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Accepted for/Published in: JMIR Serious Games

Date Submitted: Oct 18, 2020
Date Accepted: Mar 13, 2021

The final, peer-reviewed published version of this preprint can be found here:

Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study

Langlet BS, Odegi D, Zandian M, Nolstam J, Södersten P, Bergh C

Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study

JMIR Serious Games 2021;9(2):e24998

DOI: 10.2196/24998

PMID: 33847593

PMCID: 8057519

Virtual Reality Application for Treating Eating Behaviour in Eating Disorders: Development and Usability Study

  • Billy Sundström Langlet; 
  • Dorothy Odegi; 
  • Modjtaba Zandian; 
  • Jenny Nolstam; 
  • Per Södersten; 
  • Cecilia Bergh

ABSTRACT

Background:

One of the more severe eating disorders is anorexia nervosa, characterised by reduced food intake, leading to emaciation and mental change. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a drop-out rate from 20% to 50% and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviours towards food. Virtual reality has been successful in treating vertigo, anxiety disorder and post-traumatic stress syndrome and could potentially be used as an aid in treating eating disorders.

Objective:

The aim of the current study was to evaluate the feasibility and usability of a Virtual Reality app intended for use by patients with eating disorders when eat training.

Methods:

Twenty-six participants, 19 eating disorder and 5 IT personnel, were recruited through emails and personal invitations. Participants used immersive virtual reality technology, comprised of a headset and two hand-controllers, to interact with food, first in a tutorial and then when eating an entire meal with feedback on eating rate. Participants then rated feasibility and usability by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usabilty Scale and a 20-point Heuristic Evaluation questionnaire. A Cognitive Walkthrough was also conducted, using video recordings of participants interactions in the virtual environment.

Results:

The mean (SD) age of participants was 37.9 (9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggest implementation of the app would face minor infrastructural, technological, interoperability, financial and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use, but most participants agreed the app should be used at least once per week. The application scored 73.4 (min 55, max 90), earning a ‘Good’ rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6, out of 5. The lowest score (2.6) was given to ‘Accuracy’. During the cognitive walkthrough 32% of participants displayed difficulty understanding what to do at the initial selection screen. After the selection screen all participants understood how to progress through the tasks of the app.

Conclusions:

Participants found the app usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges of the current app, participants thought the app should be improved to allow environmental and social (e.g., crowded room vs eating alone) challenges.


 Citation

Please cite as:

Langlet BS, Odegi D, Zandian M, Nolstam J, Södersten P, Bergh C

Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study

JMIR Serious Games 2021;9(2):e24998

DOI: 10.2196/24998

PMID: 33847593

PMCID: 8057519

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