If something is fun and engaging, we’re more likely to do it again, and again, and again – until it becomes a habit, for better or worse. Let’s focus on the better, shall we? Public health experts have long known this, and decades of interventions, studies, and theories show that making healthier choices easier – and even fun – can be an interesting ally in promoting health and well-being within communities. 

In fact, when people enjoy an experience, they’re more motivated to repeat it, and motivation is crucial for sponsor and maintain a behavior change. This is especially important when the goal is to maintain a healthy lifestyle in a long-term. 

Nudging 

Early in my academic journey, I came across the term “nudging”, which is a strategy commonly used in health promotion and prevention. Nudging in public healhthealth, involves giving people a gentle push towards healthier options, consciously or unconsciously. 

For example, placing fruits and vegetables at eye level or at the entrance in supermarkets. Making them more visible, encourages their purchase. Similarly, designing buildings so that stairs are more vidiblevisible and accessible than elevators promotes physical activity. Even reminders for health check-ups that highlight where to get the check-up, rather than just merely reminding people to book one, can be an effective nudge. Lastly, financial incentives to access a health check-up or treatment, go under the nudging strategy. 

Going back to fun example, one very famous one is the “piano stairs” installation at Odenplan station in Stockholm back in 2009. The stairs at the entrance of this station were transformed into a giant playable piano, where each step was a key piano with a sound, giving commuters the choice between a fun musical experience or the usual escalator. Not surprisingly, more people than usual, chose the stairs. Why? Because it was fun! The playful intervention was replicated in other cities worldwide. 

Gamification  

The piano-stairs example as nudging, also overlaps with another powerful approach: gamification. Gamification uses game-like elements, such as rewards and challenges, in usually non-game contexts. In public health, it’s more often used to encourage physical activity but has also been applied in nutrition, stroke rehabilitation, and more. 

For example, many eHealth and mHealth solutions (you can read more about these here) incorporate gaming features. Apps that reward users with points for taking a walk, or smartwatches that send supportive messages for reaching the users’ daily goals, are just a couple of common examples. By useingusing our love for rewards and competition, gamification makes healthy behaviors more engaging and enjoyable. 

The pros and cons 

These strategies have their advantages. They’re attractive, engaging, and can motivate healthier choices, or reminding them. In some cases, they’re also cost-effective, reaching a population with minimal resources. For example, making stairs visually appealing, even just by painting them with an attractive color, can be a cheap solution for municipalities when improving public areas or for private companies (please note: this should not be the solelysole solution). Moreover, fitness apps can often be an alternative cost-effective solution for people that cannot afford a membership to a gym, or live too far from one. 

These strategies have the ambition and potential to prevent the early onset of disease that are influenced by our lifestyle, such as cardiovascular disease. By promoting physical activity and healthy eating, they help reduce risk factors like obesity, high blood pressure, and high cholesterol, ultimately easing the burden on healthcare systems and improving quality of life in the long run. 

However, as with any intervention, there are some limitations and potential risks to keep in mind. Not all nudging or gamification strategies work across all cultures or communities. What is seeing to work in one country might not work in another due to cultural differences, healthcare trust, or just by chance, to name some. 

Social inequalities should be taken into account when designing health interventions, including those that use nudging and gamification approaches. 

If these strategies rely solely on technology, we might not reach everyone in society, including those who woouldwould benefit health intervention the most. InfactIn fact, not everyone has access to smartphones, smartwatches, or to a reliable internet connection. Additionally, apps focusing on diet and physical activity could inadvertently trigger unhealthy behaviors in individuals with a history of eating disorders or contribute to the development of new cases. 

This is why careful design and implementation are crucial, as well follow-up studies on their efficacy, should be prioritised. Every strategy should be weighed for its potential benefits and risks, and proper regulatory oversight can ensure safe and effective health outcomes. 

This is a complex topic that touch upon social behaviour, psychological mechanisms and many other areas – we could talk about it for hours! But I don’t want to take the fun out of it, so I’ll stop here. 😉 

Have you heard about nudging and gamification before? What do you think about their application in health promotion and prevention? I hope this article has given you some food for thought. 

See you in the next article on the Saichologist blog.  

Author: Carmela Basanisi 

References and sources 

• Gamification - Wikipedia 

• What is Gamification? 10 Engaging Examples and How It's Changing the World [2024] 🕹️ - Gamification Hub  

• Gamification in Healthcare (usfhealthonline.com) 

• This piano staircase social experiment revealed how music makes everything better - Classic FM  

• Hospital installs ‘piano staircase’ to boost exercise - Classic FM  

• Piano Stairs - A New Reason for Choosing Staircases | Actipedia  

• Johnson et al., 2016. Gamification for health and wellbeing: A systematic review of the literature. Internet Interventions. 10.1016/j.invent.2016.10.002  

• Murayama H, et al., 2023. Applying Nudge to Public Health Policy: Practical Examples and Tips for Designing Nudge Interventions. Int J Environ Res Public Health. doi: 10.3390/ijerph20053962. 

• Visek AJ, et al., 2015. The fun integration theory: toward sustaining children and adolescents sport participation. J Phys Act Health. doi: 10.1123/jpah.2013-0180.