Health and medicine

Are our apps manipulating us? How gamification can help, or hinder, our health and wellbeing

It’s fair to say many of us, myself included, could probably take a little better care of ourselves. With levels of sedentary behaviour increasing around Australia (Department of Health 2017), we’re finding it more and more difficult to get active.

I used to be much fitter, but my bike is gathering dust and my running shoes tossed in a corner. So when I decided to start running again and compete in a half-marathon, I wanted to track my progress.

One smart watch and app later, I was ready to see how I was going. But I found that I was becoming motivated by the app itself to improve my performance, through psychological nudges like rewards and ranking against friends.

And then looking at other apps – they did the same. In order to keep me involved on the task, they appeared to be taking cues from games in order to motivate me to perform. This approach even has a name – gamification.

Gamification is defined as the use of game design concepts in non-game contexts (Deterding et al 2011). In essence this means taking inspiration from games – whether video games or otherwise – and applying them in other situations to increase user engagement. And the aim is to encourage us to do something we normally wouldn’t.

The applications are varied – the increased engagement through gamification can be used to assist education and training, innovation, civic engagement, and even self-improvement (Nacke & Deterding 2017).

But, given that these apps are trying to encourage us to do something we might not normally do, are they in fact manipulating us?

Gamification brings games into other contexts

The so-called “holy trinity” of gamification elements are points, leaderboards, and levels (Nacke & Deterding 2017). However, there are other elements which are typical of gamification, such as quests – challenges that a user must complete, badges – visual rewards for achievement, and progress bars – depicting progression (Sailer 2013). And like games, these elements are usually wrapped together with a narrative which links the elements together (Sailer 2013, Deterding et al 2011).

These concepts play on, and arguably distil into, three human behavioural motivators. Afterall, to change someone’s behaviour requires motivation (such as what I needed to keep running), and Sebastian Deterding has identified three factors which make gamification “meaningful” and motivating (Meaningful Play, 2011). These are Purpose, Mastery, and Autonomy.

The purpose entails the narrative and goal-setting within an app and how it fits a users interests externally, while mastery involves the skill development and progression required to achieve rewards. The autonomy comes from being free to play when, where and how the user wishes. Together, these three elements create a gamified situation which is meaningful and motivating for users (Meaningful Play 2011).

These outcomes generally make us feel positive about our experience and increases our feeling of self-actualisation and achievement. And that motivation helps keep us on track with our task (running, cleaning dishes, or anything else).

In many ways, this manipulation of our motivation is beneficial. A plethora of apps which use gamification to try to improve health and wellbeing of users have emerged onto the market. There are countless apps including major players like Garmin and Fitbit which motivate players to increase physical activity, while others like SuperBetter are targeted at mental health.

And it really does make a difference. In a review of 19 individual studies into gamified health and wellbeing apps, researchers found nearly 60% of the studies showed gamified apps had positive effects on participants (Johnson 2016).

How do these apps work in practice? I looked at my running app “Garmin Connect” to see how successfully it applied gamification concepts to increase engagement with fitness:

This all sounds very positive – gamification can increase our motivation to make changes that we normally may struggle to – whether it’s getting fit or making changes to habits. However the same techniques can be used, and are used, for marketing purposes.

Fast food companies are just one proponent of using digital media and gamification – McDonald’s long-running “Monopoly” promotion recently moved into app form, while Hungry Jack’s have used a “Shake and Win” app as a way of engaging customers (Lynchy 2012).

When gamification takes its toll

There is also a second form of motivators used. Quests, leaderboards and other factors all encourage mastery and competition, but at the root of it all is the autonomy. But there is some gamification which instead seeks to remove that autonomy, increase stress amongst users, and build a feeling of pressure and fear of punishment.

These tactics, sometimes called black hat gamification, use countdown timers, as one example, to create a feeling of scarcity and pressure to act, and feeds a fear of loss. Loot boxes that require fast action from users to acquire also act in the same way. And their use can start to get ethically dubious, especially as those pressure tactics burn people out, build the feeling of manipulation, and affect physical and mental health (Chou 2019).

Black hat gamification tactics can increase stress and affect wellbeing. Emotional Signs Of Stress by Maheen Fatima (CC PDM 1.0)

Indeed, Yu-kai Chou (2019, p.374) has identified that these techniques make people feel obsessed and addicted to the stimulus. However, while apps that use black hat gamification may go viral and explode in popularity, their lifespan is very short before users drop out of using it. This is due, he suggests, to the psychological toll removing he fun element, leaving players feeling demoralised and leaving the game to try to rediscover joy elsewhere (Chou 2019, p.372). In the end, people will ultimately feel manipulated and come to resent the brand itself (Hertel and Chou 2019).

This is not to say that black hat gamification does not have a place. While white hat techniques create a feeling of wellbeing and satisfaction, they do not create a sense of urgency. Indeed, used sparingly or without abuse, black hat tactics can support white hat tactics, such as a countdown timer within a larger white-hat narrative.

The power lays in creating a sense of urgency that white hat tactics alone cannot (Chou 2019, p.374), which could explain why it is often seen within marketing strategies. Hungry Jack’s Shake to Win app, for example, offers users product promotions, however only if they reach a store within 20 minutes (Lynchy 2012). This inducement to action and extrinsic reward may encourage customers to stores, however undermines the ‘Autonomy’ aspect discussed earlier (Meaningful Play 2011).

As gamification is motivating us, positively or negatively, to make behavioural changes we may not have otherwise, it is indeed manipulating us. The tactics speak to us on a psychological level to increase engagement and, in some cases, translate into real-world action. So we are in fact being manipulated by our apps.

Recognising the tactics used and the effects they have on us, could mean we have the opportunity to reclaim that autonomy in cases where it has been exploited. While gamification can be incredibly powerful for motivating behaviour, retaining autonomy ensures we retain control of our wellbeing.


Chou Y-K 2019, Actionable Gamification: Beyond Points, Badges, and Leaderboards, Packt Publishing, Birmingham, UK.

Department of Health 2017, ‘Physical Activity and Sedentary Behaviour Research and Statistics’, Australian Government Department of Health, 21 November, retrieved 28 May 2020 <>

Deterding S, Dixon D, Khaled R & Nacke L 2011, ‘From Game Design Elements to Gamefulness: Defining Gamification’, MindTrek ’11 Proceedings of the 15th International Academic MindTrek Conference: Envisioning Future Media Environments, pp.9-15.

Hertel A & Chou Y-K 2019, ‘Gamification is going to get stronger — but for good or evil?’, Venturebeat, 17 January, retrieved 24 May 2020 <>

Johnson D, Deterding S, Kuhn K-A, Staneva A, Stoyanov S, Hides L 2016, ‘Gamification for health and wellbeing: A systematic review of the literature’, Internet Interventions, Vol.6, pp. 89–106. doi:10.1016/j.invent.2016.10.002

Lynchy 2012, ‘Australian mobile rewards first for Hungry Jack’s fast food app via Clemenger BBDO Sydney’, Campaign Brief, 18 May, retrieved 24 May 2020 <>

Meaningful Play: Getting Gamification Right 2011, YouTube, GoogleTechTalks, 18 February, retrieved 26 April 2020 <>

Nacke, LE & Deterding S 2017, ‘The maturing of gamification research’, Computers in Human Behavior, Vol. 71, pp. 450-454. doi:10.1016/j.chb.2016.11.062

Sailer M, Hense J, Mandl H & Klevers M 2013, ‘Psychological Perspectives on Motivation through Gamification’, Interaction Design and Architecture(s) Journal, no. 19, pp. 28-37.

Additional video reference

Pink D 2009, ‘Drive: The surprising truth about what motivates us’, Riverhead, New York USA.

Additional video

Google Earth Studio

Power KOM attempt by Mendip Cycling Club (CC BY)

Sound credits

One and Only by Yung Kartz (CC BY-NC-ND 4.0)

Run Come by Shaolin Dub (CC BY-NC-ND 4.0)