Can Gamified Mobile Apps Increase Prescription Adherence?

Nearly a decade ago when I started gyming, more than the struggle to acclimatize myself to the strenuous workouts, I struggled with getting used to a regular exercising schedule.  I would religiously follow a plan for a few weeks only to return to being consistently irregular. Fast forward a couple of years, I was not only able to stick to an exercising regimen but also started enjoying my workouts immensely. One change that brought about this transformation – switching from solo workouts to group workouts.

In his book, The Power of Habit, Charles Duhigg discusses the psychology of habits and how they drive actions. With his cue, routine, rewards framework he describes how one can identify habits and also change them if need be. According to the framework what I did was tweaked my routine (workouts) to incorporate better rewards (group workouts rather than solo activities) to motivate myself. And that’s indeed true. While I often got bored with solo cardio activities such as running on treadmill or using a stepper, I realized that the group energy in activities such as zumba, aerobics made me look forward to every session. A single change in routine and rewards brought about a tremendous behavioural shift in me. Mobile apps increasingly are adopting this technique, also called gamification, to get users to alter their behaviour. The question is can gamified mobile apps bring about behavioural change in users?digital_health_apps_success

One of the biggest troubles plaguing healthcare is not medicine related but behaviour related. Nearly 50% of patients do not adhere to medical prescriptions. Prescription adherence, considered mainly as a patient behaviour issue, costs around $300 Billion annually. While there are scores of gamification apps claiming to improve patient behaviour to adhere to prescriptions, I am wary of those claims. Here is why I think gamification in mobile apps fail to get desired outcomes:

  1. No Long-Term Sustained Change: People seek novelty and a gamified app offers limited newness beyond a point. After a certain amount of time when I got bored with aerobics I explored other group activities such as zumba, spinning etc. which helped me sustain a regular regimen.  This is not the case in apps. Post a certain level, the newness wears off which results in users abandoning the app.
  2. Have To doesn’t become Want To: To get people to do something they need to feel in control and believe that their actions are governed by no one but themselves. Patient adherence apps recommended by doctors or insurance companies therefore will not yield the same results as when a patient voluntarily adopts the app. For eg. a prescription adherence app might be a great tool for someone who already manages a journal or has employed other methods to stick to a medication schedule. That is the patient is motivated and wants to change and doesn’t have to change. Unfortunately, a gamified mobile app doesn’t convert a Have To to a Want To.
  3. Monetary Rewards are Limited in Value: Gamification apps today are unable to improve stickiness by employing only social rewards. They are turning to monetary rewards (gift cards) to incentivize users. This is counterintuitive. Extrinsic rewards have been proved to be less effective than intrinsic ones, especially when it concerns issues such as healthcare. If monetary incentives would have worked, the scores of gyming memberships today wouldn’t be as underutilized as they are.

Gamification has worked really well in other healthcare areas such as education. But as far as prescription adherence is concerned, more creative ways need to be identified to make it successful.