Design and Methods for a Comparative Effectiveness Pilot Study: Virtual World vs. Face-to-Face Diabetes Self-Management

BACKGROUND: Type 2 diabetes (diabetes) is a serious threat to public health in the United States and disproportionally affects many racial/ethnic minority groups, including African Americans. Limited access to treatment and high attrition rates further contribute to health disparities in diabetes-related morbidity and mortality among minorities. Greater opportunities for increasing access and decreasing barriers to treatment are needed. Technology-based interventions have potential for accomplishing this goal but evidence of feasibility and potential effectiveness is lacking, especially for populations that traditionally have limited educational attainment and low computer literacy. OBJECTIVE: This paper describes the design and methods of a pilot randomized clinical trial that will compare the feasibility and potential efficacy of delivering a diabetes self-management intervention via a virtual world vs. a face-to-face format. METHODS: Study participants (n=100) will be African American women with uncontrolled type 2 diabetes recruited from primary care practices and affiliated health centers at a large safety net hospital in Massachusetts. Participants will be randomized into a virtual world-based (VW) intervention condition or a face-to-face control condition. Both conditions provide the same theory-based curriculum and equivalent exposure to the self-management program (eight group sessions), and both will be delivered by a single intervention team (a dietitian and a diabetes educator). Assessments will be conducted at baseline and 4 months. Feasibility will be determined by evaluating the degree to which participants engage in the VW-based intervention compared to face to face (number of sessions completed). Potential efficacy will be determined by comparing change in physiological (glycemic control) and behavioral (self-reported dietary intake, physical activity, blood glucose self-monitoring, and medication adherence) outcomes between the experimental and control groups. RESULTS: The primary outcomes of interest are feasibility of the VW intervention and its potential efficacy on glucose control and diabetes self-management behaviors, compared to the face-to-face condition. Analysis will use a two-sample Kolmogorov-Smirnov test for changes in variable distribution. P values will be calculated using binomial tests for proportions and t tests for continuous variables. CONCLUSIONS: If the intervention is found to be feasible and promising, it will be tested in a larger RCT

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

BACKGROUND: Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost. OBJECTIVE: We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention. METHODS: We 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). RESULTS: Participants (N = 89) were an average of 52 years old (SD 10), 60% had \u3c /=high school, 82% had household incomes \u3c 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$1117 versus US $931 for face-to-face. CONCLUSIONS: It 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 REGISTRATION: ClinicalTrials.gov NCT01340079; http://clinicaltrials.gov/show/NCT01340079 (Archived by WebCite at http://www.webcitation.org/6T2aSvmka)

Use of a virtual world computer environment for international distance education: lessons from a pilot project using Second Life

Virtual worlds (VWs), in which participants navigate as avatars through three-dimensional, computer-generated, realistic-looking environments, are emerging as important new technologies for distance health education. However, there is relatively little documented experience using VWs for international healthcare training. The Geneva Foundation for Medical Education and Research (GFMER) conducted a VW training for healthcare professionals enrolled in a GFMER training course. This paper describes the development, delivery, and results of a pilot project undertaken to explore the potential of VWs as an environment for distance healthcare education for an international audience that has generally limited access to conventionally delivered education

Conductive polyacrylonitrile/graphite textile coatings

Conductive textile coatings are necessary for a broad variety of applications, from textile ECG electrodes to capacitive sensors to transport of energy and data through textile networks. Besides wires which mostly alter the textile haptics in an undesired way and conductive yarns which tend to break or oxidize during washing and wearing, conductive coatings can be used for this purpose. In addition to conductive polymers, such as poly(3,4-ethylenedioxythiophene):polystyrene sulfonate (PEDOT:PSS) or polyaniline (PAni) which are known to be photo-degradable, graphite-filled polymers can be used to create conductive areas on textile fabrics. Most commonly, polyurethane is used for this purpose. Here we report on first tests with graphite-filled polyacrylonitrile which has the advantage of not necessitating toxic precursors, opposite to polyurethane. Generally, such polyacrylonitrile (PAN)/graphite coatings can be applied on textile fabrics using the typical doctor blade technique. Washing tests reveal that while the surface is not significantly disturbed in this process, breaking of the filled polymer may occur, suggesting further experiments with additional silicone or other softeners

Matching learning style to instructional format penalizes learning

Experiments have failed to support the matching hypothesis that students’ learning style preferences should be matched to instructional modality to optimize learning. These studies have generally been restricted to considering sensory modality learning style dimensions. We extend this extant work by examining the matching hypothesis with regard to another learning styles model, one that distinguishes between active/reflective learning preferences (Felder & Silverman, 1988). Participants preferring each learning style were assigned to one of two versions of a digital-based Biology lesson (textbook chapter). The interactive version contained interactive exercises consisting of text and visuals. In the non-interactive version, the interactivity was removed, and participants watched while the identical exercises were completed by the computer. We assumed that an active learning style would align with the interactive lesson, whereas a reflective learning style would better align with the non-interactive lesson. For two learning tests (definition recall and multiple-choice questions) the nature of the lesson (interactive vs. non-interactive) did not interact with participants’ learning style. For a test that targeted the content for which the interactive exercises were designed, learning performance was better when the lesson format mismatched the preferred learning style. The results importantly enrich the experimental evidence countering the matching hypothesis. The current finding is particularly strong because it does not rely on a null effect. Further, the current findings significantly extend the experimental literature from a focus on the modality-specific matching hypothesis to a broader consideration of learning-styles that includes an activity-based (active/reflective) learning style model

Longevity of business firms : a four-stage framework for analysis

SIGLEAvailable at INIST (FR), Document Supply Service, under shelf-number : DO 782 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc