Interventions to assist patients in chronic illness self-management are needed to: eliminate barriers to healthcare;accommodate limited health literacy;provide sustainable, cost-effective patient education and support;and move beyond ineffective, non-interactive health behavior interventions. Advances in communication technology such as the Web 2.0 are a means to fill these needs. Virtual environments (VE) promote social interaction and learning via application and feedback, leading to superior learning and skill set transfer. We propose to test a theoretically grounded, technologically-based, bio-behavioral intervention using a VE to facilitate self-management of diabetes. Diabetes affects 23.6 million US adults, most of whom have Type 2 Diabetes (T2D) (NIDDK, 2009). Metabolic control is known to reduce diabetes morbidity and mortality, yet it remains a leading cause of death in the U.S. Individuals with T2D provide a majority of their own care, making diabetes self-management (DSM) (e.g. diet, exercise) integral to control. Tailored DSM interventions utilizing patient-provider interaction have had encouraging short-term effects. However, this frequent interaction is unattainable and costly. Internet interventions have the potential to capture the dynamics of patient-provider interaction, but to date remain "flat" with asynchronous communication. VEs are a potential solution to capture patient-provider dynamics via interactivity, synchronous communication, knowledge application, and social networking in an immersive environment. Preliminary findings from our R21 (R21LM010727-01) showed that a virtual diabetes community with real-time interaction among adults with T2D, and with healthcare professionals is feasible and has the potential to influence metabolic control and psychosocial mediators. Thus we are proposing a randomized controlled trial to determine whether the effects of participation in a VE that incorporates real-time diabetes self-management training and support will be associated with positive changes in health behaviors. The LIVE community will consist of a community center, gym, grocery store, and other locations, each allowing for interactive knowledge application. Based on this design our primary aim is to (1) determine the effects of providing DSMT/S in a VE on diet and physical activity behavior change in adults with T2D compared to traditional DSMT/S over 12 months. Our secondary aims are: (2) to determine the effects on metabolic outcomes;(3) to assess whether level of engagement and social network formation in LIVE differentially impacts behavioral outcomes;and (4) to examine the potential mediating effects of changes in self-efficacy;diabetes knowledge, diabetes-related distress and social support on behavior change and metabolic outcomes. Should LIVE prove effective in improved self-management of diabetes, similar interventions could be applied to other prevalent chronic diseases. Innovative programs such as LIVE have potential for improving healthcare access in an easily disseminated alternative model of care that potentially improves the reach of DSMT/S.

Public Health Relevance

Health programs in virtual worlds may be a useful way to bring diabetes education and support to more people who are living with diabetes. We will test a virtual world as a way to provide classes and support for adults with type 2 diabetes.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
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Ershow, Abby
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Duke University
Schools of Nursing
United States
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