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Gamification is the discipline in which developers indtroduce game design elements in a non-game application[1]. It can be used for a number of purposes but its main goal is to the increase and improve the usability of the product or service offered. It has seen a dramatic rise in interest over the last decade but its effect on healthcare is still yet to be determined. Gamification is one part of a larger ecology of games applications.


While the first use of the term gamification appeared around 2002 by a British programmer named Nick Pelling, the concept of using game design elements can be dated back even to the 1980’s when text adventure games like Adventure were influential in the application of user interface heuristics [1]. However, the term became more popularly used in the early 2000’s but was still not properly defined.


Deterding et al wrote a paper that defined the term gamification as the “use of game design elements in non-game contexts”[1]. This is further understood by examining each aspect of this definition:


Games are different from play. The greek word paidia and ludus are precurors to this distinction. Paidia or “play” is a freeform expression of entertainment and joy. Ludus or “games” are extensions of play but contain challenges that a player must overcome or a goal they have to reach using a set of structured rules.


This definition is more ambiguous. Reeves and Read wrote an article called the Ten Ingredients of Great Games and it contained the following[4]:

1. Self-Representation with Avatars

2. Three-Dimensional Environments

3. Narrative Context

4. Feedback

5. Reputations, Ranks, and Levels

6. Marketplaces and Economies

7. Competition Under Rules that are Explicit and Enforced

8. Teams

9. Parallel Communications Systems That Can be Easily Reconfigured

10. Time Pressure

However, there are many critically successful products that contain few, if any of these elements and are considered games. Also each element taken on its own would not be sufficient in creating a ‘gameful’ experience and some of these elements can be found outside of games themselves. Deterding proposes that game elements should be defined as elements characteristic of games that play a role in gameplay.


Gamification is one aspect of a larger part of game ecology. Within the marketplace there are also examples of games and game technologies being used for purposes other than entertainment. One example is the system GestSure designed at Sunnybrook which used the Microsoft Kinect sensor to allow surgeons to view medical images while in sterile equipment[3]. This software uses game technology but would not be considered gamification. Another example is “Escape from Diab” a game that was designed with the purposes of increasing healthy food consumption in young teens. This falls under the category of a serious game which is a game designed with the purpose of providing a benefit beyond entertainment[2]. Design in the context of gamification is the application of one element of the design of a game. Some elements of game design include:

• Game design interface (leaderboards, badges, ranks, avatars)

• Game mechanics (turn based, action points, timers)

• Game principles and heuristics (goal setting, narrative, enduring play)


Gamification has received a great deal of interest over the last decade due to the popularity of video games and the growing evidence showing strong engagement and enjoyment from users. However, because of its nascence there are limited studies that have shown benefits. One systematic review by Hamari et al looking at 27 published articles found a positive benefit in gamified applications but the effect depended on the context in which the application was used [6]. Gamified applications for education or learning context and gamified applications in promoting exercise show the most promise with studies demonstrating increased user engagement and physical activity. However, there are several limitation and criticisms of gamification. Many of the applications that employ gamification use multiple design features and so there are limited studies that investigate the effects of one specific feature to assess their value. Also most of these studies are short term studies and do not measure long term outcomes. This has also been a point of contention by critics who claim that gamification as a means of tricking people and using extrinsic rewards such as points and achievements is not sustainable nor will it lead to meaningful changes in behavior. There is a need for close examination of how to employ smart game design such that it can motivate users through intrinsic rewards and help create process changes and long term behavior modifications.


1. Deterding, Sebastian, Dan Dixon, Rilla Khaled, and Lennart Nacke. "From Game Design Elements to Gamefulness." Proceedings of the 15th International Academic MindTrek Conference on Envisioning Future Media Environments - MindTrek '11 (2011): n. pag. Web.

2.@LizWFB. "Feds Spent $10 Million on a Video Game About Escaping a Fat Town." Washington Free Beacon. N.p., n.d. Web. 23 Oct. 2016.

3.Comstock, By Jonah. "Eight Ways the Microsoft Kinect Will Change Healthcare." MobiHealthNews. N.p., 10 Sept. 2013. Web. 23 Oct. 2016.

4.By Byron Reeves And J. Leighton Read. Ten Ingredients of Great Games (Apr 10) (n.d.): n. pag. Web. <>.

5."'Gamification': Influencing Health Behaviours with Games." 'Gamification': Influencing Health Behaviours with Games. N.p., n.d. Web. 23 Oct. 2016. <>.

6.Hamari, Juho. "Does Gamification Work? - A Literature Review of Empirical Studies on Gamification." 47th Hawaii International Conference on System Science. N.p.: n.p., n.d. N. pag. Print.

Submitted by Anirudh Chintalapani