A Virtual World Versus Face-to-Face Intervention Format to Promote Diabetes Self-Management Among African American Women: A Pilot Randomized Clinical Trial

Abstract

BackgroundVirtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost.ObjectiveWe tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention.MethodsWe recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent, a behavior-change in-person group program for African Americans with diabetes or pre-diabetes. The program is social cognitive theory–guided, evidence-based, and culturally tailored. Participants were randomized to participate in the program via virtual world (Second Life) or face-to-face, both delivered by a single intervention team. Blinded assessors conducted in-person clinical (HbA1c), behavioral, and psychosocial measurements at baseline and 4-month follow-up. Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests (two-sided and intention-to-treat analyses for all comparisons).ResultsParticipants (N=89) were an average of 52 years old (SD 10), 60% had ≤high school, 82% had household incomes <US $30,000, and computer experience was variable. Overall session attendance was similar across the groups (6.8/8 sessions, P=.90). Compared to face-to-face, virtual world was slightly superior for total activity, light activity, and inactivity (P=.05, P=.07, and P=.025, respectively). HbA1c reduction was significant within face-to-face (−0.46, P=02) but not within virtual world (−0.31, P=.19), although there were no significant between group differences in HbA1c (P=.52). In both groups, 14% fewer patients had post-intervention HbA1c ≥9% (virtual world P=.014; face-to-face P=.002), with no significant between group difference (P=.493). Compared to virtual world, face-to-face was marginally superior for reducing depression symptoms (P=.051). The virtual world intervention costs were US $1117 versus US $931 for face-to-face.ConclusionsIt is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds, and outcomes may be comparable to those of face-to-face interventions. Further effectiveness research is warranted.Trial RegistrationClinicalTrials.gov NCT01340079; http://clinicaltrials.gov/show/NCT01340079 (Archived by WebCite at http://www.webcitation.org/6T2aSvmka).

The Use of Videogames, Gamification, and Virtual Environments in the Self-Management of Diabetes: A Systematic Review of Evidence

“…1), and 10 studies met all the inclusion criteria. Four studies were based on videogames, [19][20][21][22] three studies used VEs, [23][24][25] and three studies used principles of gamification for the management of diabetes. [26][27][28] Three studies reviewed used a randomized control trial (RCT) design.…”

“…[26][27][28] Three studies reviewed used a randomized control trial (RCT) design. 19,22,25 Five were quasi-experimental, 23,24,[26][27][28] one was a qualitative focus group discussion, 20 and one study was of an independent measures experimental design. 21 In addressing RQ1, a summary of the reviewed studies' characteristics is presented in Table 1.…”

Type 2 Diabetes Education and Support in a Virtual Environment: A Secondary Analysis of Synchronously Exchanged Social Interaction and Support (Preprint)

“…[18,[22][23][24] One way to provide personalized, frequent interaction and support is via T2D-specific VEs that assist individuals in healthcare decision making. [10][11][12]25] Research indicates that these VEs facilitated the interaction among providers and peers and replicated locations that an individual with T2D would typically encounter while engaging in self-management. [10][11][12]25] However, these studies provided little information on how these VE-mediated interactions among peers and providers compared to face-to-face interactions.…”

“…[10][11][12]25] Research indicates that these VEs facilitated the interaction among providers and peers and replicated locations that an individual with T2D would typically encounter while engaging in self-management. [10][11][12]25] However, these studies provided little information on how these VE-mediated interactions among peers and providers compared to face-to-face interactions. Therefore, an understanding of how individuals interact in a disease-specific VE and what these individuals discuss can improve how researchers design consumer health informatics interventions aimed at improving selfmanagement.…”

“…[1,6] A community of like-individuals fosters the continued exchange of information and support, which may help an individual with chronic illness "not feel alone" while engaging in chronic illness self-management. [7][8][9][10][11][12] Individuals with type 2 diabetes (T2D) complete the majority of self-management outside of a healthcare setting, [13] and struggle to adopt healthy behaviors. [14][15][16] The frequency and amount of T2D self-management behaviors may cause an individual to feel overwhelmed, which may lead to further feelings of frustration and general inattention to these self-management behaviors.…”