The interview partners
Prof. Dr. Patrick Da-Cruz is Professor of Business Administration and Healthcare Management at the Faculty of Healthcare Management at Neu-Ulm University of Applied Sciences (HNU) and Academic Director of the MBA program Leadership and Management in Healthcare. Before joining the HNU, Mr. Da-Cruz worked for renowned strategy consultancies in the pharmaceutical/healthcare sector and in management positions in companies in the healthcare industry in Germany and abroad.
Rudolf Inderst (Dr. phil. Dr. rer. cult.) is Professor of Game Studies and Game Design at Neu-Ulm University of Applied Sciences. He is the founder and host of the international podcast Game Studies, head of the game culture department at TITEL kulturmagazin and a member of the advisory board for game culture at the German Association of Specialist Journalists (DFJV). His latest publication is the conference contribution “Please Press ‘X’ To Unionize!” Workers' struggles and uprisings in the digital game ecosphere. pp. 125-145. in: Peter Seyferth/ Falko Blumenthal (eds.): Science Fiction and Labor Fiction. Future visions of work and labor struggles. Bielefeld, 2025.
What does “gamification” actually mean?
Prof. Dr. Dr. Rudolf Inderst: “Gamification” generally refers to the targeted use of game elements in non-game contexts with the aim of increasing motivation and influencing behavior. In my opinion, its potential is particularly evident in the healthcare sector, where elements such as progress bars, points systems and reward mechanisms are used to make patients more active participants in their own therapy. Basically, three axes of action of gamification can be distinguished. Firstly, many applications use ludic elements - i.e. typical game structures such as levels, badges or rankings - that provide immediate feedback and make successes visible. Secondly, narrative frameworks are used that transform medical measures into “missions” or “quests”. This transforms daily running training into an exciting adventure, as demonstrated by the Zombies, Run! app, which lets users run through a post-apocalyptic world. Thirdly, psychological reward systems work by tapping into the intrinsic motivation of users - i.e. the feeling of competence, autonomy and social inclusion, as described by Deci and Ryan's self-determination theory.
How can playful elements actually influence the behavior of patients?
Prof. Dr. Dr. Rudolf Inderst: Influencing the behavior of patients through playful elements is based on several psychological principles: Operant conditioning can be seen in apps such as Medisafe, which reinforce medication intake with virtual rewards and can thus significantly increase treatment adherence. Social comparison effects are used in platforms such as MySugr, where diabetics compete with each other in group challenges. The creation of flow states through VR systems such as SnowWorld, which distracts burn victims from their pain through immersive game worlds, is particularly interesting. The identification effect of applications such as Monster Manor, where patients develop a better understanding of their own bodies by caring for a virtual creature, should also not be underestimated.
In which areas of healthcare is gamification currently used most frequently? What developments can be expected in the future?
Prof. Dr. Dr. Rudolf Inderst: Gamification is currently being used in three areas of healthcare in particular. Firstly, in prevention: apps such as Pokémon GO or Yazio motivate people to exercise more or eat more consciously. Secondly, in rehabilitation, for example through the integration of exercise games via Xbox Kinect or Wii Fit into physiotherapy programs (although the use of these programs/platforms already dates back some time). Thirdly, in the area of mental health: applications such as SuperBetter or Happify help users to deal with stress, depression or anxiety by breaking down mental challenges into small, achievable goals. However, the future of gamification lies in the intelligent combination with technologies such as artificial intelligence (AI) and wearables. AI can adapt game progression to health status in real time, while fitness trackers or smartwatches continuously record health data and thus generate individualized challenges. There are probably also blockchain-based system projects that reward therapeutic success with tokenized rewards.
What are the risks or challenges of introducing gamification in the healthcare sector?
Prof. Dr. Dr. Rudolf Inderst: Despite the numerous potentials, there are also risks. A key problem is motivational overdrive: if virtual rewards become more important than actual physical self-awareness, there is a risk that patients will overlook warning signals - for example, ignoring pain just to achieve a goal. Data protection aspects must also be critically scrutinized, as many of these applications process highly sensitive health data. A clear legal framework, transparent data use and technical security standards are needed here; attention must also be paid to the digital divide: Not all groups of patients have equal access to smartphones, wearables or internet connections, which can lead to inequalities in healthcare. Finally, the ethical limits of the gaming metaphor must also be considered: If serious medical interventions or serious diagnoses are “gamed” too much, there is a risk of trivializing or trivializing the real burden for those affected. Vulnerable groups in particular - such as children or people with cognitive impairments - need special protection here!
How could gamification help shape the future of healthcare - also in combination with artificial intelligence or wearables?
Prof. Dr. Dr. Rudolf Inderst: Why do I have the feeling that this answer will still be haunting me in ten years' time? Seriously, a look into the future shows a great opportunity: gamification can make healthcare more human, more motivating and more sustainable - provided it is designed responsibly. Imagine a system that generates a personalized game world based on real-time health data, in which an AI-supported companion embeds the treatment plan in a motivating story. Progress is made visible, setbacks are not punished, but understood and communicated as part of a learning curve. The true value of gamification lies not in the technology itself, but in its ability to transform dry or unpleasant treatment routines into meaningful experiences. It is crucial that game designers, doctors, therapists and ethics experts work together to shape this new form of healthcare communication. Incidentally, the topic of gamification is one that occupies a central position in our BA program in Game Production and Management.
Thank you very much for the interview!
The content and statements presented in the interviews reflect the perspective of the interviewees and do not necessarily reflect the position of the editorial team.
