Navigating Immersion: Usability Study of a Virtual Reality Application Designed for Older Adults with Dementia and Their Caregivers.

Patients’ acceptance of health care provider recommendations to initiate and escalate effective medications is critical to achieving the best outcomes in rheumatic diseases. However, acceptance of treat-to-target recommendations and adherence to treatment is often low in this population. Discordance between rheumatologists’ recommendations and patients’ willingness to escalate therapy was found to contribute to risk of developing difficult-to-treat rheumatoid arthritis. As postulated by the Health Belief Model, inaccurate perceptions of risk and severity of disease progression and/or the perception that treatment benefits do not outweigh the short-term potential harms and costs can negatively impact acceptance of treatment recommendations. The consequences of poorly controlled rheumatologic diseases are difficult to demonstrate using traditional risk communication approaches. Providing balanced information is essential to effectively frame appropriate messaging and present both the risks of undertreatment and the benefits of treatment in a way that is salient and cognitively impactful to patients. Interventions to support communication between patients and rheumatologists have the potential to increase treatment acceptance and improve patient outcomes. Owensby et al. examined perceived barriers to achieving treat-to-target goals among patients with rheumatoid arthritis and rheumatologists and found that suboptimal patient–rheumatologist communication and perceived patient medication risk aversion were among the most frequently endorsed barriers that could likely be addressed through a behavioral intervention. Patients with rheumatic disease face the prospect of negative future impacts on daily functioning and quality of life. Fraenkel et al. found that high disease activity was associated with future escalation of therapy in patients with rheumatoid arthritis, but only when the perceived severity of consequences of disease progression was high. Educational interventions that help patients better understand how their condition may progress over time if inadequately treated may support their decision-making related to engagement in, and maintenance of, the recommended treatment plan. Virtual reality (VR) offers a novel solution to improve perceptions of the risks of uncontrolled rheumatologic diseases. Because of the realistic qualities of an immersive VR experience, consequences of the natural progression of disease presented in VR can have greater salience compared with verbal or textual presentation. By creating a sense of “being there” (presence), a sense that events in VR are actually happening (plausibility), and a sense that the body of a virtual avatar is one’s own body (body ownership), immersive VR can simulate realistic scenarios allowing the user to experience “first-hand” the effects of disease progression on physical functioning and quality of life. Past research has demonstrated positive perceptions among the general public on the use of VR in health care, and as an intervention, VR has been shown to decrease pain and anxiety in patients with rheumatologic conditions. Additionally, VR serves as a valuable tool for conveying information to patients about their disease and for exercise training and rehabilitation. However, user acceptance of VR as an educational tool among people with rheumatologic conditions is unknown.