Implementing Affordable Virtual Reality Interventions for Older Adults in Latin America: A Feasibility Study

Introduction Virtual Reality (VR)-based meditation has shown to help reduce, stress, anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults. Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful adoption and outcomes in different cultures and languages. The availability of affordable hardware and rapidly growing content that can be freely accessed in the public domain raises the possibility of VR being used globally and in a very broad range of settings, including low and middle-income countries. The goal of this study is to describe and highlight some key considerations and challenges when implementing low-cost VR mindfulness interventions with older adults in Quito, Ecuador. Methods We created a guided mindfulness intervention using low-cost VR (smartphones and Destek V5 headsets) for older adults with anxiety in Quito, Ecuador. This project is a collaboration between the Technology and Aging Lab at McLean Hospital and the Universidad San Francisco de Quito in Ecuador. Our goal is to recruit 20 older adults with anxiety from various outpatient settings in Quito. We used the free “Sites in VR” app and selected different nature scenes for each intervention. The intervention consists of a total of 10 sessions each lasting 30 minutes. In each session, we fit participants with the VR headset with a smartphone running the Sites for VR app. The phone, placed in the viewing compartment of the headset, shows a nature scene of the participant's choosing. Once participants have acclimated to the scene and understand how to look around the VR scene (by moving their heads in different directions), we will read a mindfulness script with a guided body scan and instructions to engage participants through experiencing the virtual reality nature scene with all senses. We will assess depression using the Geriatric Depression Scale (GDS), and anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7). In addition, we will also administer the Mindfulness Attention Awareness Scale (MAAS) and the Behavior Activation for Depression scale (BADS). Participants will also complete the Simulator Sickness Questionnaire (SSQ) immediately after each intervention to assess tolerability. We translated all measures into Spanish. The Ecuador team was trained by the McLean Team on the specifications of the intervention, to review the protocol, and to resolve any problems encountered during the administration of the intervention. The mindfulness sessions will be recorded with video and audio for quality control and intervention supervision to ensure that there is consistency in how the intervention is implemented. Results At the time of writing, we have reached 75% of our recruitment goal and anticipate completing data analysis by March 2023. Qualitatively, our intervention revealed barriers to designing scalable VR Spanish language interventions in Latin America. Some of the main difficulties we encountered are described below: (i) There are few virtual reality videos (360° videos) that are available for use with the DesTeK VS VR Headset in Spanish. (ii) It is also challenging to standardize the content of videos (e.g., embedding a standardized Spanish narration to guide the mindfulness practice). We solved this by the utilization of a Spanish translated standardized mindfulness script used in similar interventions in the United States. (iii) We found that majority of the available content is meant for recreational virtual reality and is not suitable for mindfulness. Our decision to use the application Sites in VR remedied this concern, as it provides static 360° images that is suitable for mindfulness. (iv) Not all technology necessary for VR interventions is readily available in Latin America: smartphones sold in Latin America do not always have a gyroscope sensor. (v) The Sites in VR app used for this intervention occasionally spontaneously tilts the VR image, causing disruptions to the intervention. This required another cellphone running the same scene to replace the phone with the glitch. (vi) When recruiting participants, many expressed fears of not knowing how to use the virtual reality equipment. We are actively trying different strategies to manage this anxiety. Conclusions Mindfulness interventions using virtual reality may be an effective way to address stress and mood symptoms in older adults across cultures. However, there are many culture-specific aspects that must be addressed before applying these interventions in different cultures. This study, conducted in Latin America, is an initial step toward the establishment of best practices and standardized low-cost VR mindfulness intervention in older adults, and many aspects addressed here may be generalizable to other cultures, settings, and countries. This research was funded by This work was supported in part by an unrestricted gift from Eric Warren Goldman to the Technology and Aging Lab at McLean Hospital