Beverly Elizabeth Ann, Love Carrie, Love Matthew, Williams Eric, Bowditch John
Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, United States.
Game Research and Immersive Design Lab, J Warren McClure School of Emerging Communication Technologies, Ohio University, Athens, OH, United States.
JMIR Diabetes. 2021 Jan 27;6(1):e23708. doi: 10.2196/23708.
In southeastern Appalachian Ohio, the prevalence of diabetes is 19.9%, nearly double that of the national average of 10.5%. Here, people with diabetes are more likely to have a delayed diagnosis, limited access to health care, and lower health literacy. Despite the high rates of diabetes in the region, the availability of endocrinologists and certified diabetes care and education specialists is limited. Therefore, innovative strategies to address the growing diabetes care demands are needed. One approach is to train the primary care workforce in new and emerging therapies for type 2 diabetes to meet the increasing demands and complexity of diabetes care.
The aim of this study was to assess the effectiveness of a virtual reality training program designed to improve cultural self-efficacy and diabetes attitudes.
Health care providers and administrators were recruited from large health care systems, private practices, university-owned hospitals or clinics, Federally Qualified Health Centers, local health departments, and AmeriCorps. Providers and administrators participated in a 3-hour virtual reality training program consisting of 360-degree videos produced in a professional, cinematic manner; this technique is called virtual reality cinema (cine-VR). Questionnaires measuring cultural self-efficacy, diabetes attitudes, and presence in cine-VR were administered to providers and administrators before and after the program.
A total of 69 participants completed the study. The mean age of the sample was 42.2 years (SD 13.7), 86% (59/69) identified as female, 83% (57/69) identified as White, 86% (59/69) identified as providers, and 25% (17/69) identified as nurses. Following the training program, we observed positive improvements in all three of the cultural self-efficacy subscales: Cognitive (mean change -1.29; t=-9.309; P<.001), Practical (mean change -1.85; t=-9.319; P<.001), and Affective (mean change -0.75; t=-7.067; P<.001). We observed the largest magnitude of change with the subscale, with a Cohen d of 1.16 indicating a very large effect. In addition, we observed positive improvements in all five of the diabetes attitude subscales: Need for special training (mean change -0.21; t=-6.154; P<.001), Seriousness of type 2 diabetes (mean change -0.34; t=-8.114; P<.001), Value of tight glucose control (mean change -0.13; t=-3.029; P=.001), Psychosocial impact of diabetes (mean change -0.33; t=-6.610; P<.001), and Attitude toward patient autonomy (mean change -0.17; t=-3.889; P<.001). We observed the largest magnitude of change with the Psychosocial impact of diabetes subscale, with a Cohen d of 0.87 indicating a large effect. We observed only one significant correlation between presence in cine-VR (ie, Interface Quality) and a positive change score (ie, Affective self-efficacy) (r=.285; P=.03).
Our findings support the notion that cine-VR education is an innovative approach to improve cultural self-efficacy and diabetes attitudes among health care providers and administrators. The long-term impact of cine-VR education on cultural self-efficacy and diabetes attitudes needs to be determined.
在俄亥俄州阿巴拉契亚地区东南部，糖尿病患病率为19.9%，几乎是全国平均水平10.5%的两倍。在此地，糖尿病患者更有可能诊断延迟、获得医疗保健的机会有限且健康素养较低。尽管该地区糖尿病发病率很高，但内分泌科医生以及认证糖尿病护理和教育专家的数量有限。因此，需要创新策略来应对日益增长的糖尿病护理需求。一种方法是培训基层医疗人员掌握2型糖尿病的新型和新兴疗法，以满足糖尿病护理日益增长的需求和复杂性。
本研究的目的是评估旨在提高文化自我效能感和糖尿病相关态度的虚拟现实培训项目的有效性。
从大型医疗系统、私人诊所、大学附属医院或诊所、联邦合格健康中心、当地卫生部门和美国志愿服务团招募医疗保健提供者和管理人员。提供者和管理人员参加了一个3小时的虚拟现实培训项目，该项目由以专业电影方式制作的360度视频组成；这种技术称为虚拟现实电影（cine-VR）。在项目前后，对提供者和管理人员进行了测量文化自我效能感、糖尿病相关态度以及在cine-VR中的沉浸感的问卷调查。
共有69名参与者完成了研究。样本的平均年龄为42.2岁（标准差13.7），86%（59/69）为女性，83%（57/69）为白人，86%（59/69）为提供者，25%（17/69）为护士。在培训项目之后，我们观察到文化自我效能感的所有三个子量表都有积极改善：认知（平均变化-1.29；t=-9.309；P<.001）、实践（平均变化-1.85；t=-9.319；P<.001）和情感（平均变化-0.75；t=-7.067；P<.001）。我们观察到该子量表的变化幅度最大，科恩d值为1.16，表明效果非常显著。此外，我们观察到糖尿病相关态度的所有五个子量表都有积极改善：对特殊培训的需求（平均变化-0.21；t=-6.154；P<.001）、2型糖尿病的严重性（平均变化-0.34；t=-8.114；P<.001）、严格血糖控制的价值（平均变化-0.13；t=-3.029；P=.001）、糖尿病的心理社会影响（平均变化-0.33；t=-6.610；P<.001）以及对患者自主性的态度（平均变化-0.17；t=-3.889；P<.001）。我们观察到糖尿病的心理社会影响子量表的变化幅度最大，科恩d值为0.87，表明效果显著。我们仅观察到在cine-VR中的沉浸感（即界面质量）与积极变化得分（即情感自我效能感）之间存在显著相关性（r=.285；P=.03）。
我们的研究结果支持这样一种观点，即cine-VR教育是一种创新方法，可提高医疗保健提供者和管理人员的文化自我效能感和糖尿病相关态度。需要确定cine-VR教育对文化自我效能感和糖尿病相关态度的长期影响。
