JMIR Publications

ABSTRACT

Background:

The greater prevalence of obesity and diabetes in some racial/ethnic groups, such as African Americans, underscores the importance of raising community awareness of diabetes prevention. Community Health Workers (CHWs) play a critical role in extending our reach into communities to raise awareness of diabetes prevention. Providing systematic training and support is central to the work of CHWs. Virtual approaches have been helpful in delivering training to overcome common barriers to participation. One virtual approach, immersive three-dimensional (3D) virtual worlds offer a unique approach to providing remote training incorporating engaging interactive contextual learning opportunities.

Objective:

The overall aims were to implement and evaluate an internet-based 3-D virtual world model to remotely deliver a CHW training to support their efforts to raise awareness about diabetes prevention in racial/ethnic minority communitie

Methods:

A sequential mixed-methods research design was used including a pre-post pilot and an explanatory phase examining the feasibility and acceptability of the virtual world training. Female CHWs who self-identified as African American/black/African Ancestry; between 21-65 years of age, fluent in English, and with risk factors for diabetes were recruited into the study. The diabetes prevention awareness training was delivered over 10 weeks. The primary quantitative pre-post training and behavioral outcomes included: content knowledge; confidence in training content and delivery skills; self-efficacy; and motivation for lifestyle change and eating habits. In the explanatory phase, feedback was collected from participants on acceptability and feasibility of the training and delivery approach. Quantitative and qualitative analysis approaches were used to examine the acceptability, feasibility, and preliminary impact of the virtual world training model.

Results:

A total of 26 CHWs initiated the study and 22 completed the post-assessment. The descriptive and exploratory pre-post results for the virtual world training group suggest changes in the direction of improvement for overall eating habits, stage of change, behavioral self-efficacy, fruit and vegetable intake, and knowledge score. The individual training session post-surveys indicated that greater than 95% of participants, on average, felt that their expectations were met across all sessions and content topics. Findings regarding satisfaction with the information provided and level of interactivity of the training sessions indicated that CHWs generally felt satisfied with the information provided and reported a high level of interactivity in the training. Results of the post-training acceptability and feasibility quantitative survey questions and post-training qualitative feedback were generally positive. Areas for further refinement and development of this virtual world training model (e.g., more training in avatar use) were also identified.

Conclusions:

Preliminary findings on the acceptability, feasibility, and preliminary impact of the virtual world training model are promising and support continued use and development of this approach. Clinical Trial: ClinicalTrials.gov Identifier: NCT04161846