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2019 HSR&D/QUERI National Conference Abstract

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4009 — Whole Health Avatar-based Virtual World THRIVE Program

Lead/Presenter: Sandra Winkler,  James A Haley VA Hospital
All Authors: Winkler SL (James A Haley VA Hospital), Haun, J (James A Haley VA Hospital), Paykel, J (James A Haley VA Hospital) Fowler, C (James A Haley VA Hospital) Ludwig, A (Virtual Ability, Inc.)

Objectives:
The objective was to determine if observing yourself as an avatar immersed in performing desired health behaviors, improved outcomes, satisfaction, and engagement when compared to experiencing the same self-management content delivered via an e-learning environment.

Methods:
This prospective study randomized 57 upper and lower limb amputees to either the virtual world or e-learning groups. Qualitative and quantitative data were collected. Using a phenomenology approach, semi-structured interviews were conducted with virtual world participants to understand their perceived experience of the virtual world.

Results:
Both groups benefited from the self-management training, with small increases observed in self-efficacy, increases in social support, decreases in pain interference, and increases in lower limb function. While the virtual world group showed slightly better improvements, when using statistical tests to compare the groups on change scores, no statistically significant differences were observed. Qualitative findings suggest that there is a learning curve but the virtual world was overwhelmingly a transformational experience and enjoyable challenge. Participants expressed feeling freedom and a "release" from the real world. Participants reported liking and strongly identifying with their avatars. Participants liked the interactive nature of learning in a virtual world sharing that the training gave them an expanded sense of options and possibilities and that noted that participating in the training gave them a sense of connection with peers.

Implications:
Findings support the use of a virtual world to increase access to and enhance the experience of learning and practicing desired health behaviors. The virtual world provides a remote opportunity for users to virtually access health services for self-care management to support their improved outcomes.

Impacts:
This Agency for Healthcare Research and Quality (AHRQ) study (#R24HS022021, Sandra Winkler, PI, 2013-2017) funded the virtual world infrastructure that has been sustained beyond the funding period with VISN 8 Patient Safety Center of Inquiry and James A Haley VA Whole Health Service projects. We are using this virtual world infrastructure and pilot data presented above to increase access to the Whole Health Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE) program. v-THRIVE will also provide peer interaction to support healing and wholeness beyond the 14-week formal training.