require learning how to deal with them. Let’s take Re-Mission, a very successful game for young cancer patients. In it, players have to control a humanoid nanorobot. The nanorobt’s mission is to destroy different types of cancers, while learning the importance of compliance to chemotherapy. The game makes the desirable outcome ― being free of cancer ― virtually present, motivating the patient. The process of cancer destruction is fun, and gaining knowledge about chemotherapy is necessary to achieve this outcome. In a study on 375 patients, the game was found to be associated with better knowledge, self-efficacy, and adherence to oral chemotherapies.
Another video game, EndeavorRX, was actually the first to be approved by the FDA as actual video game medicine. EndeavorRX is developed for children aged 8-12 with ADHD. Concentrating and focusing on specific tasks is hard for ADHD patients, so the game challenges a child’s brain to do just that, but while playing the game ― something most kids love doing. Seven clinical trials with over 600 participating ADHD children showed that the game improved “objectively measured inattention” with minimal adverse side effects.
In a popular game for congestive heart failure patients, the patient has to play the game before being released from a hospital. The game challenges the player to guide a character through a series of health-related tasks. Tasks include tracking the character’s weight, getting him to take his medication, and calling the doctor if specific problems arise. If the character can avoid readmission to the hospital after a virtual week, the patient has won ― and learned.
Now that we know how interactive games can help patients, let’s turn our attention to less apparent users ― health professionals. Serious games have been proven to be extremely effective for their education and have been used widely to help doctors absorb all the overwhelming amount of required medical knowledge. CyberPaient, InSimu, and Body Interact all provide health professionals with an environment that is engaging, motivating, and risk-free ― perfect for mastering their skills.
Finally, let’s recall that those of us not experiencing any health issues at the moment might prevent diseases by also playing games. For example, in current trying times of the global pandemic, something as seemingly easy as hand hygiene adherence could save lives. And apparently, even this can be improved by interactive games.
What are the downsides to interactive gaming?
No method is without its problems. When it comes to introducing games in healthcare, the financial and implementation issues are secondary. The main issues lie within the same domain as the main domains: gaming is engaging.
Gaming takes up much of the young people’s life anyway, and due to its nature it has obvious health side-effects. And, games can be properly addictive: the WHO included gaming disorder as a behavioural addiction in the 11th revision of its International Statistical Classification of Diseases (ICD). This can be a real issue for the patients who are already struggling with behaviour and social skills.
The other problem with interactive games is making them as great as this article suggests they are. The best games are effective, however, it’s a real challenge to create a good serious game in the first place. It has to be entertaining, educational, challenging, with the challenge being just right for the learner: if the challenge is too high, the player will get frustrated quickly, if the challenge is too low, the player will get bored. Hitting that line is a real dare that requires thorough research and testing.
Gaming doesn’t have the best reputation, which leads to its potential being overlooked. Games are often believed to have adverse developmental effects on children and young adults. However, the longest study ever done on the developmental effects of video games, published in March 2020, concluded that for 90% of gamers there are no harmful effects or negative long-term consequences. At the same time, with 3.48 billions of existing gamers worldwide, spending hours per day at the computer as it is, this is an untapped resource. We know that people love playing games, and we know that games can be useful for an individual’s health. At the moment, serious games attract growing attention in healthcare, and it’s expected to increase in the near future. However, while the field is promising, it’s also a real challenge. Creating an effective game is complex. Developers should consider not only the plot and the goals of a game, but also pedagogical principles of learning and best edutainment practices. And there is always more research to be done.