Gamification Comes Second

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Stack Overflow celebrated its fifth anniversary earlier this week. For those who don’t know, Stack Overflow is an incredibly popular Q&A site for programmers. Over the past five years, the site has grown into a brand name for most software developers, and in the process it has compiled a valuable, huge, user-curated, and up-to-date data store related to programming.

What’s more important than being a brand name is that Stack Overflow is almost always at the top of Google searches for programming-related questions. This is brilliant because the site, just by virtue of the service and the continually updated data, continues to improve its search engine rankings. People are asking and answering questions in the same way others are searching Google, so the match is close and the site is always near the top of the results. Come to think of it, I don’t think I’ve ever searched on Stack Overflow, I think I always get there through general Google searches.

If you think about it, it’s easy to see why a Q&A site like HealthTap holds potential for healthcare searching on the Internet. Tons of people are looking for the same health information and asking the same health questions on Google. People are very likely using the same search terms, so HealthTap will continue to move up in the rankings assuming people continue to use it. I do think there is great potential for a healthcare version of Stack Overflow and HealthTap may be it, but Medicine is also a potential new site on the same tech engine as Stack Overflow. I think this type of site makes sense for both providers and for patients.

The other really interesting thing about Stack Overflow is the points and privileges system. Users get points on Stack Overflow for getting questions and answers voted up. This is really very cool. Users don’t simply get points for contributing. Users get points and grow their reputation in the community when other community members and peers vote contributions up. I love this system. It means it takes considerable time and effort to get points because responses and questions have to be relevant to the community.

People care about points because of reputation, but there are other reasons Stack Overflow users want to accrue points. Stack Overflow has different types of privileges based on the points a user has earned. Here’s a list.

Between the points and the privileges, this is a great form of gamification. It definitely works to encourage people to keep contributing. That’s why I found the blog post about the fifth anniversary of the site fascinating. One of the main points in the blog post is that gamification doesn’t work unless people are already motivated to do something. "In the history of the world, gamification has never gotten a single person do anything they didn’t already basically like to do."

In other words, gamification doesn’t motivate people to do things they don’t already want to do. It’s powerful at getting people to do more of something in which they see some value. That’s how it works on sites like Stack Overflow. I assume it would provide similar motivation on sites like PatientsLikeMe and Chronology. It’s also similar to HealthTap, and Dr. Gregg wrote a really interesting post earlier this week about doctor rankings on HealthTap. The post was about a new competition HealthTap was having to try to encourages physicians to contribute on HealthTap.

People are generally motivated to contribute to the overall knowledge and well-being of the communities of their peers — Stack Overflow, PatientsLikeMe, Quora, HackerNews, etc. But there’s a major limitation with gamification, or at least the founders of Stack Overflow think there is. I agree that gamification doesn’t motivate people to do something they aren’t already interested in doing. What do you think?

This has clear ramifications for healthcare, more on the patient side than the provider side. I still really think Q&A sites for clinicians haven’t tipped yet. I think we’ve shown that many people, especially chronic disease sufferers, are not inherently interested in using apps for their health or in tracking metrics related to their conditions. If that motivation existed even a little bit, then gamification would be a powerful tool to drive up engagement and usage metrics for digital health services.

The obstacle then is finding things that people are interested in when it comes to health. Of course there is tracking, but not everybody is into tracking _________.  There are Q&A and patient communities, but those work better for conditions like ALS and IBS than for diabetes and hypertension. Proactive messaging is probably a pretty good start if it’s personal and has the potential for two-way. On the employer side, companies like Keas and RedBrick use combinations of tech and personal interactions to boost interest. These are broad buckets, but the point is more that there isn’t a silver bullet.

What is left to motivate people to start using a digital health app or service is financial incentive. To participate in certain apps or programs or to record weight, for example. With financial incentives, it could either be carrot or stick. But after being financially coerced into using something, would gamification motivate people to keep using it, or increase their use of it? I like financial carrots and sticks in healthcare and I think we’ll see them used more and more, so I wonder how gamification fits.

Is gamification a secondary issue, one that only becomes relevant once we build health technology that people have an interest in using?


Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Those folks at Health Tap marketed me in very immature way, and I realize they also bought AVVO, one of those error filled MD rating and directory sites, I blogged that one after a couple posts on the dead doctors referenced on AVVO and they were not alone. Health Tap bugged me over and over to please put their widget on my blog and I said I offer advertising but was told they are a start up and are too poor to have money to do that:) Even after that I still got bugged trying to sell me on the value of Health Tap for all my readers to see. Looks like de-identifed data sales here and privacy page that is way too complex. If a start up is that cheap to spend a little tiny bit on advertising, well…they don’t realize that bloggers help them, so I going in the other direction with this one.

  • Michael Fergusson

    Hi Travis. I had to chuckle reading the Stack Overflow post. I assume the person who wrote the sentence “In the history of the world, gamification has never gotten a single person do anything they didn’t already basically like to do” isn’t a parent.

    In all seriousness, this analysis of gamification that doesn’t stand up to even rudimentary scrutiny. For example (and just off the top of my head), this morning I rewarded my children for completing their chores with stickers on their “chore chart”. Presumably, nobody is claiming that everybody really, in their hearts, actually wants to do their chores. Parenting jokes aside, chores are defined as “dull, unpleasant, routine tasks”; chores are things you do *despite not wanting to do them*. Yes, you can get satisfaction from doing chores, but that satisfaction is precisely the gamification effect – contextualizing the thing you do not want to do in such a way as to make it part of something that you do want to do.

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