On the sidelines of the Games for Health event in Boston this week, Dr. Mark Sivak, assistant academic specialist at Northeastern University, explained to MobiHealthNews that the conversation around health games has evolved from one focused on novelty to one more concerned with outcomes.

"What we're staring to get into now on the research level is that previously people would ask, 'Okay, prove to us you can make a health game, or an educational game, any kind of game with impact,' and the answer has been yeah, we can do that," Sivak said. "All the researchers have been trying to just make these kinds of games. Now we are at the second stage, now we are proving efficacy."

One panel discussion at the event focused on engagement strategies and breaking through the barrier between the mobile device's screen and healthy actions the player can take in their "real" life.

Panelist Doris Rusch, an assistant professor at DePaul University, suggested one possibly effective gaming tactic was "poking as punishment".

"You try to avoid the pokes," she said. "[In other words] force intrinsic motivation to check-in or do something before the tool yells at you."

Rusch's suggestion, which other panelists built on, is an example of a passive game, one played in the background while the user goes about their daily lives. That's different from, for example, an active game played by swiping at cartoon fruit on an iPad screen.

Panelist Ben Sawyer, event chair and co-founder of games consulting firm Digital Mill, agreed with Rusch that getting people to play a game passively might be a good strategy for healthy games, but designers don't completely understand how to pull that off yet.

During a brief interview at the event, Josh Whitkin, a project lead at Northwest Media, also shared some insights from his research into health games and engagement.

Whitkin argued that some of the most successful game strategies for motivating healthy behavior are ones that closely align the end result of the activity with the goal of the game. So, for example, when trying to encourage someone to wash their hands, Whitkin said a parent might just pay a child to wash his or her hands, or they could create a war between the child and the germs. In both a gaming strategy is in play, but, for one, the reward is much more aligned with the specific activity.

"The essence is the experience itself," Whitkin told MobiHealthNews. "In a shooting game you build that game around the experience of shooting and the mastery of your weapons or exploring a world. Maybe you love being immersed in 18th century gothic empire stories so all of those things are at the core of the experience, the score doesn’t matter."

Still, he agrees some games, such as Zombies, Run!, have successfully aligned their games to the activities that correlate, even if the game and the reward aren't as closely aligned as it could be.

"Gamification would be saying, whoever runs the most gets highest on the leaderboard," Whitkin said. "The activity, the core mechanic, is running, and running is intrinsically fun, so even Zombies, Run! can be seen as a form of gamification. Zombies, Run! is great and will encourage people to run and the game brings a story in, which is a deeper part of a game experience."