Abstract
Background: Diabetes is a serious worldwide public health challenge. The burden of diabetes, including prevalence and risk of complications, is greater for minorities, particularly African Americans. Internet-based immersive virtual worlds offer a unique opportunity to reach large and diverse populations with diabetes for self-management education and support. Objective: The objective of the study was to examine the acceptability, usage, and preliminary outcome of a virtual world intervention, Diabetes Island, in low-income African Americans with type 2 diabetes. The main hypotheses were that the intervention would: (1) be perceived as acceptable and useful; and (2) improve diabetes self-care (eg, behaviors and barriers) and self-care related outcomes, including glycemic control (A1C), body mass index (BMI), and psychosocial factors (ie, empowerment and distress) over six months. Methods: The evaluation of the intervention impact used a single-group repeated measures design, including three assessment time points: (1) baseline, (2) 3 month (mid intervention), and (3) 6 month (immediate post intervention). Participants were recruited from a university primary care clinic. A total of 41 participants enrolled in the 6 month intervention study. The intervention components included: (1) a study website for communication, feedback, and tracking; and (2) access to an immersive virtual world (Diabetes Island) through Second Life, where a variety of diabetes self-care education activities and resources were available. Outcome measures included A1C, BMI, self-care behaviors, barriers to adherence, eating habits, empowerment, and distress. In addition, acceptability and usage were examined. A series of mixed-effects analyses, with time as a single repeated measures factor, were performed to examine preliminary outcomes. Results: The intervention study sample (N=41) characteristics were: (1) mean age of 55 years, (2) 71% (29/41) female, (3) 100% (41/41) African American, and (4) 76% (31/41) reported annual incomes below US $20,000. Significant changes over time in the expected direction were observed for BMI (P<.02); diabetes-related distress (P<.02); global (P<.01) and dietary (P<.01) environmental barriers to self-care; one physical activity subscale (P<.04); and one dietary intake (P<.01) subscale. The participant feedback regarding the intervention (eg, ease of use, interest, and perceived impact) was consistently positive. The usage patterns showed that the majority of participants logged in regularly during the first two months, and around half logged in each week on average across the six month period. Conclusions: This study demonstrated promising initial results of an immersive virtual world approach to reaching underserved individuals with diabetes to deliver diabetes self-management education. This intervention model and method show promise and could be tailored for other populations. A large scale controlled trial is needed to further examine efficacy.
| Original language | English (US) |
|---|---|
| Article number | e10 |
| Journal | JMIR Serious Games |
| Volume | 2 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jul 1 2014 |
Funding
The National Library of Medicine of the National Institutes of Health under grant number 1RC1LM010656-01 supported research reported in this publication. The content is solely the responsibility of the authors, and does not necessarily represent the official views of the National Institutes of Health or the position or policy of the Department of Veterans Affairs or the United States government. The authors would like to acknowledge the support of the following individuals, Henry Arnold, BS; Shikhi C. Bhansari; Young K Choi, PhD; Sandra Franklin, BA; Rosalba Hernandez, PhD; Michelle Hochwert, MPH; Jennifer Mayer RD, LDN, CDE; Jessica Michaud, PharmD; Anastasia McGee Montoya, RD; Jack Neuner, BA; Christine A Pellegrini, PhD; Tisa Ross, RD; Natoya Sain, RD; and Erica Seltzer, DrPH, MPH. The researchers would also like to acknowledge and thank the following groups, Diabetes Island guest presenters, our technical support and development teams, all of our advisory committee members, our study participants, the staff at the University of Illinois Medical Center Primary Care Clinic, and the staff of the Chicago Partnership for Health Promotion.
Keywords
- Minority group
- Self-management
- Type 2 diabetes mellitus
ASJC Scopus subject areas
- Physical Therapy, Sports Therapy and Rehabilitation
- Rehabilitation
- Psychiatry and Mental health
- Biomedical Engineering
