Lack of medication adherence can have serious consequences for a patient, but also for the health care system. Serious games and gamification are used to improve adherence by motivating and rewarding players to stick to their treatment. However, sometimes there are challenges where you need more than just gamification. There can be a social stigma among young people on taking medicine and understanding the long term effects of not sticking to medication is difficult. Serious games tackle this more complex issue by educating the player and boosting their confidence through rich storytelling.
64% of kidney transplant patients don’t stick to their medication schedule
A patient who has had a kidney transplant needs to take medication daily. Not taking their medication results in a 60% increased risk of their body rejecting the kidney (*1). Alarmingly, 64% of patients between 20 to 30 years do not stick to their drug schedule (*2). This of course causes severe complications in the patients’ health and impacts society directly through additional health care costs. According to studies(*3,4), there are several reasons for those patients to not take their medicine, including a lack of self-control and forgetfulness. But also because they don’t think it’s important, don’t want to suffer the side effects or are unaware of the risks.
Gamification can help with medication adherence
This is just one example of why medication and treatment adherence is important. By reading about some of the problems that patients have with adherence, those familiar with gamification can already draw the conclusion that gamification is a good way to address these problems. Gamification uses game elements to make an activity or chore more fun and engaging by helping the player to set goals and rewarding the player for reaching those goals. This helps to create habits for the patient which improves self-control and makes sure that players don’t forget important tasks.
Teens can be uncomfortable with taking medication
For one of our projects, we started with exactly this idea. Remind and motivate players on key moments when they need to take their medicine. But when we started talking to patients who were having problems taking medication regularly, we realized that it’s not just a lack of self-control or forgetfulness. They told about their experiences having to take their medicine at inconvenient moments. For example when they were at a party with their friends, or In a full classroom during class. Their friends and class mates would ask why they need to take medicine, confronting them with their already difficult situation or making them uncomfortable. In some cases their friends would give them remarks like ‘what does it hurt to take them a few hours later’, unaware that it’s actually a big risk.
A serious game with rich storytelling helps with acceptance
These are issues that you only understand when you talk face to face with the people who suffer from this problem. It also shows the complexity of the issue and that it can’t simply be fixed by reminders or digital rewards. This is where serious games come in.
For this particular audience we started building an adventure game that tells the story of Jake, a tech-savvy teen, brilliant mind and multimillionaire. Unfortunately he also suffered from a disease and had to get a kidney transplant. Focused on improving the life of all kidney transplant patients, he started working on a great invention of a new type of bioartificial kidney. But the evil kidney conglomerate is trying to thwart Jake’s plans. They send superspy Luna to sabotage Jake by making him forget to take his medicine. It’s the players task to help Luna sabotage Jake.
Let’s highlight a few important aspects in which this game addresses the target audiences problems:
- In the story, the patient is a hero. Painting the person with the kidney transplant as someone who can accomplish a lot, boosts their confidence about their situation.
- The story is a little bit over the top, making it easier to discuss the topic and lowering the barrier to talk about the situations in the game.
- Despite the story being over the top, the situations that are portrayed are based on real life situations that patients often struggle with. This improves transfer of experience to the real world.
- The player is put in the role of the adversary, the one who has to find a way so that Jake doesn’t take his medicine. Making the players switch roles, gives them an outside view of their situation and helps them see their blind spots.
Stories are a great way to educate players, for example about the long term effects of their decisions. It gives context to the boring rules and warnings about the effects on their health. It can help patients get a better view of their situation and why medication adherence is important because they can actually see their situation on their screens. We hope to see more serious games for different target audiences that address this topic and helps people take their medicine.
The serious game which is used as an example in this article is called ‘Slik’ and was made for the Radboud University Medical Center in cooperation with ‘De Nierstichting’, a foundation that improves the wellbeing of kidney patients. The game is currently in development and not publicly available yet.
*1 Pinsky BW, Takemoto SK, Lentine KL, Burroughs TE, Schnitzler MA, Salvalaggio PR. Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. Am J Transplant. 2009;9(11):2597-606.).
*2 Massey EK, Meys K, Kerner R, Weimar W, Roodnat J, Cransberg K. Young Adult Kidney Transplant Recipients: Nonadherent and Happy. Transplantation. 2015;99(8):E89-E96.)
*3. Massey EK, Tielen M, Laging M, Beck DK, Khemai R, van Gelder T, et al. The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: a cohort study. J Psychosom Res. 2013;75(3):229-34.
*4. De Geest S, Sabate E. Adherence to long-term therapies: evidence for action. Eur J Cardiovasc Nurs. 2003;2(4):323