Video Games: Key to the Future of Healthcare?

Initial survey and results suggest that health games and virtual worlds bear the potential to be “game changers” by improving education, provoking greater engagement, and engendering positive behavior to enhance health and wellness.

While more clinical studies are still needed, preliminary results are beginning to demonstrate proof of principle. In the wake of the 2009 Games For Health conference, the five factors below, as well as key lessons outlined by the speakers, provide a perspective on what may be involved in bringing Health eGames into 2010 planning and beyond. (Note: For a summary of the two-day event, along with the associated marketing implications of games, see PharmExec blogs “The Next Frontier” and “Can Healthcare Games Change the Game of Healthcare?”)

Gaming for Health
Games are not just for kids, or teenage boys, but are increasingly played by digital moms and 50+ consumers; 57 percent of moms with children 12-18 report that they game online or by console, and among the 50+ target, 25 percent play video games. Women are generally considered the health CEO’s of a family, and are the largest segment of casual gamers, according to iConecto 2008 market study, Entertainment Software Association (ESA) 2009 study.

Games enjoy broad penetration-in the US, 68 percent of households play computer or video games, according to the ESA 2009 study. The worldwide game industry is increasing in popularity, and is expected to surpass $62 billion by 2012. The Health eGaming market, while still relatively small, is estimated at approximately $7 billion, driven largely by exergaming ($6.4 billion) and brain fitness ($267 million) products, according to a 2008 iConecto market study.

America faces serious health issues that need extra attention, including obesity, sedentary lifestyles, smoking and its complications, and lack of adherence to medications and recommended behavioral changes for sustainable wellness outcomes. Games can provide a fun and innovative way to reach new audiences with pertinent and targeted health messages, as revealed by a 2008 Center for Disease Control and Prevention (CDC) summary on Health eGames.

According to the CDC, early success stories for health games suggest meaningful public health benefits in a variety of target audiences and for a number of health issues, such as increasing physical activity, combating dementia, and improving compliance in cancer patients. A few examples of health games with measureable clinical results include:

Hope Labs Re-Mission Game for teens. This video game encourages adolescent and young-adult (AYA) cancer patients to take an active role in fighting their cancer by targeting key behavioral and psychological outcomes. Players control a microscopic robot named Roxxi as she enters the bodies of cancer patients to blast away malignant cancer cells to stop them from spreading. Players must also monitor the side effects of cancer treatment, and manage various other effects of cancer and treatments. As published in Pediatrics, the first large-scale, randomized trial conducted exclusively with AYA cancer patients showed that playing Re-Mission significantly improved treatment adherence-a pervasive problem in this population- as well as indicators of cancer-related self-efficacy and knowledge in young cancer patients. The findings support current efforts to develop effective video-game interventions for education and training in health care.

Dance Dance Revolution (DDR). Developed in the arcades of Japan more than a decade ago, this exergame requires players to dance in progressively more complicated and strenuous patterns in time with music. A study by the Mayo Clinic found that children playing DDR expended significantly more physical energy than children watching television and paying traditional video games. West Virginia sponsored its own study and has taken the lead in deploying the game to schools throughout its school districts. Their 24-week study (all the children were above the 85th percentile for body mass index for their age and gender) found that the majority of children participating did not gain weight during the course of the study, and experienced improvements in aerobic capacity, blood pressure, and overall fitness level. Perhaps more significant for the children’s long term health: their attitudes to exercise become more positive, and the children’s self-esteem improved.

A Study of Seniors and Wii Exercise. A six-week study by the University of California San Diego and San Diego State University of 29 seniors and the Wii exercise showed a decrease in depression (a major issue for senior citizens), an overall improvement in QOL parameters (SF 36) such as mental capacity, emotional health, social aspects, pain, and no change in sleep or anxiety scores. Overall results were positive and reinforce the need for more study.

Packy & Marlon. An adventure video game for the Nintendo platform popular in the early 1990s is used as experiential learning to improve self-management among diabetic children and adolescents. Players take on the role of a character with diabetes; they manage their character’s blood-glucose monitoring, insulin use, and food selections for four simulated days while the character tried to save a diabetes summer camp from marauding rats and mice. Keeping their character’s blood glucose within the normal range through appropriate insulin use and food choices helps players win the game. A six-month, randomized clinical trial of outpatients at both Stanford University Medical Center and Kaiser Permanente clinic found that diabetic children and adolescents who took home the diabetes game reduced their diabetes-related, urgent-care, and emergency room visits by 77 percent compared to the control group.

Serious players are supporting the growth of health games, including health insurers such as Humana and foundations like Robert Wood Johnson. In June, Hope Labs and Virtual Heroes announced that they would create the next version of the Re-Mission Video Game for teens with cancer (the effort will be funded by the Annenberg and Lance Armstrong foundations.) Also in June, the Sesame Workshop’s Joan Ganz Cooney Center co-authored an influential report: “Game Changer-Investing in Digital Play to Advance Children’s Education and Health.”

Bring More to Your Brand’s Arsenal
To improve adherence, a health game should be part of your brand’s total package. Not only can it provide entertaining awareness and serve as an education tool, but health games can also act as a forum for virtual training. As you plan for 2010 and beyond, consider these lessons for boosting health game development, as presented by the Games For Health conference speakers:

• Focus on fun. While it may sound easy and obvious, keeping up the fun factor takes creativity and insight. A dedicated team, committed to patient-centered learning and improvement, is required.

• Provide relevant value. Each game must maintain absolute clarity about its target identification, the desired customer experience, and the unique value proposition. This requires a cross-functional team with diverse experience, including experts from game development, medical, marketing, behavioral or psychological sciences, and perceived experts of your customers. And to gage fun and relevance, incorporate customer feedback throughout the development process
  

• Wherever possible, personalize the experience. Today’s customer desires personalized engagement and learning

• Keep it simple. Delivering a guided experience that is easy and doesn’t make consumers think too much or work too hard requires continuous testing among target customers.
  

• Think 24/7 experiences. Consider many channels and platforms to enable easy and convenient customer use in the places and situations where they stand to gain the most value from the game. Each channel and platform may serve different purposes and benefits for customers, and the game must be adaptable for each. (For example, what someone wants from his or her mobile device may be different than when they’re playing on a large console.)

• Maximize social interactions. Build in social aspects for sharing, support, and competition.
  

• Keep metrics and measurement front-and-center. Track the number of uses, levels of engagement, and awareness levels achieved; measure long term brand-building and loyalty with an integrated, sustained gaming effort. And of course keep scientific measures of health outcomes and behavior change.

Healthcare games hold huge potential for the pharmaceutical industry, by both engaging consumers and improving health and brand outcomes-all that in an interactive electronic format that will be an important part of consumers’ lives for many years. Games for Health may even represent pharma’s chance to leapfrog Web 2.0 straight to 3.0.

So let the games begin!