Pamela Kato is a health psychologist who founded a nonprofit called HopeLab that developed video games to help cancer patients improve treatment adherence. This document discusses the potential for games and gamification to address challenges in healthcare like chronic diseases and prevention. It provides examples of games that have improved outcomes for conditions like cancer, asthma, diabetes and depression. While research shows some benefits, the field needs more high-quality studies to demonstrate effectiveness and cost-effectiveness before widespread adoption. Gamification techniques outside of games may also help sustain healthy behaviors.

1. Games and Gamification
Revolutionizing
Healthcare: Risks and
Benefits
Pamela M. Kato, EdM, PhD
Owner, P. M. Kato Consulting

2. My Background
Harvard and Stanford trained Health
Psychologist
Founding President and CEO of HopeLab,
led development of Re-Mission
Current Owner of P. M. Kato Consulting

3. Healthcare Challenges
Acute Care Model  Chronic Care Model
Chronic diseases
Aging population
Prevention
Patient Safety

4. Behavioral Challenges
Effective treatments will have no impact on health
outcomes if people fail to use them
There are no immediate rewards for engaging in
preventive health behaviors

5. Gaming
Booming industry
The global videogame market will grow from $67
billion in 2012 to $82 billion in 2017 (DFC
Intelligence)
One in three Europeans plays video games regularly
(Interactive Software Federation of Europe,
Consumer Research 2008)
People play video games because….

7. The 2011 Essential Facts About the Computer and Video Game Industry was released by the Entertainment
Software Association (ESA) at E3 2011.

8. The 2011 Essential Facts About the Computer and Video Game Industry was released by the Entertainment
Software Association (ESA) at E3 2011.

9. A Serious Game
A game that is designed for education and training
usually on a digital platform

10. Games for Health
Innovation
Passive Patient  Patient Empowerment

11. The Fun Theory
http://youtu.be/2lXh2n0aPyw

12. Games Addressing
Challenges
Chronic diseases
Aging population

13. Cancer
Since the 1980’s video games have been shown to
be effective in healthcare in managing pain and
nausea related to treatment
Video games improve management of nausea and
conditioned nausea in pediatric oncology
.Redd WH, Jacobsen PB, Die-Trill M, Dermatis H, McEvoy M, Holland JC. Cognitive/attentional distraction in the control of
conditioned nausea in pediatric cancer patients receiving chemotherapyJ Consult Clin Psychol. 1987 Jun;55(3):391-5.

14. http://youtu.be/kjLdu7SEMNs

15. Treatment Adherence
Effective cancer therapies exist but adolescents and
young adults were not benefitting (Archie Blyer)

17. Re-Mission RCT Research
n=374 young people with cancer
34 medical centers
Design
Control game vs. Control game + Re-Mission
Primary outcome = Adherence to treatment

18. Results

19. Adherence

21. Re-Mission Today
• Available at www.re-mission.net
• Over 200,000 copies distributed world-wide
• Follow-up research showed that interactivity
responsible for improved motivation to adhere
• Re-Mission 2 scheduled for 2013
Cole, S.W., Yoo, D.J., Knutson, B. (2012). Interactivity and Reward-Related Neural Activation During a
Serious Videogame. PLoS ONE.

22. Asthma
Improved knowledge, self-efficacy to manage illness,
and increased social support after 1 month of play (not
randomized)
RCT showed increase in self-efficacy with game and
decrease in self-efficacy with educational video
Lieberman, D.A. (2001). Management of chronic pediatric diseases with interactive health games: Theory and
research findings. Journal of Ambulatory Care Management, 24(1), 26-38.

23. Diabetes
Improved knowledge, communication and self-efficacy
to manage illness
Reduced urgent care visits related to diabetes
Brown, S. J., Lieberman, D. A., Germeny, B. A., Fan, Y. C., Wilson, D. M., & Pasta, D. J. (1997). Educational video
game for juvenile diabetes: Results of a controlled trial. Medical informatics, 22(1), 77-89.

24. Mental Health

25. Depression
• N=187 ages 12-19, seeking help for depressive
symptoms
• SPARX vs. traditional therapy for 4 to 7 weeks
• Higher remission in depressive symptoms (44% vs.
26%) with SPARX
• Mean reduction in depressive symptoms and
response rates no different from traditional therapy
Merry S, Stasiak K, Shepherd M, et al. The effectiveness of SPARX, a computerised self help intervention for
adolescents seeking help for depression: randomised controlled non-inferiority trial. BMJ 2012;344:e2598.

26. Exergames with the Elderly
• N=19 seniors (ages 63-94)
• Play for 35 mins, 3x/week for 12
weeks (84% adherence)
• Reduced depressive
symptoms (QIDS)
• Increased mental QOL (SF-
36)
• Improved neurocognitive
status (RBANS)
D. Rosenberg, C. A. Depp, I. V. Vahia, J. Reichstadt, B. W. Palmer, J. Kerr, G. Norman, and D. V. Jeste. Exergames for Subsyndrom
Depression in Older Adults: A Pilot Study of a Novel Intervention. American Journal of Geriatric Psychiatry, 18(3), 221-226, 2010.

27. Games for Stroke Rehab

28. Strengths and Weaknesses
of G4H
• Willingness to invest in
production
• A handful of studies support
effectiveness
• Potential to address challenges
in healthcare
• Not willing/able to invest in
research or
marketing/distribution
• Not enough research
• Can’t ask “how” they work until you
know “if” they work

29. Threats and Opportunities
• Scant evidence for cost-
effectiveness
• Rising costs if regulatory
commissions are involved
• Lack of a proven sustainable
business model
• Getting stuck in games as a
cottage industry with a reputation
for lousy production values
• Difficult to engage elderly
population
• May be an economical way to
promote health
• People are more digitally
connected, data sharing is easier
which could promote
commercialization
• More and more serious games
companies are being established
• Gamers are getting old!
• Gamification

30. Gamification
• The application of game design and game mechanics outside of
an immersive game to increase engagement
• Loyalty programs
• Exclusive membership
• Badges
• Points

31. Conclusion
Research findings are promising but a majority of
games for health are not evaluated or studied to
improve the field
Marketing and distribution needs to be planned for
from the beginning
Gamification can be a positive way to supplement and
work with games to sustain behavior
Let’s work together for continued success!

32. Thank you!
E-mail: pamela.kato@yahoo.com
Twitter: @pamkato
Blog: pamkato.wordpress.com