60-OR: Patient Engagement in Diabetes Self-Management Education and Support (DSME/S) Using Immersive Virtual World Technology

Introduction: Immersive online technologies, such as virtual world (VW) platforms, can increase patient engagement in DSME/S. The Women in Control 2.0 (WIC2) trial compared DSME/S delivered in a VW vs. in-person for minority women with uncontrolled type 2 diabetes (HbA1c ≥8.0). We hypothesize the sense of presence afforded by a VW platform fosters patient engagement. Presence in a virtual reality setting is defined as a feeling of being immersed in an environment despite its artificiality.

Methods: We used a triangulation mixed-methods design embedded within the WIC2 clinical trial. For the 145 participants randomized to the VW study arm, we measured participant experience of physical, self and social “presence” in the VW using the validated Multimodal Presence Scale (MPS) and 63 participated in qualitative interviews. We analyzed participant experiences in the VW with qualitative data collected via direct observation, focus group, and key informant interviews. We calculated the MPS scores and conducted a qualitative thematic analysis of transcripts. Qualitative and quantitative data were collected independently and integrated using a conceptual mapping process to correlate participants’ experience of DSME/S in the VW.

Results: Half of participants were over 56yo and had a mean baseline HbA1c of 9.9% (SD=1.75). Two-thirds of the VW participants reported a sense of social (63.7%) and physical (63.1%) presence, while half-experienced self (49.0%) presence in the VW. Data integration led to three themes related to “presence” in a VW: (1) Self-presence fosters user identification with the personalized avatar (2) Physical presence fosters a growth mindset through imaginative play and visualization, and (3) social presence fosters peer social support.

Conclusion: Patient engagement in DSME/S is enhanced by the sense of physical, social and self- presence experienced by learners when using immersive technology software in a peer group context.