Virtual World Health Behavior Counseling for Patients with Diabetes

Wiecha, John; Rosal, Milagros

Abstract

This application addresses broad Challenge Area (05): Comparative Effectiveness Research and specific Challenge Topic: 05-LM-104. Value of """"""""Virtual Reality"""""""" Interaction in Improving Compliance with Diabetic Regimen. Title: VW-HBCPD: Virtual World Health Behavior Counseling for Patients with Diabetes Type 2 diabetes mellitus (T2DM) is a serious public health concern and its prevalence is greater among African-Americans (AA) compared to Caucasians. Increased physical activity (PA), consumption of a healthy diet and medication intake are key to glycemic control and prevention of complications among persons with T2DM. T2DM self-management programs (SMP) have proven efficacy in improving the risk profile among individuals with diabetes, but attrition rates are high due to conflict with family responsibilities, program hours, and accessibility. Virtual reality (VR) environments like Second Life (SL) are potentially suitable for delivering T2DM SMP. However, studies on the use of VR to influence health behaviors are limited and have not targeted T2DM self-management (SM) behaviors. This 2-year pilot RCT will evaluate the feasibility and potential efficacy of a theory-driven intervention delivered through interactive sessions within SL to improve DM SM behaviors. The proposed intervention is based on the CDC/NIH """"""""Power to Prevent"""""""" (P2P) culturally appropriate evidence-based behavior-change curriculum designed for face to face delivery to AA patients with T2DM or pre-diabetes. The intervention will target knowledge, self-efficacy, and behavioral capabilities for the targeted behaviors. It includes 2 components delivered within SL: 1) group counseling sessions based on P2P and, 2) individual counseling sessions to reinforcement of intervention messages. Behavioral targets include a reduction in calorie intake, enhanced dietary quality, increased PA, and increased T2DM medication adherence. Subjects (n=100) will be sedentary AA women with uncontrolled T2DM recruited from primary care practices at Boston Medical Center. Participants will be randomized into the VW-HBCPD intervention, or an equivalent exposure to the curriculum delivered face to face, delivered over 8 months in both arms with assessments at baseline and 8 months. The study's primary aims are to: 1. Determine the feasibility of VW-HBCPD by evaluating the degree to which subjects engage in the intervention (number of sessions completed). 2: Determine the potential efficacy of VW- HBCPD, compared to a control group receiving face to face counseling, on increasing PA. Secondary aims are to: 1) Determine the effect of the VW-HBCPD intervention, vs. face to face counseling, on behavioral (calorie, fat, and fiber intake and medication compliance), anthropometric and physiological (weight, BMI, waist circum., blood pressure, lipids, and HbA1c), and psychosocial (self-efficacy and quality of life) outcomes;2) Determine the cost (per subject) of implementing the intervention;3) Document baseline values and variance of outcome variables in order to accurately estimate sample size and statistical power in a subsequent RCT. Despite often intensive educational efforts, patients with diabetes commonly mismanage or under- manage their illness despite the known ability of optimal management to reduce complications and morbidity. Interactions between avatars in virtual reality environments such as Second Life are known to influence behavior. This study will explore the effectiveness of an evidence-based behavior change counseling program for patients delivered in the virtual reality environment Second Life, as compared to the same curriculum delivered face to face, among African-American women with poorly controlled type 2 diabetes who are physically inactive.

Public Health Relevance

Despite often intensive educational efforts, patients with diabetes commonly mismanage or under- manage their illness despite the known ability of optimal management to reduce complications and morbidity. Interactions between avatars in virtual reality environments such as Second Life are known to influence behavior. This study will explore the effectiveness of an evidence-based behavior change counseling program for patients delivered in the virtual reality environment Second Life, as compared to the same curriculum delivered face to face, among African-American women with poorly controlled type 2 diabetes who are physically inactive.