Redesigning the Incentive Spirometer through Gamification

Bower, Megan, School of Engineering and Applied Science, University of Virginia
JACQUES, RICHARD, EN-Engineering and Society, University of Virginia
Morikawa, Masahiro, MD-FMED Family Medicine, University of Virginia

My STS research and technical work is intertwined with each other. Both papers draw on the
concept of gamification. My STS work analyzed the complex ethics related to gamification,
while my technical work used gamification to redesign a medical device, the incentive
spirometer. Together, my work aims to understand the impacts of gamification and implement it
in an ethical way.
My STS paper addressed the ethical concerns that arise from implementing gamification
in technology. Gamification is the process of adding game-like elements to non-game
applications. It is used across many industries and is successful at engaging users. The first
ethical concern I explore is the fact that this engagement can be seen as a form of manipulation.
The engaging quality of gamification can lead users to make decisions they would not otherwise
make. This leads me to the conclusion that gamification in its redirection of attention is
manipulation. However, the second ethical concern that is explored is if manipulation is always
unethical. This has a more ambiguous conclusion as I assert that there are ways to have actions
of manipulative quality, such as gamification, which are not entirely unethical. I suggest that the
balance of manipulation and ethics comes through a process of transparency between the
designer and user.
My technical work redesigned the incentive spirometer (IS), a commonly used medical
device. This work was motivated by the lack of patient engagement with the IS. Although it is
commonly prescribed, many patients do not follow through with provider recommendations. The
new design my team and I created uses gamification to motivate patient use. Our design used a
simple gamification of lights that turned on to correspond with use of the device. The device
is visually engaging and makes using the IS more fun. To come to our final design decision, we
iterated designs and interviewed providers. Overall, this project provides a pathway towards a
more patient-centric IS design.
My simultaneous work on both my STS and technical projects helped me to have a
deeper understanding of the impact of my work. Particularly in the design decisions of my
technical work, I worked to consider and balance the ethical implications that any design would
bring. The designs that we proposed to the providers all fit within my concept of ethical
gamification. This is because they were all able to be implemented in a way that allowed for
transparency and user understanding. At the same time, my STS work was highly inspired by the
decision of my technical project to use gamification. Without this method being used in the
technical work, I likely would not have been inspired to dig deeper. In the end, both parts of my
work collaborated with each other to create an impactful project.
My technical work was completed in collaboration with Chioma Illoh and Wendy Lin. Our
advisor was Masahiro Morikawa, MD of the UVA Health Family Medicine Department.

BS (Bachelor of Science)
Incentive Spirometer, Gamification, Respiratory Therapy, Patient Adherence, Medical Device

Bachelor of Science in Biomedical Engineering
Technical Advisor: Masahiro Morikawa, MD
STS Advisor: Richard Jacques, PhD
Technical Team Members: Megan Bower, Chioma Illoh, Wendy Lin

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