Blog post by Bernadette Keefe MD
Playing a game is the voluntary effort to overcome unnecessary obstacles.
-Bernard Suits
Introduction
Game-play focuses and controls our attention, taps into our innate strengths, thrills us utterly, and compels us to greater resilience in the attainment of more powerful and effective skills. For these reasons, some believe that game-play is an invaluable tool to employ in tackling the biggest problems in our world today.
The ability of gaming to focus human attention so completely has attracted all those who wish to harness just a piece of that attention for their own ends. Business, education, and healthcare have all used gamification with the hopes of affecting certain desired behaviors. The goals of gamification in healthcare would be no less than to effect personal and societal behavior change, to achieve improved individual health, and the health of populations.
A flurry of aspirational papers and some early results propelled gamification in healthcare to a Gartner’s Hype Cycle * peak ‘hype’ in 2011-2013. Years 2014-2015 found gamification in healthcare in a period of disillusionment. Now the sentiment for gaming seems to be on the upswing, as more attention is being paid to high quality game design and targeted use.
In this paper, I will give some history and context to game play, video game design, and the gameful mindset to show how gamification in health and healthcare can and does happen successfully when done well. I will also include demonstrative examples and a large number of references for further perusal.
What is A Game
Games are a structured “form of play or sport, especially a competitive one played according to rules and decided by skill, strength, or luck.” –wikipedia
The history of gaming goes back to ancient times and game-play is one of the oldest forms of social interaction. In essence, the games we play are a celebration of our potential, our dreams, and our innermost passions. Game-play is self-revelatory, and, at the same time, takes us ‘out of ourselves’.
The vast variety of game forms, both ancient and modern, speaks to the centrality of games, and game-play in human life. We play games seated, across from each other, standing, poised ‘in combat’ at the 50 yard line in stadiums, and across the world, in online video games. We stand, jump, kick, run for both online and offline physical games. ‘Exergaming’, the combination of video gaming and exercise, has taken individual and group exercise to a new level. The brilliant ancient Chinese game of ‘Go’, a territorial board game of strategy, is played with as much passion today, as it was several centuries ago!
Collage of non-sport gaming
Video Gaming, and Game Design
‘Link’ – the protagonist and ‘hero’ of the Legend of Zelda series
The advent of video games ushered in lush, visual, and dramatic digital stories in game-play. By ingeniously combining the elements of challenge, fantasy, uncertainty and player control, gaming captured the hearts and minds of many around the world.
Notably, great game design takes considerable skill on the part of the designers and is expensive to produce. Those who wish to apply gamification concepts to other fields must realize that the reason video games for entertainment are a multi-billion dollar juggernaut today is because the key elements of gaming are woven together exquisitely, in such a way to universally capture, and captivate us! Consider these staggering numbers: in the U. S. alone, 175 million people play video games, and spend 22 billion dollars annually. Worldwide 1.23 billion people play video games and dole out 90 billion dollars annually on them.
Gamification of a system, or desired behavior, requires an understanding of, and exquisite attention to, details of game design, in order to be successful. In the following section, I will provide a brief overview of the major elements of game design: player agency, flow, challenges and goals, player types, intrinsic motivation and rewards.
Player Agency
Player agency, the ability of the player to act independently and make their own choices, is at the heart of game design. Without choice, or volition, there is no ‘game’ but a set of unwanted rules. The worst efforts at gamification make the crucial mistake of not respecting the centrality of player agency.
Flow
Flow is sometimes described as ‘being in the zone’, and is characterized by a person’s complete absorption in the activity at hand. It is a state characterized by immersion, energized focus and enjoyment. The experience of flow is one of the features that many associate with gaming and is the ‘holy grail’ of game design.
Digital games have the unique ability to give immediate feedback, to adjust challenge to levels of accomplishment, and to tailor the timing and substance of rewards, giving the player incredible motivation to keep learning and improving towards mastery. The expertise of game design involves blending those game elements to create ‘flow’ and then, to keep the player in the ‘flow channel’, that space where a player is deeply engaged by challenge and learning, but not overly frustrated or anxious, nor overcome with boredom.
Goals
Games with Goals VS Open, Expressive Games
Classically, games have clear challenges and goals, and end when those goals are met. In other words, there is a winner. However, not all gaming is goal-oriented, nor should be. From this excellent article on this topic, “Without a goal: on open and expressive video games“:
Clear goals also mean clear failure, which may not suit a specific player since different players have different levels of frustration tolerance. Goals may also run counter to what the player wants to do: Players may care more about the aesthetic or sentimental value of game choices than about the optimal way of playing the game. Games with goals afford certain types of experiences well, and leave less room for others.
Games without goals or with optional goals can accommodate more playing styles and player types…and player experiences.
‘Optional-goal’ or even ‘non-goal’ games, with their open-endedness, inclusivity, and creative options can be extremely popular, witness the popularity of Microsoft’s ‘Minecraft’ game. Minecraft has two game versions: Survival and Creative. In the Creative version, there are no rules, and no goals. Just three years old, it is the third best selling game of all time (after ‘Tetris” and “Wii Sports”). See the Minecraft Game Advert:
Some video games have stated challenges and goals, but allow more choice and flexibility than usual, with options for more personalized input, including individual goal making. Such games are more about self-actualization, creativity and process, rather than specified goals and winning. The framework of these games, often has a greater social experience.
If ‘flow’ is created when the structure of challenges via quests and goals is so enthralling, what is the appeal of goal- less, or goal optional games?
In essence, the answer lies in two design considerations: intrinsic player motivation and player type. Both of these determine the degree to which a particular player is attracted to a game’s role, narrative, or structure. I recommend the excellent reference “Without a goal: on open and expressive video games”
Intrinsic Motivation and Player Type
In his recent book on game design, Andrezej Marcezewski, addressed the importance of intrinsic player motivation in keeping a player engaged. He created the following schema to describe intrinsic motivation in gaming: RAMP, stressing that good game design must have one or more of these intrinsic motivators built in.
The structure, missions and goals of a particular game, will generally tap into and utilize specific intrinsic motivators. If there is a mismatch between an individual player’s key intrinsic motivators, and those required in the game, that game may become unappealing and less engaging to that player. For instance, if a player has, at their core, an intrinsic motivator of ‘autonomy’ and the game design has little opportunity for freedom or options, the game will likely not work for that player.
Marcezewski created the player hexad (see addendum) to connect the two elements of intrinsic motivation and player type. He defined six player types as follows:
Socializers – motivated by relatedness, who want to intersect with others and create social connections.
Free Spirits – motivated by autonomy and self–expression, who wish to create and explore.
Achievers – motivated by mastery, who are seeking knowledge, acquisition of new skills and self-improvement; they want challenges to overcome.
Philanthropists – motivated by purpose and meaning, are altruistic, wanting to give to other people and enrich the lives of others in some way – with no expectation of reward.
Disruptors are motivated by change, In general, they want to disrupt your system, either directly or through other users to force positive or negative change.
Players are motivated by extrinsic rewards. They will do what is needed to collect rewards from a system and not much more. They are in it for themselves.
It’s not hard to find ourselves in his descriptions and he allows that we often are mixtures, and, of course, can change!
Reward
The mechanisms and data underlying how the brain is motivated in game play are a fascinating subject and underpin all successful game design. Analysis of data from years of digital gaming allows game designers to continuously improve their rewards strategy to keep us highly engaged. I recommend this excellent talk (video, transcript LINKS below) by the gifted game theorist and designer, Tom Chatfield, on gaming, rewards and our brain!
7 Ways Games Reward the Brain –Video Tom Chatfield
7 Ways Games Reward the Brain – Transcript of Video
In his talk, Chatfield explains how games reward us through the following mechanisms:
Avatar ownership – experience bars, other tools for measuring progress and improvement
Tailored challenges – multiple long and short term aims, allow just the right balance of anxiety and boredom
Rewarding all Effort
Feedback – the linking of consequences to action, is essential for learning
Uncertainty – human curiosity is quintessentially heightened by uncertainty.
Timing – of rewards, tailored at maximum receptivity.
Social element of collaboration, the biggest neurological turn on for us is other people and collaborating with other people.
Careful consideration of player agency, flow, goals, player preferences, player motivation and rewards is imperative in game design. Without exquisite attention to the end user, gamification efforts, in any field, including health and healthcare, will not be successful, and will not effect behavior change. Those games designers who are crafting games, specifically for behavior change in individuals and populations, can increase the chances of success through researching their end users, matching game design, goals, and rewards to these players, and incorporating more flexibility and personal options, even for challenges and goals.
– The Dopamine Connection
The science underlying the appeal of game-play and gaming revolves around a brain hormone, dopamine and the ‘dopaminergic’ system. The dopaminergic system is comprised of the connections between areas of the brain which respond when dopamine is released. The major functions of dopamine are: to reward motivation, prepare for motor function, and to foster compulsion and perseverance.
Multiple studies in mice and humans have demonstrated heightened dopamine output and activation of the dopaminergic system during game play. Gaming taps into the dopaminergic system, a system of alert for, and anticipation of, thought and action. Dopamine is the hormone of want, of motivation, and of enhanced concentration and engagement. With increased dopamine, we are less able to be discouraged and we function as more resilient, stronger, and braver individuals.
It is worth mentioning that the effect of compulsion produced by dopamine is not always useful or healthy, and, sustained elevated dopamine levels are not good for us. Thus, it is recommended to stick to a cut-off of three hours per day and 20 hours per week of gaming.
Also worth noting are game-play’s positive effects in participating in non-video games such as board games, card games and athletics.
Games For Health (sometimes called ‘Serious Games’)
Making the leap from the ‘flow’ of entertainment video games to games for health may seem like a leap too far. While we all buy into entertainment, leisure and play, our health and our challenges with it, are not something most of us relish dwelling on. We know that daily attention to our health habits is important and we desire to make behavior changes to achieve better personal health outcomes. Nonetheless a huge gap persists between that knowledge and desire, and, achievement.
The importance of behaviors, lifestyle, to overall health.
The large gap between knowledge/desire for behavior change, and achievement.
Many individuals, corporations, government and game designers have imagined that the focus and empowerment of gamification might just be strong enough to help us with the behavior changes we need to make.
But making the leap from game design in entertainment to its application in health and behavior change, is not necessarily easy. The theories of scientist Jane McGonigal, PhD, senior researcher at the Institute for the Future in Palo Alto, California are helpful to consider. She is a renowned designer of alternate reality games, games that are designed to improve lives and solve problems by challenging our current perceptions of reality, and effecting personal behavior change. (See multiple references on Jane McGonigal PhD included at the end).
McGonigal emphasizes the following ways that gaming accomplishes behavior change. Firstly, gaming allows us to access and practice our strengths by tapping into innate qualities we already have. McGonigal describes three key innate strengths we access which help us improve and bring about behavior change: we are stronger than we know, we’re surrounded by allies and supporters, and we are the heros of our own story. These strengths underpin player agency and empowerment, elements central to success.
Secondly, McGonigal emphasizes that gaming exquisitely focuses and controls our attention (and our acts and feelings) as we, the hero of our story, address sequential and progressive quests and challenges. She explains that when we engage in gaming using real life health challenges, recovery becomes attainable by creating optimism. By arousing our curiosity and giving us agency, personalization and choice, we become more motivated. Through our attraction to the fantasy we are more invested, feel and see more meaning.
Slide by Jane McGonigal PhD
Game-play in lifestyle health and medicine
There have been countless isolated studies on the success of game play in health behavior improvement. Please peruse the references below to read more about the incredible range of uses of gamification for enhanced wellness, abilities.
I have selected the following games for health to highlight, as they are immediately engaging and appealing, and good demonstrations of player agency and mastery. Please note that while these are digital examples, real life games for health are played throughout the world on fields, courts, pitches and in stadiums!
I.) Medical – Situational
Physical Rehabilitation- “Bandit’s Shark Showdown”
“Bandit’s Shark Showdown” is a gamification app that combines cutting-edge robotics, neuroscience, and game design to treat patients early after a stroke. A stroke causes tissue death and resultant repair process. This repair process can be influenced by behavior if performed early after the stroke, within one to three months. The “Bandit’s Shark Showdown” was developed as a rehabilitation exercise game to be played during this time.
The patient wears a robotic arm outfitted with a motion-capture camera, and tries to control the movement of a dolphin in the water with their arms. The user and Bandit the dolphin are one, hunting mackerel and battling sharks.
Medication (Understanding – Use) – “ReMission Video Game”
Young patients with cancer can be frustrated by the long duration of treatments and the issue of remission. The “Re-Mission Video Game” was designed to help these patients understand and participate in their therapy, and take their medication.
II.) Lifestyle –anytime
Gamification of fitness and exercise is incredibly popular. There are numerous gamified exercise apps. Exergaming, the blending of a video game with the an exercise program is a relatively recent phenomenon. Wii fit games by Nintendo, introduced in 2007, have gamified innumerable physical activities.
“Zombie Run” is a popular running game out of the UK.
“SuperBetter” by Jane McGonigal, PhD
A game and game template to help with depression, anxiety, and other challenging life events.
Jane McGonigal, PhD developed the game, Jane, The Concussion Slayer while early in the battle with post concussion depression. In 2009 she had suffered a fall-related concussion, and became depressed and suicidal. To help her cope with these distressing symptoms, she created Jane, The Concussion Slayer. In it McGonigal combined the key elements of Power-Ups, Quests, Bad Guys and Allies to create a compelling personal game to help her fight her depression.
SuperBetter, modeled on Jane, The Concussion Slayer, is a game /game template for how to tackle nagging or challenging wellness issues such as depression, anxiety, weight loss, chronic fatigue syndrome, anxiety, chronic pain etc. The player chooses the specific Power-Ups, Quests, Bad Guys and Allies suitable for the issue at hand. The game functions as a creative and entertaining gamified, self-help approach, and a way to adopt a gameful mindset during times that don’t feel pleasurable in any way.
WATCH Jane McGonigal’s Ignite talk to hear her story, and her description of gamification.
The Healthcare Gamification Misfires, Backfires
The Digital Whip
While gamification for health can certainly be a positive, the story is not all rosy. People who struggle with health issues such as obesity, or diabetes control, may feel undue pressure to lose weight or diet, at the same time they are under other stresses. If an employer is tracking their health behaviors, they may be concerned about keeping their job, or perhaps discrimination on the job. An employee who struggles with behavior change may worry that their health insurance premiums will be raised, even though they may be trying hard to have healthier lifestyle habits.
In 2016, Fitbit announced that it was partnering with employers, corporations to track employees and mine that data in order to monitor employee health habits.
Fitbit ultimately wants to become a repository of digital health data that could charge subscription fees to health providers and employers to track patient and employee fitness and wellness information…
– James Park, CEO of Fitbit
It is fun to use Fitbit with your friends, as a game. It might feel a little less fun to know your employer, who negotiates your health insurance and might factors premiums into wage adjustments, has all that data.
As stated in this article about workplace gamification:
(Gamification) can also be exploitative, especially when used with vulnerable populations. For workers, especially low-paid workers, who desperately need their jobs yet know they can be easily replaced, gamification may feel more like the Hunger Games. (See addendum #5)
False Promises /Exaggerated Benefits
The Case of “Lumosity”
Improvement in memory, brain function and intelligence have always been a subject of intense interest. But recently, with significant aging of populations around the world, online brain training to ward off, or mitigate against, dementia became hot.
A few notes on intelligence:
Intelligence is the ability to learn, to profit from experience, the ability to adapt to new situations, and the ability to solve problems
Two types of intelligence; fluid intelligence, the ability to adapt to new situations and solve novel problems and is felt to be relatively unchangeable and crystallized intelligence, knowledge acquired through experience which can increase throughout life.
“Lumosity”, a popular online ‘brain training’ game program, claimed to improve memory and attention, problem solving and other skills. Numerous researchers have attempted to replicate Lumosity’s medical claims since its release in 2007 and have been unable to do so.
In October 2014 a group of concerned scientists and neuroscientists around the world released a paper objecting to Lumosity’s claims.
A relevant quote from the paper follows:
We object to the claim that brain games offer consumers a scientifically grounded avenue to reduce or reverse cognitive decline when there is no compelling scientific evidence to date that they do. The promise of a magic bullet detracts from the best evidence to date, which is that cognitive health in old age reflects the long-term effects of healthy, engaged lifestyles. In the judgment of the signatories below, exaggerated and misleading claims exploit the anxieties of older adults about impending cognitive decline. We encourage continued careful research and validation in this field.
Ultimately, in February 2016, the Lumos corporation, makers of Lumosity, were fined two million dollars because their medical claims were not able to be verified.
Interestingly, traditional entertainment video games may help older patients with cognition. A probable explanation why traditional gaming rather than focused brain training might be more successful in improving brain function is suggested:
Traditional video games are more complex and harder to master, and they require that the player learn a wider and more challenging range of skills and abilities.
– Jane McGonigal
A Gameful Culture
On March 7, 2016, the U.S. Surgeon General in his keynote at The Society of Hospital Medicine Annual Meeting asked the physicians and healthcare professional organizations to foster a more celebratory and joyful message around our health and healthcare efforts. He asked the audience to bridge the pain/pleasure divide by connecting people in communities.
As we consider the exuberance that occurs with game-play, the passion, joy and determination involved, and the power we have by tapping into it individually and with each other, it seems we are missing out if we don’t encourage game play and employ gamification techniques in our health-related efforts.
Healthcare professionals, and local and federal government, through public policy and public health, can be united in using game-play to foster resilient, collaborative, and healthy populations. There is much to celebrate, and get excited about with a societal culture of health and we are gradually witnessing public health initiatives which are joyful, playful and celebratory. Not surprisingly, people respond!
The following video shows what a gameful mindset can accomplish in our built environment:
Conclusion
Gamification of our health and in healthcare, though still a field of research, with no large scientific trials, is a promising endeavor. The best game design principles must be used, with special attention to players’ mindset, context, and motivations, while crafting tailored challenges and goals to match. Maintaining a robust ‘flow channel’ so that the user does not get overly anxious or bored is essential.
The endeavor must be a collaborative effort between the highest quality game designers, prospective users, and healthcare professionals. This will insure an empowered user protagonist, who is thrilled with relevant challenges, and, through persistence and focus, gains increased mastery over their health.
Incorporation of social experiences and optional, goal-less or expressive gaming are all worth considering when trying to effect behavior change in general populations. Games for health that have a social element should favor mutual support, and use competitions to creatively brainstorm ways to help one another.
In summary, games, and game-play afford us the opportunities to tap into inner resources which may not be readily apparent to us as we go about lives. As we engage in gaming, we tap our considerable capacity for cooperation, resilience, focus, drive, competition and creativity. When tailored to our needs and goals, games for helping behavior change, can become a personal, and societal, ‘go-to’ tool!
A Celebration of All Gaming: 2014 in Gaming: The Year Under 2 minutes
#HCLDR Topic Questions
Please join us on Tuesday March 22nd at 8:30pm EDT (for your local time click here) when we will discuss the following questions:
T1 Have you participated in, or seen an application of gamification for health, healthcare? Your thoughts?
T2 Fitbit contracts with employers to track & improve employee habits. Can Fitbit still be ‘gameful’, or is it a ‘digital whip’?
T3 Do you have fears about children’s video gaming? Or do you view it as a positive, in moderation?
T4 Would you use the SuperBetter game, to gamify a health issue, such as diet, exercise, sleep, mood, anxiety, meds, other?
Image Credit
Image Dungeons and Dragons – Die
Addendums
1.) Gartner Hype Cycles – schema to describe the maturity and adoption of technologies and applications, has five regions: Innovation Trigger, Peak of Inflated Expectations, Trough of Disillusionment, Slope of Enlightenment and Plateau of Productivity. Gamification for health is in the Slope of Enlightenment and with more encouraging research, should proceed to the final stage.
2.) The Full Player Hexad in Game Design – by Andrzej Marczewski , created to combine player (user) types and motivation, and game goals, in game design
Reference: Using the Gamification User Types in the Real World http://www.gamified.uk/2013/12/09/using-gamification-user-types-real-world/
3.) Humans are hard-wired for learning and mastery
Source: Slideshare: Applying Game Concepts to Learning http://www.slideshare.net/timboileau/game-conceptstolearning
4.) Jane McGonigal, PhD
Jane McGonigal is the New York Times bestselling author of Reality is Broken: Why Games Make Us Better and How They Can Change the World (Penguin Press, 2011) and is the inventor and co-founder of SuperBetter, a game that helps people tackle real-life health challenges such as depression, anxiety, chronic pain, and traumatic brain injury. She published her book ‘SuperBetter’ about the game and her associated research.
See her Website for more information on her research, books, talks etc
Jane, The Concussion Slayer, Ep 66 (2010) https://www.youtube.com/watch?v=ZztLac0Q1EI
Listen to interview on The Peoples Pharmacy Show (#1025) http://www.peoplespharmacy.com/2016/02/18/show-1025-get-superbetter-how-games-can-improve-your-health-and-your-life/
Jane McGonigal – The Science of How Games Make Us Stronger https://www.youtube.com/watch?v=b8ZJuCeAYyo
As she states in her interviews about Jane, the Concussion Slayer, her game that preceded SuperBetter and formed a model for it. The Major Elements of SuperBetter – and details about how they are used from the book SuperBetter
Power-ups: temporary boost that make you feel more powerful, stronger, better. Ex: people watching baby animal videos
Quests: a way to move forward to your goal; finely tuned to the level of difficulty; doable – smallest thing that you can do to advance the goal while staying true to your values. Ex: baking cookies for the baristas because she was depressed and felt unimportant after her concussion
Bad Guys: the things that get in the way of our goals; way of dealing with bad guys is to, “flip them”. Ex: a student of hers was especially anxious about his life, whether he would be able to accomplish what he wished, live up to his own expectations. He flipped that to “wow, I’m an especially caring person, really desirous of achieving good, that is my ‘power’, my strength
Allies : these are the people, activities you tap, formally in the game, to be your allies, to stand by your side, to encourage and keep honest (in a good way). They have your goals at heart. “There are days where I feel like there is no possible way I can win against the bad guys. It I’m having one of the days, I can just say to my favorite allies, my sister, “I’m stuck in the Void of Guilt. Help!” – Regina, 30, whose challenge is overcoming the working mom blues
5.) The Hunger Games – Movie Trailer
References
What Is A Game?
Wikipedia: Games, Gaming
Rolling Bones: The History of Dice http://www.neatorama.com/2014/08/18/Rollin-Bones-The-History-of-Dice/
These centuries old dissected maps were the earliest jigsaw puzzles http://mentalfloss.com/article/71021/these-centuries-old-dissected-maps-were-earliest-jigsaw-puzzles
Puzzle and Game Maps http://bibliodyssey.blogspot.com/2009/08/puzzle-and-game-maps.html
Video gaming
BOOK Rules of Play: Game Design Fundamentals Katie Salen and Eric Zimmerman, published by MIT
Video Games and Learning http://library.cqpress.com/cqresearcher/document.php?id=cqresrre2016021200
7 ways games reward the brain https://www.ted.com/talks/tom_chatfield_7_ways_games_reward_the_brain?language=en#t-293069
The Unsexy Truth About Dopamine https://www.theguardian.com/science/2013/feb/03/dopamine-the-unsexy-truth
Dopamine and games – Liking, learning or wanting to play? http://www.gamasutra.com/blogs/BenLewisEvans/20130827/198975/Dopamine_and_games__Liking_learning_or_wanting_to_play.php
Big Thinkers: Judy Willis on the Science of Learning https://www.youtube.com/watch?v=J6FqAiAbUFs
Gamification off the cuff http://www.innovatemyschool.com/ideas/item/1688-gamification-off-the-cuff
Applying Game Concepts to Learning http://www.slideshare.net/timboileau/game-conceptstolearning
In Educational Games, Complexity Matters Mini-games are Trivial – but “Complex” Games Are Not http://www.marcprensky.com/writing/Prensky-Complexity_Matters.pdf
Understanding Free to Play Games with the Four Pleasures Model http://www.slideshare.net/FamousAspect/understanding-freetoplay-games-with-the-four-pleasures-model
A Player Type Framework for Gamification Design http://www.gamified.uk/user-types/
Why player types matter in gamification http://www.megamification.com/why-player-types-matter-in-gamification/
Using the Gamification User Types in the Real World http://www.gamified.uk/2013/12/09/using-gamification-user-types-real-world/
Do we deal with Mario, Peach or Bowser? – A Gamification User-Type Study http://organicsocial.biz/blog/deal-mario-peach-bowser-gamification-user-type-study/
Games That Help Improve Problem Solving Skills http://www.businessinsider.com/video-games-that-help-improve-problem-solving-skills-2015-10
9 ways to boost your intelligence by playing video games http://www.businessinsider.com/video-games-and-health-benefits-2015-9?r=UK&IR=T
Review: EA Sports: Active Wii http://www.kingquagmire.com/3014/review-ea-sports-active-wii/
Without a goal: on open and expressive video games https://www.jesperjuul.net/text/withoutagoal/
The Gameful Mindset
Introduction to a Gameful Mindset http://www.slideshare.net/randyfuj/introduction-to-a-gameful-mindset
The Gameful Strengths Inventory http://janemcgonigal.com/2015/01/13/the-gameful-strengths-inventory/
Here are the benefits of a ‘gameful mindset’ in everyday life: Jane McGonigal http://technical.ly/brooklyn/2015/09/17/jane-mcgonigal-nyu-game-center/
This Women Thinks That Video Games Can Heal the World http://www.bbc.co.uk/bbcthree/item/244517ff-2861-4486-81f5-3c27e487ff8e
The Best Tools to Productively Gamify Every Aspect of Your Life http://lifehacker.com/the-best-tools-to-productively-gamify-every-aspect-of-1531404316
13 classic games you can play in your web browser http://www.businessinsider.com/13-classic-games-you-can-play-in-your-web-browser-2016-2
Hundreds of ‘Lost’ Apple II Games Saved by Internet Archive http://www.wired.co.uk/news/archive/2016-03/07/apple-ii-games-internet-archive
13 classic games you can play in your web browser http://www.businessinsider.com/13-classic-games-you-can-play-in-your-web-browser-2016-2
Games For Health
15 Ways Video Games Can Make You Smarter and Healthier http://www.businessinsider.com/video-game-health-benefits-2014-9?op=1
Gamification of the Healthcare Industry and Its Implications http://pathfindersoftware.com/2015/08/gamification-of-the-healthcare-industry-and-its-implications-html/
How Gamification Will Transform Healthcare https://www.healthexpress.co.uk/health-blog/ehealth-tech/gamification-changing-healthcare
How to Win with Gamification in Healthcare http://www.slideshare.net/thinknetplus/np-gamification-health05sf?related=1
Zombies level up fitness gamification http://www.megamification.com/zombies-level-up-fitness-gamification/
Zombies, Run! https://www.youtube.com/watch?v=GyFqZtKvya0
Helping Hands: Robots, video games and a radical new approach to treating stroke patients http://www.newyorker.com/magazine/2015/11/23/helping-hand-annals-of-medicine-karen-russell
Bandit’s Shark Showdown https://www.youtube.com/watch?v=h2MF5Bmvcyk
16 Healthcare Gamification Startups to Watch in 2014 http://hitconsultant.net/2014/06/16/15-healthcare-gamification-startups-to-watch/
The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial. http://www.ncbi.nlm.nih.gov/pubmed/25574939
Top Ten Gamification Healthcare Games http://yukaichou.com/gamification-examples/top-ten-gamification-healthcare-games/#.VsdWQZMrKCQ
Designing Digital Tools for Patient Engagement http://info.ayogo.com/ayogo-whitepaper-02
Does Healthcare Gamification Work IRL? http://www.insightforums.com/does-healthcare-gamification-work-irl/
Slideshare: Gaming to Improve Health Literacy http://www.slideshare.net/emarrapodi/consumer-health-literacy-study-project-2010-final-version
Two companies seek FDA approval for brain games to treat ADHD http://www.scientificamerican.com/article/2-companies-seek-fda-approval-for-brain-games-to-treat-adhd2/
Video Game Syncs to Your Exercise https://www.facebook.com/techinsider/videos/468425720022456/
A Multitasking Video Game Makes Old Brains Act Younger http://www.nytimes.com/2013/09/05/technology/a-multitasking-video-game-makes-old-brains-act-younger.html?_r=0
Video Games in Care Homes: Connecting Older Adults or Exposing Age Related Vulnerability https://www.sciencedaily.com/releases/2015/04/150420122625.htm
The # 1 Source for Interactive Fitness and Game Products http://www.exergamefitness.com/in-action/at-health-clubs/
Top 10 Medical Games (Apps, Board and Video Games) – The Medical Futurist https://www.youtube.com/watch?v=lyErv44VRcU and Pandemic –The Video Game
The Effect of Social support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4296094
Can Playing the Computer Game “Tetris” Reduce the Build – Up of Flashbacks for Trauma? A Proposal from Cognitive Science http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004153&representation=PDF
7 Best Gamification Apps for Fitness in 2015 http://nuviun.com/content/7-best-gamification-fitness-apps-for-2015
Child and Teen Health – Related Games
Employing Gamification to Relieve the Pain of Pediatric Cancer http://www.gamification.co/2012/05/24/employing-gamification-to-relieve-the-pain-of-pediatric-cancer/
Prescription Play: video game innovation in healthcare http://artibiotics.com/prescription-play/
The Website of Celiene Kearnes http://artibiotics.com/
What Kids Say About #D (Dental Health Game) – Attack of the S.Mutans https://www.youtube.com/watch?v=3c05aGjtKmI
Apps To Help The Kids Get Moving http://www.theonlinemom.com/apps-get-kids-moving/
NFL Play 6 https://youtu.be/bXJ4nutRHFg
Exergaming: Improve Academics, Social Development and Health and Fitness https://www.youtube.com/watch?v=WSRyXqiscow
How Gamification Improves Health and Health Education Outcomes in Children http://nuviun.com/content/how-gamification-improves-health-and-health-education-outcomes-in-children
Gamification for Health-Misc applications
Radiology Workflow Improvements Possible With Gamification: More Than Pong http://www.medicalimagingtalk.com/radiology-workflow/radiology-workflow-improvements-gamification-pong/
Stanford University’s Septris app combines gamification of healthcare with CME http://www.imedicalapps.com/2012/02/stanfords-septris-brings-gamification-healthcare-cme/
How An Obese Town Lost A Million Pounds http://blog.ted.com/the-gamification-of-weight-loss/ and Video: http://www.ted.com/talks/mick_cornett_how_an_obese_town_lost_a_million_pounds
Gamification for Health Misfires, and Backfires
Fitbit goes corporate with its digital health strategy https://www.mobilestrategies360.com/2016/02/24/fitbit-goes-corporate-its-digital-healthcare-strategy
When work becomes game http://www.smithsonianmag.com/innovation/when-work-becomes-game-180958145/?no-ist
How to motivate today’s worker http://edwardlowe.org/how-to-motivate-todays-worker/
New evidence shows brain training games don’t work http://www.zdnet.com/article/qa-new-evidence-shows-brain-training-games-dont-work/
A Consensus on the Brain Training Industry from the Scientific Community -Full version http://longevity3.stanford.edu/blog/2014/10/15/the-consensus-on-the-brain-training-industry-from-the-scientific-community-2/
Lumosity to pay 2 Million over lies about brain training games http://www.syracuse.com/business-news/index.ssf/2016/01/lumosity_to_pay_2m_over_lies_about_brain_training_games.html
Brain Training Products Get Federal Scrutiny
http://www.edweek.org/ew/articles/2016/02/10/lumosity-other-brain-training-products-get-federal-scrutiny.html
People Loves Games but Does Gamification Work? http://knowledge.wharton.upenn.edu/article/people-love-games-but-does-gamification-work/
Just A Fad? Gamification in Health and Fitness Apps http://games.jmir.org/article/viewFile/games_v2i2e9/2
Gamification in Healthcare is Booming, But is it effective? http://www.ihealthbeat.org/insight/2015/gamification-in-health-care-is-booming-but-is-it-effective
Gamification comes to clinicians http://www.healthcareitnews.com/news/gamification-comes-clinicians
Nintendo Suspends Sleep Gadget http://mashable.com/2016/02/05/nintendo-suspends-sleep-gadget/#74kSBkYEHZqW
The Dark Side of Gaming – The Females Fighting Back https://www.youtube.com/watch?v=tZMjGwjCAuQ
Books
Suits, Bernard. The Grasshopper: Games, Life and Utopia. Toronto: Broadview, 2005. Print. Original ed. published 1978.
McGonigal, Jane. Reality Is Broken: Why Games Make Us Better and How They Can Change the World. New York: Penguin, 2011. Print.
McGonigal, Jane. SuperBetter: A Revolutionary Approach to Getting Stronger, Happier, Braver, and More Resilient*. London: Thorsons, 2015. Print.
Marczewski, Andrzej. Even Ninja Monkeys like to Play: Gamification, Game Thinking & Motivational Design. United Kingdom: Gamified UK, 2015. Print.
Videos
7 Ways Games Reward the Brain –Tom Chatfield https://www.ted.com/talks/tom_chatfield_7_ways_games_reward_the_brain?language=en#t-963321
2014 in Gaming: The Year Under 2 minutes https://youtu.be/Aq2HysVdNBs
Interview w/ Jane McGonigal explanation of Superbetter template http://i1os.com/?gQ2SnQ-Glsg.video
The Game That Can Give You 10 Extra Years of Life (2012) https://www.ted.com/talks/jane_mcgonigal_the_game_that_can_give_you_10_extra_years_of_life?language=en
Jane McGonigal: Gaming Can Make A Better World (2010) https://www.ted.com/talks/jane_mcgonigal_gaming_can_make_a_better_world?language=en
Zombies, Run! https://www.youtube.com/watch?v=GyFqZtKvya0
NFL Play 6 https://youtu.be/bXJ4nutRHFg
Employing Gamification to Relieve the Pain of Pediatric Cancer http://www.gamification.co/2012/05/24/employing-gamification-to-relieve-the-pain-of-pediatric-cancer/
https://www.youtube.com/watch?list=UURXuIrY0w8NPvBptXtfDKvA&v=Q0keTVtla-8
Exergaming: Improve Academics, Social Development and Health and Fitness https://www.youtube.com/watch?v=WSRyXqiscow