Let me tell you a story about a smartwatch, a young woman, and a worldwide pandemic.
In March 2020, when staying indoors became normal and exercising with friends was taboo, I found that I needed some extra motivation to get outdoors and run. I bought myself a fancy Garmin watch that tracked runs, cycles, and walks, but also steps, elevation, calories burnt, heart rate, and sleep.
Every single one of these paradigms had a personalized daily goal — which became hard not to hit. I didn’t realize it then, but the designers of this clever tech had “gamified” exercise for me, turning every walk into a challenge to reach my elevation goal, and every night an opportunity to be congratulated for getting 8 hours’ sleep.
Behavioral Science, Democratized
We make 35,000 decisions each day, often in environments that aren’t conducive to making sound choices.
At TDL, we work with organizations in the public and private sectors—from new startups, to governments, to established players like the Gates Foundation—to debias decision-making and create better outcomes for everyone.
What is gamification?
Gamification is a general term for processes that involve gaming principles to motivate and engage individuals in non-gaming scenarios. Gamifying techniques might work by, for example, providing rewards like points or streaks to users, which motivate them to keep coming back.
You’ll have come across this in apps like Duolingo, where users are motivated to keep up with their daily lessons to avoid losing their streak. The reason this works so well is known as loss aversion: we’re more emotionally affected by a loss than a gain.
An app called AppSalt
In February last year, a behavioral insights article in the British Medical Journal caught my eye: a study in China showed that children successfully encouraged their parents to reduce the amount of salt used in home cooking, aided by an educational app focused on decreasing salt intake.4
High salt intake is linked to high blood pressure and increased risk of stroke. This is a huge problem in China, where the average salt intake is estimated to be double the World Health Organization’s recommended maximum. Around 80% of dietary salt is added when cooking at home.
It’s difficult to achieve behavior change within the home, for two main reasons:
- Most actions in this setting are habitual and harder to disrupt, as they may be done “mindlessly” (like automatically washing your hands after going to the bathroom); and
- Researchers and organizations designing behavioral change programs have limited control over individuals’ home environments, which makes it more difficult to deliver timely interventions. Successful behavior interventions need to be delivered close to the time of decision-making (like writing “smoking kills” directly on cigarette packets, so that smokers are reminded right before lighting up).
To overcome these barriers, the researchers gave children the homework of getting their families to estimate their salt intake, and using an app to set personalized salt reduction targets while cooking. After 12 months, families were eating an average of 0.88g less salt per day (from 5.50 g/day to 4.62 g/day). Adult participants showed a significant reduction in blood pressure by the end of the study.
Ever played Pokémon Go?
Gaming apps have had previous success in encouraging healthy behaviors. Take Pokémon Go, for example. The app, originally an April fool’s day collaboration between Google Maps and the Pokémon Company, was an undeniable success: it had over 500 million downloads worldwide by the end of 2016.
Pokémon Go uses GPS to locate and capture Pokémon, which appear as if they are in the player's real-world location. For many users, the app provides a strong motivation to get more exercise by walking around and catching Pokémon. One U.K. player reported walking 225 km and losing nearly 30 pounds, in their quest to catch ‘em all.2 A researcher in physical activity and sedentary behavior even remarked that the app could “ease the type 2 diabetes burden”.7
What is so surprising about Pokémon Go is that it wasn’t originally designed to be a health app. The app’s success demonstrates the power that gaming can have in discouraging sedentary behavior; it takes a fun activity and subtly attaches exercise to it, sometimes without the user noticing. Similar effects have been seen with other active video games, such as Wii Sports, where players can get competitive over a game of virtual tennis, or let out their frustrations with a boxing match.
Combining health and behavioral insights: Game on
The motivations for creating AppSalt and Pokémon Go were completely different, but the results are similar. The apps share core themes of competition, incentives, and social influence. They’re also both aligned to the concepts of self-determination theory, which speculates that our motivations can either be:1
- Proactive, fostered, and autonomous; or
- Passive, inhibited, pressured, and controlled.
Users of AppSalt are aware that they are increasing their healthy behaviors and have voluntarily signed up to do this. Pokémon Go players use the app because they’ve been passively coerced by their environment whilst they were focusing on an altogether different goal (gotta catch ‘em all!).
It has been shown that autonomous motivations lead to longer-term health and well-being outcomes.5,6 These concepts could be adopted by health interventionalists in, for example:
- Supermarket settings, where reward points can be earned for buying fruit and vegetables and taken away for buying cookies and chocolate; or
- A real-time run tracking app where you can see avatars of your friends and family who are currently exercising.
These types of app-based interventions could feasibly be used for other dietary behaviors, such as setting targets for reducing sugar or fat intake, which could have a major impact on public health. If there’s one thing we know about food and behavior, it’s that the decisions we make are often mindless. Of the 200 decisions we make about eating every day, around 90% are thought to be made without conscious thought.8
This represents a huge opportunity for health interventionalists to encourage more mindful health behavior. The hope is that, once we mindfully perform an action over and over and over again, it eventually becomes a habit. Before we know it, we’re mindlessly adding other seasonings to our food, and we’ve forgotten all about the salt.
- Corepal et al. Exploring the use of a gamified intervention for encouraging physical activity in adolescents: a qualitative longitudinal study in Northern Ireland: https://bmjopen.bmj.com/content/8/4/e019663
- Griffin, A. Pokemon Go: Trainer who became first in UK to catch 'em all lost two stone while doing so: https://www.independent.co.uk/games/pokemon-go-man-loses-two-stone-while-becoming-first-to-catch-all-143-creatures-in-uk-a7161606.html
- Hartin et al. The empowering role of mobile apps in behavior change interventions: the Gray Matters randomized controlled trial: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987494/
- He et al. App based education programme to reduce salt intake (AppSalt) in schoolchildren and their families in China: parallel, cluster randomised controlled trial: https://www.bmj.com/content/376/bmj-2021-066982
- Niemiec et al. Aspiring to physical health: the role of aspirations for physical health in facilitating long-term tobacco abstinence: https://pubmed.ncbi.nlm.nih.gov/18838243/
- Ntoumanis et al. A meta-analysis of self-determination theory-informed intervention studies in the health domain: effects on motivation, health behavior, physical, and psychological health: https://pubmed.ncbi.nlm.nih.gov/31983293/
- University of Leicester. Pokémon Go could ease Type 2 diabetes burden: https://www.sciencedaily.com/releases/2016/07/160725090154.htm
- Wansink. Mindless eating: From mindless eating to mindlessly eating better: https://www.sciencedirect.com/science/article/abs/pii/S003193841000199X
About the Author
Rachel Donnison studied Natural Sciences as an undergraduate and has a MSci in Behavioral Bioinnovation. She has an interest in health and sustainability behaviour change and works for the British Medical Journal on a clinical decision support tool called Best Practice, helping doctors make evidenced-based decisions at the point of care. She lives in London, but grew up in Aberystwyth on the coast of West Wales.