Implementation of virtual reality in health professional higher education: Protocol for a scoping review

International Registered Report Identifier (IRRID): DERR1-10.2196/37222Background: The use of virtual reality in higher education show great potential to promote novel and innovative learning experiences. Until recently, virtual reality has mostly been used in technical higher education, but lately medical education programs have begun using virtual reality. Virtual reality for health professional education improves the knowledge and skills of health professionals compared with traditional or other digital education initiatives. However, the implementation of technology in higher education is slow because of barriers to technology use and innovative and successful practices are not shared. It is, therefore, of great interest to explore how virtual reality is implemented in higher health professional and continuing education. Objective: The aim of this scoping review is to identify studies that reported implementation of virtual reality in higher health professional education, to identify barriers and facilitators for implementation, and to highlight research gaps in this area. Methods: The scoping review will be conducted according to JBI Evidence Synthesis methodologies. CINAHL, the Academic Search Elite and Education Source electronic databases, and Google Scholar will be searched for studies published between 2017 and 2022. In addition, manual searching of key items, reference tracking, and citation tracking will be performed. Searches for white papers will also be manually conducted. All authors will independently extract data from full-text papers. We will use qualitative content analysis to abstract the findings. Results: The literature searches were conducted in January and February 2022. The review is expected to be completed by fall 2022, after which time it will be submitted for publication. Conclusions: We anticipate that, from the review, we will be able to coordinate recommendations for and present the challenges of virtual reality initiatives in health professional education programs. We will present recommendations for future research.publishedVersio

Written reflection in an eHealth intervention for adults with type 2 diabetes mellitus: a qualitative study

Background: Individuals with type 2 diabetes mellitus (T2DM) are responsible for the daily decisions and actions necessary to manage their disease, which makes self-management the cornerstone of diabetes care. Many patients do not reach recommended treatment goals, and thus it is important to develop and evaluate innovative interventions that facilitate optimal motivation for adequate self-management of T2DM. Objective: The aim of the current study was to explore how adults with T2DM experience using reflection sheets to stimulate written reflection in the context of the Guided Self-Determination (GSD) eHealth intervention and how written reflection might affect their motivation for self-management of T2DM. Methods: We used a qualitative design in which data were collected through individual interviews. The sample consisted of 10 patients who completed the GSD eHealth intervention, and data were analyzed using qualitative content analysis. Results: The qualitative content analysis yielded 2 main themes. We labeled the first theme as “Written reflection affects awareness and commitment in diabetes self-management”, which reflects 2 subthemes, namely, “Writing creates space and time for autonomous reflection” and “Writing influences individuals’ focus in diabetes self-management”. We labeled the second theme as “Written reflection is perceived as inapplicable in diabetes self-management”, which reflects 2 subthemes, namely, “Responding in writing is difficult” and “The timing of the writing is inappropriate”. Conclusion: Our findings indicate that written reflection in the context of the GSD eHealth intervention may be conducive to motivation for diabetes self-management for some patients. However, it seems that in-person consultation with the diabetes nurse may be necessary to achieve the full potential benefit of the GSD as an eHealth intervention. We advocate further development and examination of the GSD as a “blended” approach, especially for those who consider written reflection to be difficult or unfamiliar.publishedVersio

Implementation of virtual reality in health professions education: scoping review

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Education, is properly cited. The complete bibliographic information, a link to the original publication on https://mededu.jmir.org/, as well as this copyright and license information must be included.Background: Virtual reality has been gaining ground in health professions education and may offer students a platform to experience and master situations without endangering patients or themselves. When implemented effectively, virtual reality technologies may enable highly engaging learning activities and interactive simulations. However, implementation processes present challenges, and the key to successful implementation is identifying barriers and facilitators as well as finding strategies to address them. Objective: This scoping review aimed to identify the literature on virtual reality implementation in health professions education, identify barriers to and facilitators of implementation, and highlight gaps in the literature in this area. Methods: The scoping review was conducted based on the Joanna Briggs Institute Evidence Synthesis methodologies. Electronic searches were conducted in the Academic Search Elite, Education Source, and CINAHL databases on January 5, 2022, in Google Scholar on February 2 and November 18, 2022, and in PubMed database on November 18, 2022. We conducted hand searches of key items, reference tracking, and citation tracking and searches on government webpages on February 2, 2022. At least 2 reviewers screened the identified literature. Eligible studies were considered based on predefined inclusion criteria. The results of the identified items were analyzed and synthesized using qualitative content analysis. Results: We included 7 papers and identified 7 categories related to facilitators of and barriers to implementation—collaborative participation, availability, expenses, guidelines, technology, careful design and evaluation, and training—and developed a model that links the categories to the 4 constructs from Carl May’s general theory of implementation. All the included reports provided recommendations for implementation, including recommendations for careful design and evaluation, training of faculty and students, and faculty presence during use. Conclusions: Virtual reality implementation in health professions education appears to be a new and underexplored research field. This scoping review has several limitations, including definitions and search words, language, and that we did not assess the included papers’ quality. Important implications from our findings are that ensuring faculty’s and students’ competence in using virtual reality technology is necessary for the implementation processes. Collaborative participation by including end users in the development process is another factor that may ensure successful implementation in higher education contexts. To ensure stakeholders’motivation and potential to use virtual reality, faculty and students could be invited to participate in the development process to ensure that the educational content is valued. Moreover, technological challenges and usability issues should be resolved before implementation to ensure that pedagogical content is the focus. This accentuates the importance of piloting, sufficient time resources, basic testing, and sharing of experiences before implementation.publishedVersio

Dropout From an eHealth Intervention for Adults With Type 2 Diabetes: A Qualitative Study

Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.05.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/).Background: Adequate self-management is the cornerstone of type 2 diabetes treatment, as people make the majority of daily treatment measures and health decisions. The increasing prevalence of type 2 diabetes mellitus (T2DM) and the complexity of diabetes self-management demonstrate the need for innovative and effective ways to deliver self-management support. eHealth interventions are promoted worldwide and hold a great potential in future health care for people with chronic diseases such as T2DM. However, many eHealth interventions face high dropout rates. This led to our interest in the experiences of participants who dropped out of an eHealth intervention for adults with T2DM, based on the Guided Self-Determination (GSD) counseling method. Objective: In this study, we aimed to explore experiences with an eHealth intervention based on GSD in general practice from the perspective of those who dropped out and to understand their reasons for dropping out. To the best of our knowledge, no previous qualitative study has focused on participants who withdrew from an eHealth self-management support intervention for adults with T2DM. Methods: A qualitative design based on telephone interviews was used to collect data. The sample comprised 12 adults with type 2 diabetes who dropped out of an eHealth intervention. Data were collected in 2016 and subjected to qualitative content analysis. Results: We identified one overall theme: “Losing motivation for intervention participation.” This theme was illustrated by four categories related to the participants’ experiences of the eHealth intervention: (1) frustrating technology, (2) perceiving the content as irrelevant and incomprehensible, (3) choosing other activities and perspectives, and (4) lacking face-to-face encounters. Conclusions: Our findings indicate that the eHealth intervention based on GSD without face-to-face encounters with nurses reduced participants’ motivation for engagement in the intervention. To maintain motivation, our study points to the importance of combining eHealth with regular face-to-face consultations. Our study also shows that the perceived benefit of the GSD eHealth intervention intertwined with choosing to focus on other matters in complex daily lives are critical aspects in motivation for such interventions. This indicates the importance of giving potential participants tailored information about the aim, the content, and the effort needed to remain engaged in complex interventions so that eligible participants are recruited. Finally, motivation for engagement in the eHealth intervention was influenced by the technology used in this study. It seems important to facilitate more user-friendly but high-security eHealth technology. Our findings have implications for improving the eHealth intervention and to inform researchers and health care providers who are organizing eHealth interventions focusing on self-management support in order to reduce dropout rates.publishedVersio

An eHealth intervention based on the Guided Self-determination program for adults with type 2 diabetes in general practice.

Background: Type 2 diabetes is a chronic, progressive condition, requiring each person to manage their symptoms, treatment and physical and psychosocial consequences of the condition, as well as to engage in healthy behaviors daily. Diabetes self-management is consequently a demanding, life-long process requiring motivation. Since many adults with type 2 diabetes do not reach all recommended treatment goals, the fundamental starting point for this project was the need for effective and innovative self-management support interventions for this patient group. Earlier research has proposed eHealth as a promising tool in health care for people with chronic conditions, such as type 2 diabetes. Therefore, self-management support intervention, Guided Self-Determination Program, was adapted as a eHealth intervention (eGSD) for people with type 2 diabetes. This PhD project piloted the sGSD. Aims: The overall purpose of this thesis is to provide insight into how adults with type 2 diabetes and registered nurses experience the eGSD conducted in general practice, and how the eGSD may influence motivation for diabetes self-management and intervention participation by means of a qualitative approach. [...

Stor og sterk - evaluering av fysiologiske effekter av et livsstilsendringsprogram

Master's thesis in Health and social sciencesHensikt: Norge har som politisk prioritet i helsevesenet å forebygge og behandle fedme og inaktivitet i befolkningen. Stadig flere kommuner starter nå Frisklivssentraler med blant annet livsstilsendringsprogram som lavterskel tilbud for mennesker med behov. Dette øker viktigheten av evalueringer for å undersøke virkningen og gjennomførbarheten av slike program. Dette studiet er etter hva jeg kjenner til et av de første i Norge som undersøker et kommunalt livsstilsendringsprogram for hjemmeboende deltakere. Metode: Studiet ble lagt opp som et randomisert kontrollert pilotstudie for å evaluere effekten av programmet med hensyn til fysiologiske forandringer som endringer i antropometri, blodtrykk og blodlipider hos deltakerne, samt ulike styrke- og bevegelighetstester. Det ble også undersøkt frafall og deltakernes arbeidsstatus for å undersøke hvem som hadde gode effekter av programmet. Tester ble gjennomført ved baseline, etter 6 måneders intervensjon og etter 12 måneder som oppfølging. Funn: Deltakerne i intervensjonsgruppen hadde forbedrede fysiologiske parametre som gjennomsnittlig økt oksygenopptak med 2,6 mlO2/kg/min, samt redusert vekt med 4,6kg og fettmasse med 4kg. Det var signifikante forskjeller mellom intervensjons- og kontrollgruppen etter 6 måneder, men ikke etter 12 måneder på grunn av stort frafall og store individuelle variasjoner. Det var betydelig mindre frafall og større forbedringer for deltakerne i intervensjonsgruppen som var i jobb. Konklusjon: Livsstilsintervensjonen gjennom Stor og Sterk reduserer flere kardiovaskulære risikofaktorer for deltakerne. Yrkesaktive deltakerne har tydeligere forbedringer og mindre frafall fra programmet enn deltakerne som ikke er i arbeid. Av denne grunn er nøye inklusjonskriterier for deltakelse viktig ved videreutvikling programmet.2014-11-1

Health Care and Social Work Students’ Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study

BackgroundVirtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students’ experiences with such a learning activity. ObjectiveThe aim of this study was to explore occupational therapy, social education, nursing, and social work students’ experiences with virtual reality simulation as a learning activity in an interdisciplinary subject. MethodsThe data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke. ResultsThe analysis revealed 3 overall themes for students’ experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students’ experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students’ learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity. ConclusionsVirtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services

Norwegian primary health care: Evaluation of a lifestyle intervention program

Aims: The aim of this study was to evaluate the physiological effects of an outpatient lifestyle intervention program prescribed by Norwegian primary health care for inactive obese people. The program includes exercise and lifestyle modification education. Methods: Inactive obese participants were randomly assigned to either an intervention group (n=18), which received six months of intensive training and health education followed by six months of follow-up once a week, or to a control group (n=17). At baseline, six months and 12 months the participants were tested for anthropometrics, VO2max, blood lipids and blood pressure. Results: Compared to the control group the intervention group reduced waist circumference and fat mass, and increased VO2max by 4.1%, 6.5% and 9.9%, respectively. The difference between the two groups was significant (p<0.05) after six months, but not after 12 months. Conclusions: This small-scale study shows that this multidisciplinary outpatient lifestyle intervention program had beneficial effects on reducing several obesity-related cardiovascular risk factors after six months. However, in the conclusion several adjustments to this and similar programs are suggested to further improve the participants’ outcome and reduce drop-out