Gamification is the application of game design principles and techniques to non-game contexts, with the intention of creating value for the players and other stakeholders. The gamification of many aspects of our culture is well under way, and some researchers are even beginning to consider the integration of gamification principles into clinical trials.
There has been a long history of using things like fun, play and competition to motivate people and make work seem more enjoyable and productive. While gamification as a concept has been around forever, use of this term in business culture has accelerated rapidly, and in 2011, Gartner added gamification to their hype cycle.
One increasingly popular example of gamification in the healthcare industry is activity trackers. Typically worn around the wrist, these devices are used to drive healthy habits and behaviors. Activity trackers like FitBit Flex, for example, use a wristband hardware device and a web app to log basic activity information throughout the day, without the need for any user intervention. Specifically, the Flex can measure steps taken, floors climbed, calories burnt, and distance traveled. In night mode, it can measure movements during sleep to give you a basic indication of how many times you awoke, how long you slept for, and the overall quality of your sleep. There are a number of gamification aspects to the Fitbit Flex:
Using the Fitbit Flex, consumers can maintain greater awareness of their activity level and are more empowered to engage in desirable behavior.
In the pharmaceutical industry, companies have begun to use gamification to improve relationships with patients by using games to encourage disease management. Sanofi launched an app for children with Type 1 diabetes that educates them on the disease, as well as another app called "Monster Manor", which encourages players to regularly test and record their blood glucose levels. In addition, Boehringer Ingleheim, in collaboration with Eli Lilly, launched an app called "Complications Combat" to educate patients on behaviors that can exacerbate their conditions.
In the context of clinical trials, gamification presents an excellent opportunity to improve performance and reduce costs. There are a number of areas that hold promise:
Oftentimes, patients drop out due to loss of interest or engagement with the study, or because they find study participation too burdensome. For these reasons, pharmaceutical companies are considering gamification to make clinical trial participation more convenient and patient centric. Games can provide a more fun, interactive and engaging experience, encouraging patient retention while collecting vital data and information that can be used to measure the effects of drug treatment. DataArt’s KidPro app, an ePRO prototype that engages young patients in a playful way, alerting them to take their medication on time and as directed. A company called Hopelab developed a video game, which allows children to learn about the drugs that are used to fight cancer known as ReMission. ReMission and the newly updated ReMission2 have shown very promising results in terms of patient engagement, retention and adherence to cancer treatment. The ACTIVE-Seated (Abilities Captured through Interactive Video-based Evaluation) application has been used to measure health outcomes in muscular dystrophy patients. It uses the Microsoft Kinect gaming interface to gather positional information about an individual's upper extremity movement to determine functional reaching volume, velocity of movement, and rate of fatigue while playing an engaging video game. In muscular dystrophy, individuals undergo progressive loss of muscle strength and function, and the game (which is played while seated) has enabled the development of an objective outcome measure in patients unable to walk.
To participate in clinical trials, patients need to learn new habits around clinical trial protocol requirements. For example, subjects might be required to keep a diary at a specified day/time. Gamification can be used as a behavioral modification tool, helping subjects create new habits that improve patient compliance. The HealthPrize Technologies' study showed that gamification efforts resulted in a 54 percent increase in prescription fill rates, and often led to prescriptions being filled more frequently. Patients with acne, diabetes, hypertension, and asthma/COPD logged onto HealthPrize’s mobile and online platforms an average of four times a week to keep earning points and rewards.
The Deloitte Learning Academy (DLA) case study provides a good template for how gamification can improve the effectiveness of investigator and site training by using missions, badges and leaderboards alongside videos, in-depth training, quizzes, and tests to encourage participation and a sense of competition.
Sponsors are looking to innovative methods such as rewarding sites with badges as they pass certain pre-determined milestones (e.g. ten patients screened, all training completed, etc.) or using leaderboards to show sites how they are performing relative to their peers. Principal investigators are motivated by watching their site on the leaderboard to see how it ranks on key metrics such as patient enrollment and data query resolution. Meanwhile, exposing clinical trial teams to metrics, leaderboards, and other activities as they undertake everyday work can potentially improve both performance and quality. Inspiring friendly competition can motivate global site performance for areas such as activation, patient enrollment and more.
Research on gamification largely supports the view that it does produce positive effects, but many caveats exist. In particular, confounding factors such as the role of the context being gamified, and qualities of the users – have a significant impact on success.
With gamification in clinical trials still in its infancy, it is the responsibility of pharmaceutical companies, CROs, and software service providers to continue searching for innovative solutions to address many of the issues found in clinical trials. Given the current enrollment and retention issues in clinical trials, what do we have to lose?