Trends in virtual reality technologies for the learning patient

NextMed convened the Medicine Meets Virtual Reality 22 (MMVR 22) conference in 2016. Since 1992, the conference has brought together a diverse group of researchers to share creative solutions for the evolving challenge of integrating virtual reality tools into medical education. Virtual reality (VR) and its enabling technologies utilize hardware and software to simulate environments and encounters where users can interact and learn. The MMVR 22 symposium proceedings contain projects that support a variety of learners: medical students, practitioners, soldiers, and patients. This report will contemplate the trends in virtual reality technologies for patients navigating their medical and healthcare learning. The learning patient seeks more than intervention; they seek prevention. From virtual humans and environments to motion sensors and haptic devices, patients are surrounded by increasingly rich and transformative data-driven tools. Applied data enables VR applications to simulate experience, predict health outcomes, and motivate new behavior. The MMVR 22 presents investigations into the usability of wearable devices, the efficacy of avatar inclusion, and the viability of multi-player gaming. With increasing need for individualized and scalable programming, only committed open source efforts will align instructional designers, technology integrators, trainers, and clinicians. Curriculum and InstructionCurriculum and Instructio

Digital Human Representations for Health Behavior Change: A Structured Literature Review

Organizations have increasingly begun using digital human representations (DHRs), such as avatars and embodied agents, to deliver health behavior change interventions (BCIs) that target modifiable risk factors in the smoking, nutrition, alcohol overconsumption, and physical inactivity (SNAP) domain. We conducted a structured literature review of 60 papers from the computing, health, and psychology literatures to investigate how DHRs’ social design affects whether BCIs succeed. Specifically, we analyzed how differences in social cues that DHRs use affect user psychology and how this can support or hinder different intervention functions. Building on established frameworks from the human-computer interaction and BCI literatures, we structure extant knowledge that can guide efforts to design future DHR-delivered BCIs. We conclude that we need more field studies to better understand the temporal dynamics and the mid-term and long-term effects of DHR social design on user perception and intervention outcomes

Using age-progression facial morphing technology to encourage smoking cessation in women and the role of the stress response

Background: Women are at increased risk from smoking and experience specific barriers to smoking cessation. Age-progression interventions that demonstrate the ageing effect of smoking to the face, appear to be effective in changing smoking intentions and behaviour in women. One underlying theme of age-progression research is a shock reaction that is thought to create stress reactivity. The impact of this shock response on efficacy of the intervention has yet to be understood. Aim: The research within this thesis aimed to investigate the effectiveness of an ageprogression intervention for smoking cessation in women aged 18-55 years, and the role of the stress response elicited by the intervention on smoking outcomes. Methods: A systematic review updated and synthesised information regarding the effectiveness of appearance based interventions. A mixed methods approach was used in a pilot study, to develop aspects of research design, including the use of physiological stress measurement and intervention instruction types (Neutral and Reassuring) to influence levels of stress. A qualitative investigation also explored the experiences of women who received the intervention. Findings from the pilot were implemented in a randomised controlled trial that assessed the impact of psychological and physiological stress induced by the intervention and its impact on the long-term smoking outcomes. Results: Qualitative study indicated the age-progression technique continues to create shock, with more instances of accounts of shock reported by women that received the Reassuring instructions. The quantitative study showed this response was accompanied by an increase in subjective and physiological stress. Lastly, findings from the randomised controlled trial indicated the age-progression intervention delivered using Reassuring instructions produced changes in smoking intentions and abstinence. Importantly, stress elicited by the intervention, positively moderated intentions to quit. Conclusions: The synthesised findings from this thesis conclude that age-progression interventions for smoking cessation can reduce smoking behaviour in women. Additionally, when administered via Reassuring instructions, high levels of shortterm stress can increase the effectiveness of the intervention. Future research should ii focus on identifying the optimal stress levels induced by smoking cessation interventions that increase successful smoking cessation

Culturally-Relevant Persuasive Technology

Persuasive technology (PT) has been defined by B. J. Fogg as "any interactive computing system designed to change peoples attitudes or behaviors". The kinds of attitudes people hold, and the behaviours they exhibit, are influenced by culture, so cultural beliefs play a large role in persuasion. The cross-cultural psychology literature has demonstrated the power of culture on attitude change. To date, however, there has been limited persuasive technology research outside of countries characterised as having individualist culture, where individualism describes cultures in which society members have a primarily individual identity. Little research has explicitly investigated the relationship between persuasive technology and culture. In this thesis, we investigated the hypothesis that persuasive technology is more effective when it reflects the culture of its intended target audience. Firstly, we established a set of effective, culturally-relevant persuasive technology strategies, almost all of which are targeted at use in tools for collectivist audiences. The strategies are based on a combination of findings from the cross-cultural psychology literature focused on the dimensions of individualism and collectivism, an analysis of existing PT strategies, and qualitative insights. Secondly, we developed a culturally-relevant PT prototype based on several of our strategies, in the form of two versions of a game titled Smoke? about smoking cessation. One version of Smoke? was designed to be more persuasive for a NZ European player audience, while the other was designed to be more persuasive for a Maori player audience. We conducted focus groups with potential players, the insights of which guided how we applied several of our culturally-relevant PT strategies in the design of the two game versions. Finally, we evaluated both game versions on individualist, and collectivist test players, using both quantitative and qualitative methods. The results of our evaluation support our hypothesis. Not only did both sets of players engage with, and use the culturally-relevant interface elements of the game designed for their culture, they also demonstrated that the culturally-relevant game versions had increased their anti-smoking beliefs

Culturally-Relevant Persuasive Technology

Persuasive technology (PT) has been defined by B. J. Fogg as "any interactive computing system designed to change peoples attitudes or behaviors". The kinds of attitudes people hold, and the behaviours they exhibit, are influenced by culture, so cultural beliefs play a large role in persuasion. The cross-cultural psychology literature has demonstrated the power of culture on attitude change. To date, however, there has been limited persuasive technology research outside of countries characterised as having individualist culture, where individualism describes cultures in which society members have a primarily individual identity. Little research has explicitly investigated the relationship between persuasive technology and culture. In this thesis, we investigated the hypothesis that persuasive technology is more effective when it reflects the culture of its intended target audience. Firstly, we established a set of effective, culturally-relevant persuasive technology strategies, almost all of which are targeted at use in tools for collectivist audiences. The strategies are based on a combination of findings from the cross-cultural psychology literature focused on the dimensions of individualism and collectivism, an analysis of existing PT strategies, and qualitative insights. Secondly, we developed a culturally-relevant PT prototype based on several of our strategies, in the form of two versions of a game titled Smoke? about smoking cessation. One version of Smoke? was designed to be more persuasive for a NZ European player audience, while the other was designed to be more persuasive for a Maori player audience. We conducted focus groups with potential players, the insights of which guided how we applied several of our culturally-relevant PT strategies in the design of the two game versions. Finally, we evaluated both game versions on individualist, and collectivist test players, using both quantitative and qualitative methods. The results of our evaluation support our hypothesis. Not only did both sets of players engage with, and use the culturally-relevant interface elements of the game designed for their culture, they also demonstrated that the culturally-relevant game versions had increased their anti-smoking beliefs

Cardiovascular risk communication strategies in primary prevention. A systematic review with narrative synthesis

Aim: To evaluate the effectiveness of cardiovascular risk communication strategies to improve understanding and promote risk factor modification. Design: Systematic review with narrative synthesis. Data sources: A comprehensive database search for quantitative and qualitative studies was conducted in five databases, Cumulative Index to Nursing and Allied health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, Applied Social Sciences Index and Abstracts (ASSIA) and Web of Science. The searches were conducted between 1980 and July 2019. Review methods: The systematic review was conducted in accordance with Cochrane review methods. Data were extracted and a narrative synthesis of quantitative and qualitative results was undertaken. Results: The abstracts of 16,613 articles were assessed and 210 underwent in‐depth review, with 31 fulfilling the inclusion criteria. We observed significant heterogeneity across study designs and outcomes. Nine communication strategies were identified including numerical formats, graphical formats, qualitative information, infographics, avatars, game interactions, timeframes, genetic risk scores and cardiovascular imaging. Strategies that used cardiovascular imaging had the biggest impact on health behaviour change and risk factor modification. Improvements were seen in diet, exercise, smoking, risk scores, cholesterol and intentions to take preventive medication. Conclusion: A wide range of cardiovascular risk communication strategies has been evaluated, with those that employ personalized and visual evidence of current cardiovascular health status more likely to promote action to reduce risk. Impact: Future risk communication strategies should incorporate methods to provide individuals with evidence of their current cardiovascular health status