Increasing the Potency of Skill Based Health Promotion Interventions with Virtual and Mixed Reality Simulations Involving Avatars

Introduction: Skill building has been identified as critical to the effectiveness of many health promotion interventions. Virtual Reality (VR) and Mixed Reality (MR) simulations involving avatars can be used to create immersive, real time, practice sessions which can boost potency or reinforce skill building intervention effects in the post-intervention period. These practice sessions can replace or supplement traditional role play and return demonstration activities. The purpose of this paper is to: (1) introduce VR/MR simulation involving avatars, (2) discuss why, and offer examples of how VR/MR might be used to increase the potency of different health promotion intervention programs, including those used for HIV prevention, and (3) illustrate various essential aspects of developing and testing a primarily VR simulation skill building component for the Mighty Girls pregnancy prevention program.

Methods:  Explanation of VR/MR, and a review of game design, developmental psychology and prevention science theories and concepts. Presentation of formative and feasibility testing research activities used to create and assess the potential of a primarily VR simulation game involving avatars (DRAMA-RAMA) as the skill building component for the Mighty Girls pregnancy prevention intervention created for early adolescent girls. Description of efficacy trial planning as it relates to technology delivery.

Results: Operationalization of essential aspects was guided by an interdisciplinary team (computer science, communication science, theatre, nursing), and a theoretical framework that integrates key concepts and theories in developmental psychology, prevention science, and game design. The net result was the development of a primarily VR simulation component delivered in a game format using digital puppetry controlled by inter-actors. Specific research activities included: interactive focus groups (n = 15); field work; low and high tech testing with early adolescents (n = 6); high tech testing with adult stakeholders (n = 6); a randomized control, feasibility trial (n = 46), conducted in a high risk population in an afterschool setting; and planning an effectiveness trial. Results support appeal, intervention tailoring, delivery fidelity, and potential effectiveness, but also identify scalability related challenges.

Conclusions: Findings illustrate how to incorporate use of VR/MR in skill building interventions, issues to consider for success, and the challenges associated with the scalability of programs involving such potentially promising, innovative technologies. Flexibility, creative problem solving, and a team committed to transdisciplinary science may be essential to both the development of new technologies for prevention science and making programs involving such technologies scalable.