Interactive Virtual Environment for Diabetes Self-Management

Background: Innovative interventions that empower patients in diabetes self-management (DSM) are needed to provide accessible, sustainable, cost-effective patient education and support that surpass current non-interactive interventions. Studies suggest that skills acquired in virtual environments (VEs) transfer to real-world behaviors. A VE is a real-time 3D representation of a setting on a computer. We developed and pilot tested a theoretically grounded VE that facilitates DSM. Our VE offers weekly synchronous DSM education classes, group meetings and social networking in a community where participants practice real world skills such as grocery shopping, exercising, and dining out, allowing for interactive knowledge application. The VE is available 24/7 on the Internet, removing access barriers. Objective: This pilot study was conducted to evaluate the feasibility, usability, and preliminary efficacy of participation in a VE for DSM education and support. Methods: This study utilized a one group, pre-mid-post measure design. At baseline, 3 and 6 months we assessed participant perceived usability and usefulness; self-efficacy; diabetes self-management behaviors; perceived social support and diabetes knowledge using validated survey measures. Metabolic indicators were assessed at these time points from medical records to determine preliminary effects on glycemic control and related clinical factors (HbA1c, BP, BMI). Process data were continuously collected in the VE (voice recordings, text chat, locations visited, objects interacted with, log-ins, movement every 15 seconds); and layered on a case-by-case basis to analyze the preliminary within subject and between subject effects of participation. Results: We have recruited and enrolled 20 racially diverse participants (73% Caucasian; 27% Black), with a mean age of 54 years (range 39-72) and duration of diabetes from 3 months to 25 years. At baseline, 93% and 80% of participants rated usefulness and ease of use, respectively as high on validated surveys with no significant changes at three or six months. Participants logged into the site approximately 4X/week for a mean of 2.5 hours/week over the course of their 6 months of access. High weekly class attendance was reflected by the largest percentage of log-in time spent in the classroom (40%). Visual analysis and mapping of process data revealed site usage, interactions with objects and other participants and relationship to outcomes for individual subjects and across subjects. At 3 months, self-efficacy, dietary self-management, social support, and diabetes knowledge showed trends toward improvement. Conclusions: Because little is known about usability, acceptability, and efficacy of health interventions in a VE, this study constitutes an important, innovative first step in exploring the potential of VEs in facilitating DSM. The preliminary data suggests that VEs provide a feasible and useful platform for patients and educators. Flexible access to both synchronous and asynchronous diabetes education, skill building activities, and support from a home computer removes barriers to attending traditional clinic based meetings. Internet access is increasingly pervasive in the U.S. with 78% of adults using the Internet, regardless of gender and location (72% in rural; 80% in suburban/79% urban areas). Thus, the program has potential for improving DSM in an easily disseminated alternative model that promotes cost-effective resource utilization. []