Langener Simon, Kolkmeier Jan, VanDerNagel Joanne, Klaassen Randy, van Manen Jeannette, Heylen Dirk
Department of Human Media Interaction, University of Twente, Enschede, Netherlands.
Centre for Addiction and Intellectual Disability, Tactus Addiction Care, Enschede, Netherlands.
JMIR Form Res. 2023 Apr 26;7:e42523. doi: 10.2196/42523.
People with mild to borderline intellectual disability (MBID; IQ=50-85) are at risk for developing an alcohol use disorder (AUD). One factor contributing to this risk is sensitivity to peer pressure. Hence, tailored trainings are needed to practice alcohol refusal in impacted patients. Immersive virtual reality (IVR) appears promising to engage patients in dialogs with virtual humans, allowing to practice alcohol refusal realistically. However, requirements for such an IVR have not been studied for MBID/AUD.
This study aims to develop an IVR alcohol refusal training for patients with MBID and AUD. In this work, we cocreated our peer pressure simulation with experienced experts in addiction care.
We followed the Persuasive System Design (PSD) model to develop our IVR alcohol refusal training. With 5 experts from a Dutch addiction clinic for patients with MBID, we held 3 focus groups to design the virtual environment, persuasive virtual human(s), and persuasive dialog. Subsequently, we developed our initial IVR prototype and conducted another focus group to evaluate IVR and procedures for clinical usage, resulting in our final peer pressure simulation.
Our experts described visiting a friend at home with multiple friends as the most relevant peer pressure situation in the clinical setting. Based on the identified requirements, we developed a social-housing apartment with multiple virtual friends present. Moreover, we embedded a virtual man with generic appearance to exert peer pressure using a persuasive dialog. Patients can respond to persuasive attempts by selecting (refusal) responses with varying degrees of risk for relapse in alcohol use. Our evaluation showed that experts value a realistic and interactable IVR. However, experts identified lacking persuasive design elements, such as paralanguage, for our virtual human. For clinical usage, a user-centered customization is needed to prevent adverse effects. Further, interventions should be therapist delivered to avoid try-and-error in patients with MBID. Lastly, we identified factors for immersion, as well as facilitators and barriers for IVR accessibility.
Our work establishes an initial PSD for IVR for alcohol refusal trainings in patients with MBID and AUD. With this, scholars can create comparable simulations by performing an analogous cocreation, replicate findings, and identify active PSD elements. For peer pressure, conveying emotional information in a virtual human's voice (eg, paralanguage) seems vital. However, previous rapport building may be needed to ensure that virtual humans are perceived as cognitively capable entities. Future work should validate our PSD with patients and start developing IVR treatment protocols using interdisciplinary teams.
轻度至边缘性智力障碍（MBID；智商=50-85）的人有患酒精使用障碍（AUD）的风险。导致这种风险的一个因素是对同伴压力敏感。因此，需要为受影响的患者量身定制训练，以练习拒绝饮酒。沉浸式虚拟现实（IVR）似乎有望让患者与虚拟人进行对话，从而切实地练习拒绝饮酒。然而，尚未针对MBID/AUD对这种IVR的要求进行研究。
本研究旨在为患有MBID和AUD的患者开发一种IVR拒绝饮酒训练。在这项工作中，我们与成瘾护理方面的经验丰富的专家共同创建了同伴压力模拟。
我们遵循说服系统设计（PSD）模型来开发我们的IVR拒绝饮酒训练。我们与一家荷兰成瘾诊所的5位针对MBID患者的专家举行了3次焦点小组会议，以设计虚拟环境、有说服力的虚拟人以及有说服力的对话。随后，我们开发了最初的IVR原型，并进行了另一次焦点小组会议，以评估IVR及临床使用程序，从而形成了我们最终的同伴压力模拟。
我们的专家将在家中与多个朋友拜访一位朋友描述为临床环境中最相关的同伴压力情境。基于确定的要求，我们开发了一个有多个虚拟朋友在场的社会住房公寓。此外，我们嵌入了一个外貌普通的虚拟男性，通过有说服力的对话施加同伴压力。患者可以通过选择具有不同程度复饮风险的（拒绝）回复来回应有说服力的尝试。我们的评估表明，专家重视逼真且可交互的IVR。然而，专家指出我们的虚拟人缺乏有说服力的设计元素，如副语言。对于临床使用，需要以用户为中心进行定制，以防止产生不良影响。此外，干预应由治疗师进行，以避免MBID患者进行尝试错误。最后，我们确定了沉浸因素以及IVR可及性的促进因素和障碍。
我们的工作为针对患有MBID和AUD的患者的拒绝饮酒训练建立了IVR的初始PSD。据此，学者们可以通过进行类似的共同创建来创建可比的模拟、复制研究结果并识别活跃的PSD元素。对于同伴压力，用虚拟人的声音传达情感信息（如副语言）似乎至关重要。然而，可能需要事先建立融洽关系，以确保虚拟人被视为具有认知能力的实体。未来的工作应在患者中验证我们的PSD，并开始使用跨学科团队制定IVR治疗方案。
