title: A virtual reality social connecting space for people living with dementia
Creators: name: Flynn, Aisling
Publisher: name: University of Galway
Year: 2024
Subjects: subject: Health Sciences
subject: Virtual reality
subject: Dementia

description: Introduction People living with dementia often experience a lack of social connectedness, described as the momentary experience of belonging or relatedness to others. This lack of social connectedness can negatively impact the health and wellbeing of people living with dementia, which in turn impacts their ability to live well with the condition. Digital technologies are increasingly being developed and implemented in dementia contexts to address negative social health and wellbeing outcomes and to support social connectedness. One such novel technology is that of virtual reality (VR). However, there is a paucity of research focused on multi-user VR (MUVR) applications designed specifically to support the social connectedness of people living with dementia in the home environment. This thesis aims to address this knowledge gap by designing a MUVR application in partnership with people living with dementia and their support persons to promote or maintain their social connectedness. Methods The thesis comprises eight chapters and five papers which address the overall aim. Papers One and Two present a qualitative evidence synthesis (QES) protocol and report the QES and thematic synthesis findings which explored key stakeholders’ experiences and perceptions of VR. The QES identified the limited VR research to support social health and wellbeing and the lack of MUVR applications designed in partnership with people living with dementia and their support persons. In order to address this deficit, a qualitative participatory action research (PAR) methodology was chosen to inform the design of the MUVR application. PAR involves multiple cycles of planning, acting and observing and reflecting, whereby each cycle builds on the next, making it well suited to iterative technology design research. Four PAR phases and six action research cycles were conducted. These phases involved: capturing people living with dementia and their support persons’ experiences of using a VR technology probe; exploring their experiences of social connectedness and their perceptions of a MUVR application to promote or maintain social connectedness; identifying their MUVR design preferences, and exploring the usability, feasibility and acceptability of the MUVR application and its potential to promote or maintain social connectedness. Data analysis across all PAR phases was guided by Braun and Clarke’s (2019) reflexive thematic analysis. Trustworthiness criteria was also maintained throughout the various PAR phases and cycles, aligned with the principles of credibility, dependability, transferability and confirmability. Findings Overall, the main findings of this thesis denote the potential of a co-designed MUVR application to promote or maintain the social connectedness of people living with dementia and their support persons. Each of the PAR phases denote the invaluable contributions of people living with dementia and their support person to inform MUVR design, bringing their unique expertise by lived experience. Each of the four PAR phases also contribute their own novel findings. The QES (Paper Two) included 15 reports of 14 studies. The thematic synthesis revealed that several factors need to be considered from the initial apprehensions surrounding MUVR use to returning to the ‘real world’ after use. The findings reported that VR was positively perceived by the majority of the people living with dementia. However, despite VR’s ability to enhance social engagement for people living with dementia, most of the studies did not use group-based VR or MUVR applications. Moreover, the VR applications used were not designed specifically to support social connectedness and often lacked the meaningful participation of key stakeholders in the design process. Regarding the four PAR phases, Phase One (Paper Three) reported four main themes relating to the experiences of using the VR technology probe. The findings demonstrated the positive and the multisensory experience afforded by the technology probe for people living with dementia. The VR probe familiarised and introduced people living with dementia and their support persons to the fundamental interactions in single-user VR and identified the need for dedicated support and assistance while people living with dementia engaged with this technology. Phase Two (Paper Four) reported that social connectedness had a broad meaning which spanned personal, community and social domains. Various barriers and facilitators to social connectedness for people living with dementia were identified ranging from personal to environment factors. All people living with dementia and their support persons considered that a bespoke MUVR application would be useful in promoting or maintaining their social connectedness. Phase Three (Chapter Six) described the importance of having an easy-to-use, familiar and adaptive MUVR design to promote or maintain social connectedness. Using the MUVR application with someone they knew, engaging with content that was relatable and having meaningful and familiar activities suited to present and past interests were also important. Design preferences were developed from these findings and were implemented in the MUVR application. Phase Four (Paper Five) reported that people living with dementia and their support persons considered the MUVR application usable, acceptable and feasible for use together in their homes. However, there were several prerequisites to usability, acceptability and feasibility, including support and assistance, adequate set up and reducing controller use. The MUVR application was reported as having the potential to promote or maintain the social connectedness of people living with dementia and their support persons. Despite this, several areas for improvement were identified that need to be addressed in future work. Conclusion This is the first body of work to design a MUVR application for social connectedness in partnership with people living with dementia and their support persons, whereby each PAR phase and cycle built on the next. Underpinned by the application of a robust PAR methodology, driven by the lived experiences of people living with dementia and their support persons from the outset resulted in a MUVR application which has the potential to promote or maintain social connectedness of people living with dementia and their support person, particularly in the home environment. While further refinement of the MUVR application is required, this thesis provides a useful platform to guide future MUVR research in the dementia landscape.