Are you passionate about harnessing the power of games to drive real-world health outcomes? Do you want to learn from someone who’s designed interventions for UNICEF, the Red Cross, and the World Bank—and who’s just as comfortable building physical games in rural Ghana as he is leading digital projects for cutting-edge therapeutics? Then this Series 3 Episode 7 of Health Points with Sam Liberty is your essential listen.
Meet Sam Liberty: A Global Leader in Health Gamification
Sam Liberty isn’t just a consultant in applied game design; he’s a pioneer who’s shaped health gamification projects across continents and cultures. From teaching at Northeastern University to delivering keynote addresses at major conferences, Sam’s experience spans hands-on fieldwork, academic rigor, and high-impact consulting for organizations like Click Therapeutics and Sidekick Health.
What Makes This Episode Stand Out?
1. Real-World Impact, Measured Results
Sam shares the inside story of a UNICEF project in Ghana, where culturally-tailored physical games were used to promote handwashing among schoolchildren. The result? Not just increased awareness, but a measurable 8.5% drop in self-reported stomach illnesses. This is a testament to the power of well-designed, context-sensitive interventions.
2. The Power of Co-Design and Cultural Context
You’ll hear how Sam’s approach goes far beyond “fun for fun’s sake.” He dives into the importance of co-designing with local stakeholders, understanding cultural definitions of play, and adapting mechanics to fit the audience and not just the platform. Whether you’re designing for digital or physical environments, Sam’s stories illustrate why context is king.
3. Evidence-Based Practice and Multidisciplinary Teams
Sam is candid about the need for rigorous evidence and collaboration. He explains how every successful project is built with input from medical experts, psychologists, and community leaders. You’ll learn why multidisciplinary teams, and robust stakeholder engagement, are non-negotiable for lasting impact.
4. Lessons from Failure: What Not to Do
It’s not all success stories. Sam shares a candid case study where a well-intentioned game failed to change behavior, despite being fun and meaningful. The takeaway? Effective gamification isn’t just about clever mechanics or elegant design. It’s about aligning game rewards with the behaviours you want to see in the real world.
5. The Future of Health Gamification: Personalization and AI
Looking ahead, Sam predicts a future where AI-driven personalization will match players with the games that best suit their needs and preferences. He highlights innovative platforms like Better Place Studio’s “cosy games,” which focus on making people feel good, not just “tricking” them into therapy.
What Will You Learn?
- How to design health games that are culturally relevant and contextually effective
- The critical role of co-design and stakeholder workshops in building interventions that last
- Why evidence-based frameworks and multidisciplinary teams are essential for success
- Common pitfalls in health gamification and how to avoid them
- The emerging role of AI and personalization in the next generation of health games
Why Should You Be Excited?
If you’re a health or gamification professional looking to move beyond theory and into practice, this episode is packed with actionable insights. Sam’s stories will inspire you to rethink your approach, challenge your assumptions, and embrace the complexity of designing for real-world behavior change.
Whether you’re working on digital therapeutics, public health campaigns, or grassroots interventions, you’ll come away with fresh ideas and proven strategies to make your next project more impactful.
🎧 Tune in now to discover the life-saving secrets behind successful health gamification and take your own projects to the next level!
You can listen to this episode below:
Episode Transcript:
Ben
Hi everyone and welcome to another episode of health points where we talk about anything and everything gamification and health and today we have with us Sam liberty. Who was a consultant in applied game design and an expert in gamification design for health clients include click therapeutics UNICEF international Red Cross and the World Bank? Some teachers gained design at northeastern university in Boston and is the former lead game designer at sidekick health he also gave a fantastic keynote on games for health the life saving secrets that make them work at Pete's recent gamification Europe conference in London Sam it's fantastic to have you on the show today.
Sam
Really glad to be here.
Ben
Right we've got a lot to squeeze into this episode so can we start with your background and how you got into. Game design yeah well I'll try to.
Sam
I'll. Squeeze it. So in another life I was a advertising copywriter in Boston and I didn't really like it but what I did like to do was was design games and make them so I was kind of doing that in all my free time eventually I got enough success kind of like the hobby game circuit that I decided to make the switch from full time. Advertising to full time games and ended up at a place called the engagement lab at Emerson College which back then was called the engagement game lab but they were an applied research lab using games for civic engagement from there I ended up doing a lot of work for international clients like the like the Red Cross the world. Bank and so on uh building games as behavioural health interventions and and other and other means.
Ben
That was really well. Right in that case what got you into designing serious games for health.
Sam
So I don't think I ever set out to be the healthcare game design guy or the healthcare gamification guy more I just wanted to use my skills to help people to build things that actually made people 's lives materially better and kind of looking for the opportunities to do that and when they started coming first at the engagement lab then as a consultant. Minute sidekick and and now the opportunities that seem to come up the most is healthcare and I think the reason for that is that one of the things that games are really good at is influencing. Behaviour and creating behaviour change and when you look at all of the problems that face people day-to-day the ones that can be the most immediately solved through behaviour change are health and the industry with the with the biggest behavioural problems is probably healthcare so I'm just kind of pulled in that direction. I'm I'm happy to fill that that niche because like I said you're talking about people 's health their lives it can actually giving them longer lives more quality years I think that's one of the most meaningful.
Ben
Things you can do and so from a passion and drive to lead you into health gamification. Do you want to talk through some of the projects you've worked on let's start with your work with UNICEF promoting hand washing with soap?
Sam
Sure so this is one of my favourite projects to talk about because we were actually able to do the measurement on it in a separate grant and I'll talk about that but this was a a project that we did in Ghana the players were good in school children that were learning about hand washing with soap. I think what was striking about it is what we learned during the code design process because you think OK well everyone knows about hand washing here in US it's part of our culture and hand wash before you eat it and all of that but gonna it wasn't and even though when you talk about it with them like they know that you should and they know the reasons why. Like these school kids could tell you what a germ is and how they make you sick and every. From kids to adults people don't do it and unfortunately a lot of people die around the world they achieve because of this especially young children so we started to investigate well why is this happening and the the cultural and institutional reasons and we started by workshopping with them and trying. To figure out. Kind of like the myriad problem. And we brought together all these different stakeholders in this workshop and have asked how you see the problem and you might have a teacher that says we don't have the right curriculum to teach this you might have a water and sanitation expert that is saying that we don't have enough hand washing stations or a parent might say that they can't afford. Hope and all of these are true and part of the problem but together they build kind of a larger problem. UM. Then from there we started talking to them about OK well we know what the problem is well what is a game what is play and that seems like kind of an academic question and to most people it is but for everyday people it's actually a practical question. Because when we asked them. Show us your games they would do things that actually really surprised us so they would sing or dance or act things that an academic in Boston or a game design formalist might not recognise as a game. And this was a wake up call to me because before then I was very focused on like the different parts of the game and how they work together but once we started actually kind of exploring this more it became clear that play is a very personal thing and as a very cultural thing and the games that appeal to some or what people have been thinking as a game. Changed drastically not just from you know Boston to Ghana but from even neighbourhood to neighbourhood right like it's it's a very cultural thing So what is a game and what is the problem. We overlap them. How can that solve it because the game no matter how good it is is never going to build a hand washing station but it can show you when why and how to hand wash with soap so the next time you you know change your little sisters diaper or go to cook or use the toilet you see that bar soap and you actually pick it? Up. And the results I think we're really really promising for this kind of intervention many times these interventions are not measured because people are more concerned with the artefact than with the results and doing a a really thorough evaluation is expensive. But we saw not only in in so we did a group of intervention schools and a group of control schools and we saw that in the intervention schools not only were they more interested in hand washing able to talk about it able to explain it expressing a a intend to do it. There's all good but when you actually looked at the self reported stomach illnesses they dropped by about 8 and a half percent which is a significant change. And as far as I know this intervention is still being used or. Versions. Of it and since then there's been a 1.75% year over year decrease in stomach illness in the region that I cannot take full credit for like other things are happening there. But I think it's it's promising that people are finally finding interventions that.
Pete
Work what do the games look like the song the dance is it one game.
Sam
Yeah there there's 3 games they're part of a a 3 week long curricula. That has kind of a meta game it's called hand washing in the ***** maybe I should have said that at the start about the folk character ***** who is kind of like the spider trickster and in the story he's stolen all the hand washing knowledge and you have to get it back so each week you listen to a story there's different activities and you you play some games. So there's a there's a Y game that teaches about disease spread. There is a a when game where you have to act out different motions and then if it's a one of the key times such as when you're preparing food or after you use the bathroom you have to touch a bar soap either before or after you do it and if it's not a key time you don't touch the soap. And then there's the how game which is a a a stone passing game that selects a boy and a girl to race against each other for their for their team boys versus girl. They have to do the correct hand washing steps in order and will really washing their hands with soap and water and the first person to do it wins and there's a video maybe you can put in the show notes of all this stuff if people are interested but you can see on that how game which I think was the most impactful one when this girl wins the game. You can see her team just explode in excitement this like ecstatic joy over over having this victory. And in my estimation this is what made the intervention successful because it really reinforces the behaviour because when washing your hands feels that good of course the next time you see a bar soap you're.
Ben
Going to pick it up I mean incredible impact especially of those stats so the population health level and just highlights that a lot of the guests we have on health points. Are thinking much more? And changing obesity smoking habits increasing medication use when it comes to public health messaging and just daily activities such as hand washing we often don't we we hardly ever get guests come on about that So what you've just described is is very much a gain in the physical world. UM. What do you see the differences between a digital health gamification and the effort to create that and what are the pros what are the cons between a physical game versus a digital game?
Sam
So each approach has its clear pros and cons in Ghana a digital game was not even an option. Because not only do the children who are in the the target population don't have smartphones often they don't have electricity and sometimes they don't even have running water which shows what what his challenge this was. I did a similar project in in India where we did use smartphones but it was a pass and play because you couldn't rely on everyone have a smartphone and Jamal to do it that time. And then other games that I've done have been fully digital interventions I see the benefit of digital being kind of twofold one is scalability. It's a lot easier to give everybody a download to their smartphone than it is to have everybody come to a place and do a physical activity and I think that's kind of obvious the second benefit to digital is it was on a smartphone that is in your pocket and it's with you 24 hours a day so you can get those triggers. You know those reminders to do what you're supposed to do. That said there are major disadvantages to it as well when you have a physical game you can physically rehearse a behaviour that you need to do in real life. Because most health interventions like most actual changes you need to make to your to your habits are not about touching your phone they're about doing things in the real world. You know you mentioned obesity smoking taking your medication right like these are things that you can't do digitally you have to do with them physically so a physical and intervention makes more sense for that in in many ways because. If you're physically rehearsing it and then getting rewarded for it then it's clear what the relationship? Especially if you're trying to get over a hurdle of some of some habit that's difficult for you to adopt so if I could have everybody in the world practise physical games and scale up that way I would but the next best thing is delivering that digitally with a an evidence based intervention. That actually.
Ben
Works in that case one other thing about your background and being able to explore and deliver of in Health Communications Sam is you've been able to do physical games digital games. Your approach to game design and how you connect game elements together and game mechanics is it ubiquitous across physical to digital or do you have a different approach to game design based on the platform you're using.
Sam
So it is the platform although it's important it's an important design consideration the real consideration is the target audience and the behaviour. So whether I'm designing a digital game or physical game the mechanisms I use will be based on the preferences of the of the user and the theory of change that we're applying so for instance in Ghana. Here's a here's an anecdote. We started with a game to teach uh why to hand wash. And we were using some popular game mechanics about deduction to where you have to guess who started the outbreak. And it was very fun and we played it with school children in Boston it went very well. But in Ghana they don't play those kinds of games deduction and and social deception games so although it was fun in Boston with the same age kids it was not fun in Ghana so we had to change. Right now I'm working on a project for click therapeutics that is an intervention for schizophrenia it's it's a cognitive remediation so we built 2 hyper casual games that are supposed to train cognitive skills and we did extensive UX research on the types of games that people liked we tried our prototypes. To show what people would actually play and what gave them the most delight and interest but like you can make a delightful game that has no effect right. So we needed to make games based on proven scientific cognitive training right because a lot of these I mean people your listeners I'm sure I've heard news reports about certain brain training games that actually don't work right they're not evidence based and once you test them they do nothing so people might have the impression that. This approach doesn't work but it can work if it's based on evidence based interventions.
Ben
In that case where does your evidence base come from where is your repository of evidence when you're designing these games.
Sam
So I never built them by myself I always have experts that are consulting with me the doctors psychologists advocates medical organisations I am not an expert in healthcare I'm not an expert in mental health I'm not an expert. And disease spread epidemiology. What I'm an expert in is? Is applied games so it really takes a team to to build these things together and like obviously I've learned a lot about behaviour change and medicine that through my work but I would always bring in experts that can do the the hard research and and turn out the evidence?
Ben
Take into account there. Yeah a wider team around you do you have a particular approach methodology that you you employ when designing these games regardless of the type of game of the population there was a steadfast way you approach game design.
Sam
So yes there is. I talked about the workshopping we did in Ghana that was really the first time I worked in that way and it was so impactful that I've I've copied it and adapted it every time since but I think it's important to point out that you you can workshop with the with stakeholders right the population and and the different experts in the. Field. But you can also workshop with your. Team and that team includes you know the designers the medical experts the the product managers you know all these people but it also includes your your stakeholder or leaders and champions and your partner organisations whether it's private public or or NGO. And doing this achieves a few things so first it does turn up the data you need to design first and foremost second. It aligns the team everyone is on the same page because we were all in the same workshop together we all feel ownership over this and it builds what I call the working group of people that can test and advise if they were involved in the start of it they are much more likely to want to weigh in. In the middle and end. And the 3rd is it builds reliability in your with your partners and your team and by that I mean. If I have one champion at an organisation who believes in this that is a good thing and that's what you need to to start getting it done but what happens when that person ends up switching departments or switching jobs? What how will I trust that this intervention can still be used 5 or 10 years from now or even next year? Unless you've built a robust network of champions across different parts of the organisation the game becomes what I've started to call a shoebox game a game that's design showed off and then put on a shoebox and shelved right which if you're a designer out there listening to this like this is probably. A familiar experience to you. So. This workshop based approach and this working group approach is a is a real solution and the only solution I found to the the shoebox game problem.
Ben
So alongside frameworks that you employ are there any particular learnings you've had over the past years of things that pitfalls things that game design should be actively avoiding or mistakes you've made that you'd like to share.
Sam
Yeah so the biggest ones are. Designing for your ego instead of for the user because game designers a lot of the times think ourselves as like artists and creatives which which we are we know what's fun and we know what's good game design and we know what's an elegant design and like something we're proud of we're clever or whatever but like just because you're proud of it and it's clever it doesn't mean that it's an effective intervention. And just because it's very fun it doesn't mean that it's an effective intervention. And just because it's fun to you doesn't mean it's going to be fun to somebody else so you really need to listen to your users and let them design as well and take their feedback and make sure that you're building something that will be effective and and actually used. Because like the most having like a beautiful game to show off to other people like might feel good but I'd rather have an ugly game that worked than a beautiful game that that somebody else liked but. And then you know I talked about the the working group and and stakeholder engagement and things like that and I've definitely had problems early on in my career where the game is designed in good faith with stakeholders and it's been effective and and enjoyable but then decision makers. Shut it down because it doesn't build them. And this could be because the science doesn't totally align or it could be because the politics don't totally align or it could just be because this this decision maker just never didn't feel consulted. And of course if they weren't consulted then it can't be good right so. By bringing in identifying the people who can get green light the thing and predicting those snags up ahead and bring those people on early. You really really solve a like a massive gap that could cause the game to totally derail.
Ben
I guess so often talk to guests about game design and kind of what are those principles what are those methodologies but ultimately designing a game is the same as designing anything a building a boat. Advertising campaign you need to have a good team with aligned goals agreed definitions of what you're working towards get the right stakeholders champions people who need to be give the thumbs ups and. Green light you can be the best design in the world but without all the other elements that make the machine and engine tick over there is no game to produce we don't talk about that anywhere near enough on health points that having the right team the right people the right organisations customers clients partners is a hugely core. Great game design. Are there ever kind of techniques out there that you've seen recently within game design or even health gamification or serious games apps services products that you'd like to share?
Sam
Yeah if I could call out the folks at better place studio what I like to so they have developed a platform called cosy that is supposed to host cosy games. These are not digital therapies but they're kind of games that just make people feel good and what I like about their approach is. Is so many so much of digital healthcare or game of God Healthcare is ways of tricking people into doing therapies right I mean maybe that might be a brutal way of of putting it but like the idea is people need to do this this this here's a game that will help them or make them? Do this this this? Whereas better play comes from a different approach which is what if play just makes us feel better what if games are just good for our mental health for because they're games right and because they're the right kind of games for the. Right. People and where their evidence based approach comes in is they're they're developing a matching. System that connects people to the games that suit them. Because they don't want to say oh this is this is the game that that makes you feel better we've made it here it is play it you will feel better instead they want to have a wide variety of different games with different mechanisms and and tones that all are about these stressing and making yourself feel better and letting people find it through. Through a matching system. So as far as I know no one else is doing something like this right now so check them out.
Ben
We definitely use the term there's so much around personalised health and personalised prescriptions and medication and I think personalised gamification is where the industry needs to move to rather than saying this is the game to make you better to look at well you as an individual what are the game mechanics and what the player. Types which most that best apply to you and now you have the options to pick the one that works I think yeah what Cody games are doing is a fantastic approach. Are there any other projects you've worked on or you've been involved in that you'd like to highlight or talk about?
Sam
Let's see. Can I give a a negative case study for you that might actually highlight highlight some of the?
Speaker
Sorry.
Sam
The game design techniques that you're kind of getting at so not long after the gunner project I did another project that I used the. Same methodology for. And this was in a intervention at the college level to help college students. Get over a mental block called homophily which is the desire to be with people that are like. You. And this was basically a. You call it a DIY project or a a diversity project. But we wanted a colleague of mine had done research in the film industry showing how it's very hard for people in our groups to break in and obviously this is a this is a. Industry dominated by men and dominated by white men in particular the game industry is is similar. And there is all these economic reasons and. Reasons of bias that makes it hard to break in so we we wanted to develop a methodology sorry we wanted to develop a game that could teach about this and help build new behaviours so we spent a long time workshopping it designing it doing all of the things that I just told you that I do. To make the game work. And we. Played it with large groups and orientations and everybody loved it and everybody understood the meaning behind it and could explain the meaning behind it perfectly. It was great fun. Then a couple years later we got the opportunity to run it in northeastern where I now teach and actually do the measurements and when we did the measurements we found that although the game. Was fun and people understood its meaning they did not change their behaviours attitudes or beliefs in any way? Well why was that and. We came up with different theories but kind of looking back on what I've learned since about behaviour change and persuasion the problem was that the game that we designed was a replication of the problems in our real world systems and by experiencing those problems we believe that they would become manifest. The player. Others who would then understand them and act on them and the the problems did become manifest and clear but they did not change their behaviours or beliefs because it was just reinscribes ING something negative and when you looked back at like how do you win this game will you win this game. By doing the things that we want you. To stop doing. Right. So if your listeners are familiar with like bogos procedural rhetoric like it's a game that makes an argument through its rules and this is what we did but this is not this is a theoretical framework that has no evidence behind it right. Whereas when we use theoretical framework or practical frameworks with evidence behind them you see the effect right so if I was redesigning the game now I would completely switch it to be a game that rewards you for finding people that are different and connecting with them.
Pete
That's great I I what a good learning. UM look So what are you working on now and what are you doing differently this time.
Sam
So right now I'm working on a project at click therapeutics this is what I'm really really excited about they have a they have a great team and they're producing good software. And good games so there are 2 hyper casual games each one is a cognitive remediation. Trainer because people with schizophrenia lose certain cognitive skills like working memory and planning and even after they receive treatment get on medication and their symptoms go away they don't regain those cognitive skills. So they they need. Help building them back the problem is the cognitive remediations that are practised in the medical field are very boring and and fruit. Freedom. And if it's hard to get people to stick to them so we have a theory of the case that we can use games to get people to perform the cognitive remediations over the. Over the appropriate period so they've developed a 16 week programme that uses games and other interventions. To get people to to actually practise these things. We've also totally revamped the overall reward system that your listeners probably would instantly recognise as as gamification that's what it is right giving awarding points those points unlock things there are. A separate batching system that are tied. To real-world skills. That are very very meaningful and and are tied to growth so we're doing all these other things to to really drive engagement and retention to this I don't know if I mentioned that it's. Part of our randomised. Control trial and it's really important that people stick to the end of it so you can generate the right data so. This is another situation where I'm glad they were measuring and I hope soon I'll have some some hard results that I can share with you the next time we talk.
Ben
In that case Sam what do you think the future looks like for health gamification or serious games for health.
Sam
Yeah that's a really good question I think in the immediate future it's going to be very rocky because people are are just trying things and and seeing if they work. There is going to be successes and failures we've seen some major companies close in the last few years and other companies downsize in the last few years. The fact that digital therapeutics needs to be regulation compliant and normally are sponsored by a insurance company or a pharma company puts a lot of constraints over what can be designed because these large organisations are very risk averse so I think for anyone that's in this field. They know how tough it is and. That. There are many many snags and pitfalls however I think that people are finally learning what works and we're about to see a lot of big successes as well and I'm bullish on on it as a whole but in terms of like what will these interventions look like. I think AI is going to be huge in how these work delivering AI chat partners to users. Who they can talk to and talk things through and get advice characters that might make people interested in in a story because a lot of people are excited about storytelling and narrative but less excited about earning a point right? So I think this is a this is a technology that has a lot of potential obviously a fraught one as well with a lot of potential problems but. If if people can crack this case and figure out how to do it safely and ethically I think we're going to see AI agents in the majority of of health apps?
Ben
Incredible future thinking there Sam it's been great to have you on the show today to talk about games being the secret ingredient in behaviour change needed to influence positive health activities choices behaviours and lifestyles and that games are cultural and contextually relate. And thinking of global health is essential that Co designers integrated into serious game design for regional and local populations cultural linguistic contextual and digital accessibility needs and the key importance in game design is understanding the population you're designing a game for and the behaviour. We're aiming to create because pretty games and fun games don't necessarily result in changes in behaviours and resulting any positive changes in health Sam has been great to have you on today.
Pete
It's been fantastic having you on here.
Sam
Sam thanks for having me it was a great conversation.