John Moore Wiecha*, Boston University Medical Center, Boston, United States Milagros Rosal, University of Massachusetts School of Medicinec, Worcester, MA, United States Robin Heyden, Heyden Ty, LLC, Alameda, CA, United States Roanne Mejilla, Boston Medical Center, Boston, MA, United States Veerappa Chetty, Boston Medical Center, Boston, MA, United States Track: Research Presentation Topic: Virtual (3D) environments, Second Life Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2014-06-09

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Background: Face to face programs designed to promote healthy lifestyle changes for patients with diabetes are hampered by a number of challenges. The Internet, through its potential for increased access to specialized behavior change experts, convenience to patients, and potentially lowered costs, offers alternatives to these challenges. However, while online alternatives show promising improvement in health behaviors and glycemic control, effect sizes have been small. Limited human interactivity and engagement in online programs have been hypothesized as contributors to the small effect size. In contrast, Virtual World (VW) technologies are potentially more suitable environments for supporting diabetes self-management programming. Through the use of 3D environments that depict real places and avatars that represent people, VW environments offer opportunities for interaction, intense engagement, and opportunities for scripted immersive experiences, simulations, role-playing, and constructivist experiences, all important facilitators of active learning. The use of VW environments continues to increase. There were 1,772 million registered VW accounts in 2011, with 27 million users registered in Second Life alone. The potential of VW environments for implementing or supplementing diabetes care interventions has been noted, but there is a scarcity about the feasibility and potential effectiveness of such an approach.

Objective: This pilot study examined the feasibility of delivering a group-based diabetes self-management intervention via a VW environment (Second Life), and explored the potential effectiveness of the VW-based intervention condition on self-management behaviors and glucose levels, as compared to a traditional face-to-face (FF) intervention condition.

Methods: A pilot randomized clinical trial design was used. African American women with type 2 diabetes were recruited and randomized to the VW or the FF intervention. Baseline and four-month follow up included clinical (HbA1c), behavioral and psychosocial measurements. Pre-post differences within and between intervention groups were assessed using t-tests and binomial tests (two-sided and intention to treat analyses for all comparisons).

Results: Participants (n=89) had an average age of 52 years, 60% had 9% (VW p=0.014; FF p=0.002), with no between group difference (p=0.493). No significant between group differences were observed for blood pressure, BMI, blood glucose self-monitoring, dietary outcomes, medication adherence, or social support, but were significant for depressive symptoms. The VW intervention costs were $1,117 vs. $931 for FF.
Conclusions: It is feasible to deliver diabetes self-management interventions to inner city African American women via VW and outcomes may be comparable. Further effectiveness research is warranted.