The Farmville of Health?

Can you play your way to better health? What does it take to get people moving? That was the question kicked around (har!) at the gaming-health session at Health 2.0.

Chris Hewett’s demo of MindBloom had the room packed. He began by talking about being motivated by fear, or, instead, being motivated by purpose. You’re either running away from something, or toward something. Mindbloom is about spending two minutes every day looking at images that mean something to you, and that motivate you. One step every day is the key to enduring change. The key is sustained engagement. Many of the tools that exist today are not engaging. The core goal is to make life change fun, and engaging. As a gamer, Hewett wants to make behavior change appealling. And it needs to be authentic. I think that he is trying to make Mindbloom into the Farmville of health – a pervasive and widely appealing game, but one that happens to have a positive effect on people’s health and life. People use Mindbloom to discover what’s most important to them. A key differentiator is to take a view of the entire life. The key reason why most people want to be healthy is to spend more time with their relationships. Mindbloom just finished their public beta with 15,000 users.

The central visual image to Mindbloom is a tree, with each of the leaves representing an area of life that means something to you (such as spirituality). The sun represents inspiration, and rain represents the steps that you are going to take today to nourish what is important to you. Users in communities can upload their favorite images (in addition to the ones provided by MindBloom), and sayings and songs that inspire them. You earn points by setting it up, and as you apply it, there is a visual response (the tree grows a bit and the sun glows). The rain is simple steps that you can take to improve your life. You again get positive feedback to improve your life. If you keep your tree green, you produce ore “seeds” and the seeds can then unlock features and content, as well as action-packs for different areas of your life. Game items include the ability to purchase sun and rain for your friends’ trees. The social element is a crucial part of personal growth. It is supported here by the ability to add friends, as well as the ability to encourage people who may not be doing so well. The worst that happens to the tree is that the leaves turn brown-ish (they don’t fall off). Coaches are also able to invite in their clients, and can see how they are doing. Mindbloom’s beta showed that people were, on average visiting three times a week and spending 15 minutes at the site.

Mindbloom’s goal is to create the most fun, simple interface, with sophisticated gaming mechanics. The gaming elements are a positive feedback element to help people feel effective. Their mobile application with be released in about a month. Aetna is a major sponsor, with plans to integrate it into their employee space. The demographic split of users is approximately 55% women and 45% men, but their goal is build a tool for everyone. In other words, the Farmville of health.

Game On: Massively Multiplayer Approaches To Behavior Change was the first panel. So why do behavior change games work, how they keep people on track, and how they are changing the approach to behavior change? Those were all questions discussed by the panel.

The panel included people from Zamzee, Shapeup and Livn.it. ShapeUp’s CEO talked about how successful patients will often leverage their existing successful social networks to create enduring change. Their products began as a 12 week shapeup challenge in Rhode Island, funded by a non-profit. People could form teams and compete to either lose weight, increase their exercise or increase walking (based on a pedometer). In the state of Rhode Island, the game went viral — studies showed that 10% of the population has participated in this game.

In addition, they looked at what the results were in terms of health. This health game was having the same impact as intensive lifestyle interventions. They found sustained change at 10 weeks, and, on average, 7 pounds of weight loss and a 1.2 BMI reduction.

So Shapeup then moved to employer-based programs. ShapeUp today creates social networks from an employer pool, by creating a social engagement engine. They found that employees who participated in Shapeup also increased their utilization of other existing health benefits that had been offered but were underutilized (like counseling) — their gaming engine encouraged people to change their health behavior across a variety of dimensions. They now cover over two million users across a wide range of employers.

Jonathan Attwood of Zamzee spoke about their approach to behavior change among kids. In the timeframe between kids to teenagers, their activity level falls about 60% from age 9 to 15. Zamzee’s goal was to “ignite a lifetime of activity.” They realized that technology was part of the problem, so they decided to use the problem as part of the solution.

To participate in Zamzee, you get a movement monitor to wear, and then ANY sort of movement gets you points. You can then redeem those points for rewards that kids care about (let’s just say Angry Birds was mentioned). An integral part of the Zamzee program is that you can go social and share or support each other with the program. They did a comparison trial and found that kids participating in Zamzee increased their moment by 30%, or about a marathon a month! In addition, kids reported that they began to move “not because I had to, but because I want to.” They also found staggering rates of referral — 50% of participants told someone else about it. In addition, they found that when they first enrolled a kid, the parents wanted it, resulting in behavior change for a family. For those whose families got involved, they found a 42% increase in activity.

Livn.it’s presentation was by Michael Kim, the CEO of Kairos Labs. Kairos in Greek represents the moment when your effort turns into achievement. So what is behavior change? The quantified self is a type of behavior change, but it is viewed by Michael as a self-redacted form of behavior change. The early reports are that self-tracking loses 90% of their participants. It’s a form of single-player game. It is “autonomous, disconnected, you get narrow (to zero) feedback and it’s basically a form of journaling or accounting. Maybe quantification isn’t enough in itself. Or, as Edward Tufte said, the point of quantification is to find causality.

So what is the smallest step that will impact behavior? According to Kim, it’s habit-formation, where falling “off the wagon” over and over stops. What that meant to a gamer is that “we need massively multi-player behavior-change games.”

The basis behind it is PERMA – Positive Emotion, Engagement, Relationships, Meaning and Achievement, as explained in Martin Seligman’s book, Flourish. It’s a definition of wellness. If you look at these elements, there are a lot of overlaps in gaming, with possibly the exception of meaning — but behavior change deliberately incorporates meaning. Using these criteria, mobile social behavior change apps might work for behavior change.

Nike Plus says that its social aspect (the Cheer Me On function on Facebook) boosts enduring change. Alcoholics Anonymous is another form of multi-player game. Tai Chi in the park for the elderly is another form of multi-player game. What is the largest behavior change game in the world today? His take on it is religion. “If you want to go fast, go alone, if you want to go far, go together.” An African proverb.

Livn.it incorporates these factors into creating a multi-player mobile habit gaming network.  It is a training program for progressively mastering sustainable daily habits via your smartphone. The first version was purely text-based, then moved into other visual sphere, and then moved into virtual goods and micropayments to support enduring change.

The Four Hour Body is the basis for one of their approaches. Livn.it slowly increases the level and intensity of the habit a person is trying to master. In the beginning it seems as though it’s not doing so much, but then, once mastery is beginning to solidify, the intensity increases. In their 100-day player test, 90% fell off the wagon, but 83% “bounced back,” which they felt was due to the design, which deliberately makes it very easy to get back on track — “the distance from the ground to the wagon is really small.”

Jan Gurley is an internist physician who practices in a homeless clinic for the San Francisco Department of Public Health. She blogs at Doc Gurley: Posts from an Insane Healthcare System where this post originally appeared.

4 replies »

  1. Terrific post. In fact, these are exactly the types of products we’re focusing on at Digido Interactive.

    We just released a new iPhone game called Pop & Dodge in which you must physically stand up and jump to move a penguin side to side to avoid getting hit by oncoming dodgeballs. Time your jumps just right, and you can also collect coins and powerups along the way.

    This is definitely not the be all and end all for health and exercise games, but we think it’s a step in the right direction. The game is free on the App Store, so test it out for yourself:


  2. Even i think that, can i play my way to get better health? very interesting article post to realized about our health and what show us how much our health is most important for us and for others. Keep blogging.