Mobile Social Games and Analytics for Health- Games for Health 2012 Conference

7/30/2019 Mobile Social Games and Analytics for Health- Games for Health 2012 Conference

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This slideshow presentation was presented at the

Games for Health Conference 2012

June 14, 2012

http://www.gamesforhealth.org/index.php/conferences/gfh-2012/
http://www.gamesforhealth.org/index.php/conferences/gfh-2012/http://www.gamesforhealth.org/index.php/conferences/gfh-2012/http://www.gamesforhealth.org/index.php/conferences/gfh-2012/http://www.gamesforhealth.org/index.php/conferences/gfh-2012/http://www.gamesforhealth.org/index.php/conferences/gfh-2012/


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Every day there is a new gizmo or gadget to entertain and delight us.

Gaming has undergone dramatic changes in the past decades:

from big clunky consoles

to mobile social games in your pocket.

Think how much this new technology has already changed the way you work, live and

play.

For me, these technology trends are converging with my own passions and interests.

So much so, that back when I was a practicing dentist and then a Wall Street equity

analyst, I would never have dreamed that I would be here today speaking about mobile

social games and analytics in healthcare.

Life, like games, comes with unexpected adventures, so let me take you on a journey of

discovery: how game developers and healthcare providers are uniting to inject fun into

the healthcare equation.


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Our story starts with ubiquitous connectivity

Both technical and social forces are driving the explosive growth in mobile social

gaming.

Technology: better, cheaper, faster, technology is enabling mobile connectivity anytime,anywhere. Smart phones and tablets put inexpensive 24/7 access into the hands of

millions of consumers, including patients and health care practitioners.

Technology plus human behavior means that social connectivity is becoming

ubiquitous

Its not just online social networking.

The social support that we barely notice, but depend on in our offline lives, is being

extended into online communities.

Social gaming involves and expands our online social networks.

Another social trend is the mainstreaming of computer games

Once a geek niche, Gaming is now mainstream entertainment, bigger than the

entertainment industry.

Adding in the mobile component to gaming,

Putting games in your pocket has disrupted the gaming industry, with faster

development and low barriers to entry


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Changes in mobile technology have enabled this explosion of new games

1. The app model: Low cost, decentralized development is producing an avalanche of

mobile games

2. With you, the user, 24/7, offering a persuasive and persistent opportunity toplayand connect

Mobile phones have created millions of new casual gaming consumer through the

simple content, easy entry and low-to-free price point of Angry Birds and Farmville.

Mobile play is a huge part of the mobile experience. Flurry Research, a mobile apps

analytic company, looked at how people in the US use their mobile phones:

79% of mobile users time is spent on social networking and games.Not surprisingly, games take up nearly half (49%) of U.S. users time.

Summary:

Gaming is now mainstream entertainment, attracting masses of new players with easy

games on mobile devices.

Consequently, we see gaming techniques, gamification applied in many industries and

now in healthcare


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The journey unfolds as our worlds collide in the form of new mobile health games.

The healthcare system needs help and is finding new ideas in the technology associated

with mobile social gaming.

Driven by rising medical costs, an aging population and a shortage of providers,providers and payors are seeking new ways to help people help themselves stay

healthy.

Mobile social gaming is a platform for 24/7 personalized technology that can engage

people and change their behaviors.

The increasing power ofcomputational sensors and data analytics, along with gaming

mechanics, social networking and crowdsourcing, is enabling pioneering companies to

develop mobile game applications for healthcare.

Healthcare payors and providers are looking to harness consumer empowerment and

personalized technology to drive patient engagement and behavior change.

As you can appreciate, with ubiquitous connectivity building an expanding user base of

mobile social gamers, healthcare and games are reaching a tipping point with the right

mix of technology, innovation and motivation to power a whirlwind of change.

As our worlds of gaming and healthcare are merging, some unlikely players are

becoming bedfellows.


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New ideas from people inside and outside healthcare create lively multidisciplinary

collaboration and interesting partnerships and acquisitions.

Inside Healthcare

Payors, Medical device developers. Pharmaceutical companies, ProvidersAre all seeing their business models change and are looking for new ways to engage

consumers. Payors are the first to respond to this consumer demand.

A walk on the floor of CES--where Uniteds huge display was filled with health and

wellness games--reflects this trend. Both United and Aetna have already been active

acquirers.

Outside Healthcare

New players outside healthcare are entering the arena to proffer creative options for

problem solving.

People from the gaming and entertainment communities,

hardware and software engineers,

behavioral and cognitive psychologists,

behavioral economists, designers, and communications experts

all want to sprinkle fun into the healthcare equation and inspire lasting behavior

change.


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As you know, Gaming has produced a new lexicon of terms like: gamification, game

mechanics, game elements, game dynamics.

Game Mechanics Motivate Behaviors

Game mechanics are the actions and control mechanisms that gamify an activity.These include: points, levels, challenges, virtual goods, donations, leaderboards.

Points - are rewards across multiple dimensions. Many studies have shown that people

like points, even when they have no monetary value. Rewards also include trophies,

badges, virtual money and goods, real gifts and charitable donations.

Leaderboards - we like high score tables because we enjoy seeing our name in lights,

showing we have achieved high status.

In health, leaderboards can track and display desired actions using competition to drive

behavior.

Levels in a game challenge players to come back and play more. Challenges and

competition appeal to basic human motivators.

Game mechanics build game dynamics that play to basic human desires for: reward,

status, achievement, self-expression, competition and altruism.

Competition works in healthcare as in multiplayer games.

As a practicing dentist who spent much time trying to get my patients to take care of

their oral health, using game techniques is appealing.

The traditional approach I was taught--threatening patients with dire consequences-

being toothless -- did not help.


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Demo:, Lumosity

Lumosity has created different types of games to train different areas of brain health

including problem solving, memory, flexibility

Memory shapes- allow to remember the shapes as they go by

Brain Shift- changing gears from recognizing even numbers and vowels


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Keas is using games to help employees be healthier, happier and more productive.

Elements of the power of play

1. Positive reinforcement

2. Shared affinity- sharing set of issues/challenges in this together with your employer

3. Team dynamics- social obligation, team depends on you

4. Feed- social suport ask for help

5. Game is fun


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Whether training your brain or joining social games at work,

When you think about it, behavior change is at the very heart of healthcare.

Simply showing up is half the battle:

Getting healthy people to show up for diagnostic screening is a big goal of public

health, as is getting people to show up or bring their children for vaccinations

A remarkably successful behavior change intervention has been getting payors to

support and patients to show up for twice-a-year dental cleaning and evaluationand

then using those sessions as opportunities to teach brushing and flossing habits.

As a dentist I wondered, why is it so hard to get people to take care of their teeth? As a

patient, who tries to brush and floss, but never well enough, how many times have I

promised my hygienist to try harder, do better?

fear doesnt work -- you need a sense of empowerment.


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Behavior change has fascinated not only dentists, but many psychologists for a long

time.

Remember Maslows famous hierarchy of needs? Safety, belonging, self-esteem and

self-actualization. This is one way to classify the basic human motivators I referred to

earlier.

This hierarchy has been simplified by Mary Meeker to just food/water, shelter, internet

and mobile phone.

Of course, I would add games/fun on top of the mobile phone!

With an hierarchy of needs in mind, questions around motivation and resilience are

hot topics of research.

Motivations are the reasons why we do things.

There are two kinds of motivation- extrinsic, which comes from outside the individual,

and intrinsic, internal movers.

Many intrinsic motivators were once extrinsic: All of us progressed from having parents

and dentists remind us to brush and floss every day, to reminding ourselves, to

habitually brushing and flossing because it feels right, because we like the clean feeling.

Creating motivation means finding tactics to move people along the continuum from

extrinsic to intrinsic motivation, from reminders to habits.


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Transition: One of many motivational theories is the one developed by BJ Fogg, as shown here.

He focuses on 3 factors to effect behavior change.

Motivation + Trigger + Ability:

Motivation relates to a desired goal: you want clean breath, healthy teeth and gums

the Trigger is a call to action- do it now!- like the toothbrush and toothpaste on the sink in your bathroom atbedtime

Internal Triggers could be your teeth feel dirty, mouth tastes bad

To reach the goal you must have the Ability to respond to the Trigger: you know how to use a toothbrush.

Motivation and ability are trade-offs - above the threshold things will happen, but not below the threshold:

If action is easy and motivation is high - the behavior happens - brushing every night before bed

If action is harder and motivation is low - the behavior does not happen- flossing after a long day

If the behavior is hard, just boosting motivation will not work, one must make the behavior easier.

In his latest work, BJ thinks that baby steps area useful approach to behavior change.So, if you want to floss, do these three steps:

Step 1- Make it tiny - floss one tooth every night

Step 2- Find a spot - put flossing into your daily pre-bed routine

Step 3- Train the cycle- repeat flossing

Putting triggers in the paths of motivated people may help them change behavior, but what does it take to make

that into a habit that lasts?

Questions around persistence and resiliency come up a lot in behavior change, because most people have difficulty

sticking to a plan, fall off the wagon and find it hard to get back on the wagon.


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Now that we have thought about getting started and getting going, we are now set toexplore how we stay on track.

Many of us think that social networks--peer pressure and support--plus user data analyticscould help us stay on track.

Alcoholics Anonymous and Weight Watchers have been helping people offline for decades,with real success.

New online social networks catering to health topics offer elements of fluidity and flexibility notseen in the offline world.

With no limits on geography or network size or number of networks - personalized networkscan be custom-created, easily assembled and disassembled, depending on changing personalpreferences and needs.

So, social networks using personalized peer-to-peer networks could become useful externalmotivators for spurring healthy behaviors.

Yet, people are complex, and influencing everyday choices is not a one-size-fits-all solution.

For some, the output of biometric data, data coming from body sensors, will help them to findtheir way.

As we will see, large sets of user data may also help developers understand human behaviorand close the feedback loop.

The key may be in experimenting with a mix/match approach.


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RallyOn is using corporate challenges to help employee wellness.

Variety The RallyOn Solution delivers an infinite array of challenges that enable

employees to work on all of their wellness goals.

Almost any fitness or health activity can be turned into a challenge fromsteps,

exercise and weight loss to nutrition,

stress management,

sleep

or charity initiatives.

The basics of challenges include:

Tracking

Seeing where you stand on the leaderboard (individual and team)

Seeing how others are doing on the leaderboard


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But the game experience can be a lot more

Starting at the beginning: the draft for team formation

Creating a team identity: photo, slogan, roster

Visuals and animation bring the challenge to life

Avatar moves when you track

Notification/messaging when you reach milestones

In addition to in-game messaging, RallyOn sends texts/emails

Communication

Participants can communicate on the public challenge wall or just with their team

Whats working to drive engagement?

Variety variants on the same game make it more interesting.Persistence of teams as well as new teams

Not focusing on wellness, focusing on the game design

Mobile devices: reaching people where they live and when they have

a few minutes of found time Rallyon can be used on any web-enabled

device, wherever employees happen to be.


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An example of a fun social way to learn more about healthy eating is found in the

Eatery.


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With technological convergence, plus increasing interest from players inside and outside of healthcare, my Ahah!moment during my research is when I found an evolving ecosystem of experimenters trying to produce behaviorchange across the disease spectrum- from health and wellness to chronic disease and addiction.

Starting at your left at the Wellness side of this visual,

I found an expanding definition of health to include life balance and self-improvement.

In life balance, Mindbloom, brings together health, relationships, lifestyle, creativity, career, spirituality andfinances providing a digital view of your total quality of life

Habitual, the first massively multiplayer, mobile, behavior-change gaming platform for mastering simple dailyhabits, is backed by psychology research from Stanford, University of Pennsylvania, and the University ofWashington.

The societal shift in attitudes toward health and wellness, with consumers leading the way, shows in the rise ofemployer-sponsored employee wellness games.

Social networking can bring people together within a trusted environment to share information and work towardcommon goals.

Social games encourage three behaviors- teamwork, friendly competition and accountability.

Our demos of Keas and RallyOn show how companies could use social games to get their workforces moving.

Brain Games

An exciting application of game technology takes advantage of a new understanding of brain plasticity.

Older people like fun, too. Dakim has designed entertaining brain exercises for the elderly. In fact, when I call mydad, who is 85, and ask him whats new?, he proudly proclaims his Dakim score for the day.

Disease Management

Interesting to us provider types is whether these principles will work in chronic disease management. Early signsare positive:

Mobile games are finding a place in disease management, making mundane tasks more fun: glucose monitoring,diet, exercise, insulin and other drugs; and developing a support network of like people.

Some Examples include: Cellnovo, and now OneRecovery which has become OneHealth


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Looking for solutions across the disease continuum, there is no one size fits all in

behavior change.

Behavior change is hard. Sure, there are theories, but we are stillexperimenting with a

mix/match approach to using game mechanics and online support networks.

What is the secret sauce? Can we find the best combination of game mechanics and

online support?

In self-help, Habitual uses points, levels, challenges, and peer-to-peer support to help

us master simple daily habits.

As with Keas and RallyOn, another mix & match approach is found in social games for

corporate health and wellness programs.

These include: earning points for activities, advancing through levels, acquiring

individual virtual money and status rewards such as badges, as well as building teams,

earning social rewards and applying social pressure.

As we think about using game mechanics and online support networks- let me share

with you the story of OneRecovery, now OneHealth.


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Discovering the work of OneRecovery was anotherAha! moment, both last summer when I didmy initial research again when I was doing an update for this talk.

I had envisioned that this mix/match approach could be applied to chronic disease, but I couldnot find any robust case studies, until now.

Using a mix of game mechanics and multiple online support networks, OneHealth began theirwork in addiction-related disorders and then expanded to other behavioral health conditionssuch as depression, anxiety, stress, smoking and weight loss. Now they are applying thisapproach to chronic medical conditions such as heart disease and diabetes.

Just like a good game developer who puts the player in the center of the experience,OneHealth has created a user experience with the patient at the center and cleverly hid aseries of game mechanics alongside clinical protocols.

As we will see in the demo, game mechanics include badges to mark achievement levels, suchas going to meetings, getting a sponsor, sharing a story, journaling.There are emoticons- a series of happy/sad faces, to show how you are feeling and expressempathy to your online support network.

For social support, you can build your own support group with varying levels of privacy,customized to personal needs that can change over time. This is very important in the clinicalworld, where many people suffer from multiple diseases - such as a patient who struggles withobesity, depression and addiction.

As you will see in the demo, this mix of game mechanics, and support groups is available 24/7in your pocket.

[after demo] For those of us dreaming of improving the lives of those with chronic disease,OneHealths mix is just what I had imagined and more!


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Early Days of User Data Analytics

The use of data analytics is a topic that captured my imagination along the journey.

If Zappos can know my shoe preferences, Amazon can suggest my next purchase, and Zynga can tantalize me with virtual currency,why cant my game deliver personalized healthcare information?

The use of data analytics is in the early days, but putting on my equity research pith helmet, I found 3 fascinating case studies fromThe Eatery, Lumosity and OneHealth to share with you.

The Eatery

Built a dataset of 7.68 million user ratings over a period of 5 month post launch.

They use data mining, machine learning, and artificial intelligence to identify patterns to determine and refine questions in aniterative analysis.

A initial data findings:

Users who eat breakfast eat 12.3% healthier throughout the day

Users with a specific diet type (e.g. low fat, vegan, etc.) eat 15.2% healthier than those who eat everything

Users eat 12.7% healthier at home but only eat at home 26% of the time

There seems to be a perception gap where:

Users eat 12.4% less healthy than they think they do

Lumosity

With 20 M users and over 320 million data points,

uncovered findings on how cognitive function can improve with life style changes - some of which were surprising.

This sample was a survey of 750,000 Lumosity users

1. Get enough sleep. For every extra hour of sleep each night up to 7 hours, users were 4% speedier, solved 4% more mathequations correctly, and increased spatial memories by 1.2%. Surprisingly, performance actually declined after more than 7 hoursof sleep. [was this statistically significant?]

2. Even being a little more active can make a difference. Users who reported aerobic exercise just once a week were 9.8% faster,solved 5.8% more equations, and had 2.7% better spatial memory than those who never exercise.

3. Drinking is okay in moderation! Users who had one drink per day outperformed those who had no drinks, but there was adecrease in performance on speed, problem solving and memory with three or more drinks per day.

4. People who reported participating in one or more of the following activities at least once a week scored higher overall thanthose who dont: Playing video games, word games, reading books, magazines or newspapers, or playing an instrument.

One Health uses a different approach

2 sides of the api- social and clinical side

Social side: user-generated content alongside the evidence-based researchusing user data (choice and language) to inform decisions about how they add new features in communities

Thinking about 3 arenas

Identify the activities that are of value to users
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It is too early in the business cycle to look just at mobile social health games, but

considering the bigger context of mobile healthcare apps (most of which have some

component of gaming elements and/or social support) there is a very positive growth

trajectory.

App Downloads, Sales of apps and investment in apps are all trending up.


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These are early days. Current healthcare gaming tech is simple and 2-D, but we know

that complex, realistic 3D games are already out there enticing players into

immersive stories.

We now expect tech to bring us a realistic 3D view and engage our emotions.

Storytelling will be a necessary part of this future.

Healthnutsmedia, which aspires to be the Sesame Street of healthcare kids education,

using animation to get engagement is one example.

Another is Mayo Clinic where people tell their health story via video.

We are creating a new kind of reality, one in which physical and digital environments,

media and interactions are woven together throughout our daily lives. It is a world

where the virtual and physical are integrated, personalized, 24/7, and where fun is an

important element in taking proactive steps to take care of ourselves.

Features that make our mobile experiences more realistic will change the lens through

we view healthcare.

Some noteworthy examples:

The USC Center for Body Computing Biosports Monitoring project is thinking about

creating a virtual mobile fantasy league.

Kaiser is using simulation in a prototype game called Dr. Hero, simulating an obstetrical

hemorrhage to train physicians.


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Taking artificial intelligence and virtual world to another level, Thrive Research is using

virtual worlds in behavior research to treat post traumatic stress and autism.


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As you have seen, at the back end, we have emerging data analytics as a way to get

personalized solutions

At the front end we have seen,

Elements of design- simplicity, beautifully executed in The Eatery Competition and teamwork as motivators of employee health we will see in Rallyon

and Keas

New ways to use technology to exercise the brain with Lumosity

The use of avatars in behavior health in Thrive Research

An effective use of game mechanics and multiple online support networks in

OneHealth

Overall, these apps design for engagement, with an emphasis on simplicity and invitinguser interfaces. Once drawn into the app, it puts triggers in the paths of motivated

people as well as using social support and data analytics to expand and enrich

participation, to help us to take better care of ourselves.


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Our worlds have collided with a shared goal to engage patients and providers.

It is an action packed story of change and resilience, of pulling real rabbits out of virtual hats!

As we have seen, the creative talents of this audience and others have jumped into creating

mobile health games with online support to help engage patients and providers. The old adage

of no pain no gain is being replaced by no fun no gain- a wonderful change.

Using a mix/match combination of game mechanics and social networking, pioneers are

experimenting with 24/7 and personalization to get engagement across the disease spectrum.

Early uses of user data analytics and more robust game play are beginning to emerge.

On a personal note, thank you for welcoming me and other healthcare providers to your world,

where dreams and imagination freely reign without fear of failure.

As my own journey has been from practicing dentist to Wall Street analyst to market

researcher and consultant in mobile games and analytics, has been one of change and

resilience, so too has been the journey in the gaming industry- from large consoles to mobile

social games in the pocket, and now finding new applications in healthcare.

It is my hope that the pace of change will continue to accelerate, so that we can continue to

create these new tools to help each of us in our quest to find health and happiness.


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Documents

Mobile Social Games and Analytics for Health- Games for Health 2012 Conference