Level up: light on the legal and ethical aspects of using gamification in mental mhealth apps

Therapeutic help can arrive in different shapes and forms. Thanks to the recent technological advances and creative thinking of health innovators, today, it can even be delivered via gamified mobile applications. This article shed a light on the legal aspects and ethical considerations to be addressed when using gamification in mental mhealth apps.

Level up: light on the legal and ethical aspects of using gamification in mental mhealth apps

Mental Health has been seen as the “cancer of tomorrow”. The pandemic further strengthened the suppressive force turning this prediction into a reality. As for their part, researchers even show that there is an unprecedented increase in stress, anxiety and depression. And in the blink of an eye, tomorrow suddenly became today. 

In the context of mental illness, there is no “risk group” as it can hit us all – our children, co-workers, family members. The damages and consequences are long-term, life-threatening and life-changing. So, not a surprise, among other digital health applications accelerated during the pandemic, a number of mental health applications got their momentum to deliver on their promise: a click away to mental health and well-being. Is the promise delivered? While there is a robust growth of mental mhealth apps offerings, their usage seems to remain inconsistent.

Do people trust mental mhealth apps? Maybe “not”.

Trust is the very first principle that allows for engaging users in sharing enough data so that they can be given help. Yet today, people may be skeptical to engage with an app that keeps track of their mental health data and rightly so. For these apps to work then, trust needs to be won first. Nevertheless, trust itself isn’t enough – people need to put in the work to get better. This requires consistency and the right amount of motivation to do so.

Do people use mental mhealth apps with consistency? Maybe “not”.

Consistency is key for progress. The problem is: keeping users motivated and consistent while being tied up to their homes, forced into quarantine and limited to zero family reunions or social activities is not a piece of cake. To keep them going, you need them to want to engage with your app, just like they would when choosing to play a video game: because it is fun, not seen as an obligation, and it might even fill them with motivation and a positive mindset… 

So what if winning over mental health could become as entertaining as playing a video game? 

Encouraging consistency in using mental mhealth applications through gamification has become a trend among digital health innovators. 

“Games with purpose”: Embedding gamification into mental health applications

Gamification is used as a tool for influencing behavior modification in many health applications. 

Due to the game elements introduced in the app, users are enticed to be more engaged in their own recovery, which makes it a formidable tool against mental health disorders. When used in this context, it can further help the users develop healthy habits that can reduce stress, anxiety or depression, such as exercising regularly or following treatment instructions.

Video game makers have banded together to promote gaming as a healthy means of physical distancing and social connection amid the coronavirus pandemic. 

One of the reasons it has become so popular in mental mhealth apps is that smartphones are excellent delivery vehicles for gamification in healthcare: easy collection of precious personal data like geolocation, inbuilt accelerometers to monitor activity and external sensors that can capture vital signs such as heart rate and blood pressure are just a few to mention.

Hence, not surprisingly, while the pandemic has inflicted income declines on many industries, video games and digital health are not among them. Nowadays, combining the two might even be the best shape for providing help to the ones who need it the most, “stay at home”-compliant. So is it checkmate? Maybe not. One thing is for sure, embedding gamification in mental mhealth apps does not come that easy.

(spoiler alert: privacy is calling!)

Legal aspects and ethical considerations of using gamification in mental health applications

If mental mhealth apps may feel like a funny game to the users, for the one who designs it, the app is nonetheless a digital therapeutic and personal data collecting tool which needs to comply with a number of regulatory requirements.

For personal data collection, privacy and data protection regulations such as the GDPR, CCPA or any relevant national Data Protection Act (DPA) depending on the business and users locations will have to be addressed. As regards to health data, more specific requirements may have to be added to the list, like the HDS Certification required for health data hosting in France. And if the app is recognized as a medical grade solution within the EU, the new EU MDR might even come into play. On a brighter note, if targeting the german market, you might also consider applying for your app to be prescribed as a treatment and reimbursed by insurance companies

Parallel to this, the “influencing the behavior of your users”-part of gamification is not to be taken lightly. Alongside the legal aspects cited above, ethical considerations should be given:

  1. Design for Trust:
    • It’s simple: if your users don’t trust you, they won’t provide you with their most sensitive, personal information about their mental health and state. Neither will they feel comfortable enough to use your app with consistency. You need trust for your app to work, so build your app around it – design it for trust.
    • It is not about turning your dev team into the new lawyers to be. But embedding privacy in all aspects of your mental mhealth app so it is trustworthy, lawful, and so that your users know what it is done with their data at every step of the way.
    • Little tip about that: enhancing trust requires rethinking consent.
  • Avoid Dark Patterns, unless For Good: 
    • Be mindful of the impact you have on users’ choices and their behaviour. While it is one thing to motivate your users through games and a user-friendly interface, it is another to get consent over addiction. Even through games, rightfully ask for consent and don’t let the prospect of a quick profit blind you. 
    • Alas, recent studies show that despite the recent upsurge in privacy and data protection regulations (GDPR, CCPA, PIPEDA…), companies still have a hard time going against their own business interests. So is it game over?
    • Maybe not! Take it to the next level: use Dark Patterns for Good.
  • Digital Ethics
    • Respect the moral principles – don’t take the game too far. While gamification can help, it can also have devastating impacts on users, such as inducing depression and crushing attention span. Be careful not to get carried away while “playing the game” and rely on digital ethics to build “games with purpose”.
    • Establish norms dedicated to ensure that the autonomy and dignity of users is respected. It is not all on your development team to understand what “ethics” and “privacy” means technically. Provide them with the tools to implement it “rightly”.
    • Lastly, allow your users to shape the debate and make informed choices.

#tip: Walk the talk and keep on your promises to build long-term engagement.

Play hard, play fair. Respect the rules with Pryv

Stay focused on your core expertise and value proposition and let us turn compliance into your competitive advantage.

Pryv.io is designed to facilitate developers creating privacy-centric digital health applications. Our Swiss-made Personal Data & Privacy Management Software is a ready-to-use middleware specifically designed for personal data and consent management. It comes with must-have consent and auditing tools to keep you compliant with existing and forthcoming regulations.

Our ultimate purpose is to remove barriers to data-driven healthcare innovation by helping digital health innovators rigorously manage personal data and build effective, lawful, patient-centric applications respectful of privacy and seamless digital experiences, faster, at a lower cost and right the first time.


Stephanie & Evelina

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