Using Virtual Reality to Improve Health Care Providers’ Cultural Self-Efficacy & Diabetes Attitudes

According to recent data, diabetes disproportionately affects people in Appalachian Ohio, with nearly 20% of adults in the southeastern part of the region having the disease. “In addition, diabetes stigma affects 52% to 76% of people with the disease,” says Elizabeth Ann Beverly, PhD. “This can lead to higher levels of psychological distress, more depressive symptoms, less social support, and lower quality of life.”

In light of diabetes burden in areas like Appalachian Ohio, innovative strategies are sorely needed to address growing diabetes care demands, according to Dr. Beverly. One such approach is to use virtual reality cinema (cine-VR), an educational technique that is dynamic, accessible, and adaptable to the needs and preferences of healthcare providers. Cine-VR provides access to life-like medical encounters without risk of harm to patients and gives a glimpse into the lives of patients in different regions.

Understanding Patients’ Backgrounds

For a study published in JMIR Diabetes, Dr. Beverly and colleagues developed a 3-hour cine-VR training program that was designed to educate providers and administrators about diabetes, social determinants of health, and Appalachian culture. “The virtual reality experiences were developed to recognize the unique cultural contributions of Appalachia,” says Dr. Beverly. “This was done because providers who understand their patients’ cultural background are more likely to observe improvements in diabetes outcomes and patient satisfaction.”

The cine-VR training program consisted of professional 360-degree videos that were produced in a cinematic manner. Questionnaires were completed by participants to measure cultural self-efficacy, diabetes attitudes, and presence in cine-VR before and after the program to assess the effectiveness of cine-VR training in improving cultural sensitivity and diabetes attitudes.

Positive Improvements With Cine-VT Training

Following implementation of the cine-VR training program, positive improvements were seen in the Transcultural Self-Efficacy Tool–Multidisciplinary Healthcare Provider (TSET-MHP), which assesses changes in self-efficacy for cultural knowledge, cultural practical skills, and cultural awareness. Specifically, positive improvements were seen in TSET-MHP subscales of cognitive, practical, and affective subscales (Table). “All 3 domains of cultural self-efficacy showed medium to very large effect sizes, which means the improvements from before to after the virtual reality training had medium to very large effects on cultural self-efficacy,” Dr. Beverly says. “The finding with the most importance was the practical self-efficacy scale. We observed a very large effect in improving providers’ confidence in interviewing patients about social determinants of health, which was a key focus of our study.”

In addition, positive improvements were seen in all five diabetes attitude subscales in the Diabetes Attitude Scale-3 (DAS-3), which measures diabetes-related attitudes. Positive improvements were seen in DAS-3 subscale scores regarding need for special training, seriousness of type 2 diabetes, value of tight glucose control, psychosocial impact of diabetes, and attitude toward patient autonomy. The largest magnitude of change was seen with the psychosocial impact of diabetes subscale.

The Value of Culturally Tailored Stories

“Our study demonstrates the value of culturally tailored stories to positively affect knowledge and beliefs,” says Dr. Beverly. “Cine-VR is an innovative approach that is engaging and effective in educating providers on cultural self-efficacy, social determinants of health, and diabetes. The advantage of 360-degree virtual reality is the realism afforded by providing participants with access to the whole environment. Providers can get a glimpse inside the personal lives of their patients and see why things are the way they are. The more that providers understand about their patients’ personal lives, the more they can empathize with their challenges and struggles.”

Dr. Beverly notes that the virtual reality trainings can accessed for free at https://mesp.ohio.edu. “We also welcome healthcare providers to contact us to schedule a live videoconferencing session with 360-degree virtual reality headsets,” she says.

More to Come

According to Dr. Beverly, the next step with the cine-VR intervention is to determine if the cultural self-efficacy and diabetes attitudes improvements can be sustained over time. “In addition, we will examine the impact of this training on diabetes outcomes and patient satisfaction,” she says. “We’re also conducting research with health professional students to assess changes in empathy, cultural self-efficacy, and diabetes attitudes and hope to have these data collected and published in the near future.”

<ACKNOWLEDGEMENT>

This study was part of the Medicaid Equity Simulation Project funded by the Ohio Department of Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center. The views expressed in the cine-VR simulations for this publication are solely those of the creators and do not represent the views of the state of Ohio or federal Medicaid programs.