Virtual worlds: public health opportunities
October 29th, 2009 | 
Author: I spent some time today reading some fascinating (offline) information about the 1918-1919 influenza pandemic and later on stumbled across an interesting article by Robert Bloomfield on the recent H1N1 (Swine Flu) outbreak. The take home message:
If you look at it this way, epidemics provide something of a ‘perfect storm’ for virtual worlds. They generate a strong demand for high-engagement distance collaboration (especially education for children and telecommuting for parents), and cause little damage to our infrastructure. So they are the right place to start.
It’s hard to argue with, although in a high-stress pandemic situation, it’s easy to see how people would naturally revert to to more hardy technologies like the phone. Time is likely to change that perspective though.
Informed consent for medical procedures: the use of virtual environments
Dr Suzanne Conboy Hill is a Consultant Clinical Psychologist and a Visiting Research Fellow at the University of Brighton in the UK. She appeared on Radio National’s Future Tense program this morning, talking about her involvement in a virtual hospital project that I’ve mentioned here previously.
It’s an interview well worth listening to for the passion Dr Conboy Hill shows for the topic and her belief on the opportunities virtual worlds provide around informed consent for medical procedures by those with some form of mental impairment. It’s an area I hadn’t thought about much, but it makes sense that an immersive 3D environment would be an ideal medium to promote understanding of medical procedures in a non-threatening environment.
The key challenge at this stage is giving the level of access to provide those benefits in a more widespread way. Additionally, equipping current students of health sciences with the knowledge to navigate such environments is another challenge in an already crowded curriculum in most circumstances.
The same episode of Future Tense also has a short interview with me on the media hype cycle with virtual worlds, their role in education and the precedents likely to be set by the pending class action against Linden Lab on intellectual property grounds.
Posted in Disability, Health Industry | 
Tags: future tense, imperial london hospital, media | 
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Virtual worlds and health: some media focus
The past couple of weeks have seen some interesting articles in the mainstream media on virtual environments and health.
The first is in the Jerusalem Post, showing the benefits for the vision impaired. You can view the full article here.
The second appears in Information Week and covers the use of Second Life by Chicago Children’s Memorial Hospital for disaster preparedness and the work done on Virtual Ability island.
I’m noticing a slow but steady trickle of mainstream news reporting on the opportunities of virtual environments and health. The challenge is to ensure there’s really solid evidence to back those claims when they receive more widespread scrutiny.
HIV/AIDS education and virtual environments
(This story originally appeared over at The Metaverse Journal)
The Virtual World’s Story Project (TVWSP) is a partnership between Jena Ball (SL: Jenaia Morane) and Marty Keltz (SL: Marty Snowpaw). We’ve previously covered one of their other story quests and they’ve certainly been prolific in the health and education field.
Their latest project is focused on HIV/AIDS and is titled The Life and Times of Uncle D, which you can get a taste of in this four-minute summation:
This week sees the in-world launch of The Life and Times of Uncle D. It’s occurring on the 1st October at Noon SL time, which is 5am on Friday the 2nd October AEST – you can find out more info here on the TVSWP site.
It’s another example of the power of machinima, and the virtual environments they’re created in, to assist in providing meaning to real world issues.
(For those interested in the use of virtual worlds in sexual health education or in health more broadly, don’t forget to keep an eye on sister-site Metaverse Health.)
The Journal of Virtual Worlds and Education
It’s great to see the research base for virtual worlds continuing to grow. A new addition is the Journal of Virtual Worlds and Education. It states its mission simply:
The Journal of Virtual Worlds and Education is a trans-disciplinary academic journal that offers a publication venue for articles and authors examining issues, ideas, and research inspired by the intersection of emerging virtual worlds technologies and education. The Journal maintains the highest standards of peer review and seeks to attract and engage new and emerging authors and scholars across the globe.
The call for papers for the first issue (to be published online early 2010) is already out. Given the dynamism of Australian educators in virtual worlds, I’d be surprised if this neck of the real world woods isn’t well represented in future issues.
Midwifery, Birthing and Second Life
For the past couple of years I’ve been aware of the work going on in New Zealand with midwifery training and Second Life, mostly thanks to the updates over at SLENZ.
Machinima maker Pooky Amsterdam dropped me a line about a film she’s helped produce that explains the role of Te Wāhi Whānau – The Birth Place in Second Life. The lead educator on the project is Sarah Stewart (SL: Petal Stransky), with SLENZ Project co-leader, Terry Neal (SL: Tere Tinkel) and Scotland based Russell (Rosco) Boyd also heavily involved.
After walking through the actual build and after watching the machinima, the main impression I’m left with is how midwife-driven this project is. What I mean by that, is the birthing unit is so much better than most in existence in the real world. As a Registered Nurse (but not a midwife), I’ve witnessed half a dozen births and even from that limited perspective I can totally appreciate how much better a birthing environment Te Wāhi Whānau is compared to even the better hospital-based birthing units. As a clinical simulation for midwives, I can see its power as a key adjunct to lab-based learning and practicums. The gamut from initial assessment of labour to initiating breastfeeding and perineal care is covered in a comprehensive way.
Take some time to watch the 6-minute machinima:
The SLENZ team deserve major kudos for their work over the past couple of years – they’re some of the true pioneers in virtual worlds and health.
You can of course view the birthing unit for yourself here.
The physical health impacts of virtual environments
(Originally published earlier this week over at The Metaverse Journal)
Over the past few days a product announcement and some interesting research have come together for me in illustrating some of the downsides of heavy regular use of virtual environments. I’m talking specifically about the physical impacts here: we’ve covered the psychological positives and negatives repeatedly (e.g. here and here). In regard to the psychological side, I’ve always believed the benefits and opportunities well outweigh the downsides, which is being recognised by professionals working in the area.
The research that caught my eye comes from the American Journal of Preventative Medicine, as reported by MSNBC. The researchers tested the hypothesis that gamers tended to be more overweight and had poorer mental health than non-players. The results, after surveying 552 people in the Seattle area of the US, showed that the hypothesis was essentially correct. Looking at the overweight issue, most people may say “well gee there’s no surprise there”. The gamer stereotype is certainly one of the overweight male staying up at all hours whilst eating endless bags of potato chips. Like any stereotype there can be distorted echoes of reality and this research is doing just that. I doubt there’s anyone claiming that heavy gaming or virtual environment use is good for one’s physical health in respect to exercise and nutrition. Sure, consoles like the Wii are increasing the level of physical activity but the jury is well and truly out on whether it equates to other forms of desirable physical activity. This research was conducted in 2006 but only published now, with an admission it’s just a taste for further research needing to be done – its findings however do point to the challenges for gaming, and by association, virtual environments.
The product announcement that I saw not long after the research above was for an MMO-gaming mouse produced by Razer, called the Naga. Here’s Razer’s PR pitch for it:
It’s not unique in that there’s no shortage of multi-button gaming mouses. What struck me though was the twelve buttons on the left-hand side that are designed purely for thumb use. Knowing the pace of MMO gaming at times, it seems astounding to me that you’d put one thumb through the trauma of operating twelve buttons continuously. In the five minutes-plus of sales pitch above, you’ll hear the word ‘comfort’ a few times, but that’s it. You’ll also hear a couple of mentions of statements like “playing all day” as qualifications for the level of effort that went into producing the design.
Am I alone in thinking that no matter how good the device’s ergonomics are, relying on one digit to control twelve buttons is a recipe for disaster? Sure, the heavy use of a keyboard for the same activity isn’t ideal either, but usually the repetition is spread around a few more digits if keyboard shortcuts are being used. Of course, gaming is different to broader virtual world use, but in proportion the same issues remain.
My point overall? Virtual environments are really no different to the real world in respects of the need to engage in physical activity. The ever improving development of new interface options may assist, but the reality in the short to medium term is that plenty of real world concentration on nutrition and exercise is needed. The three people I know best who are involved in virtual environments 8-16 hours a day all own pets and tend to have an exercise schedule. Do you?
Healthcare Support Groups in Virtual Worlds
As promised, I wanted to spend some time going over the recent handful of peer-reviewed papers submitted for the health-focused recent issue of the Journal of Virtual Worlds Research.
First cab off the rank is the paper titled The Growth and Direction of Healthcare Support Groups in Virtual Worlds by John Norris. Its focus is a review of four virtual worlds (Second Life, Kaneva, There and IMVU) and the breadth and popularity of support groups in existence around health issues.
For the regular virtual worlds follower, there’s nothing too surprising in the findings, but they’re noteworthy all the same:
- Second Life support groups revolved predominantly around disabilities and mental health issues in regards to numbers of members.
- IMVU groups also featured mental health issues heavily,mainly due to a very popular ‘Suicide, Depression, and Relationships’ group.
- There.com skewed toward general health topics with a significant cohort of interest in the disabilities area.
- Kaneva had a slightly different focus on Gay, Lesbian and Transgender issues, as well as autism.
There is a caveat openly referred to by John Norris in his work: the numbers of participants in these groups are relatively small, particularly when compared to the burgeoning 2D health support space with its myriad discussion forums and other community mechanisms. That said, he makes some good assertions:
1. That the advent of virtual worlds provides another means for people to seek highly customised healthcare support, meaning the potential for finding the exact niche being sought is higher as adoption grows.
2. That, like any emerging area of healthcare, there needs to be more research done on the efficacy of the approach.
3. That the lack of access to good quantitative and qualitative data poses a challenge for those who see the need for more research.
Journal of Virtual Worlds Research: 3D Virtual Worlds for Health and Healthcare
The Journal of Virtual Worlds Research continues to go from strength to strength, and the current edition is devoted to health and virtual worlds. I’ll be writing about some of the specific pieces in coming weeks, but you’ll see the full table of contents below:
Table of Contents
Editor’s Corner
Musings on the State of ‘3-D Virtual Worlds for Health and Healthcare’ in 2009
Maria Toro-Troconis, Maged N. Kamel Boulos
Invited Articles
Virtual Worlds in Health Care Higher Education
Constance M Johnson, Allison A Vorderstrasse, Ryan Shaw
Peer Reviewed Research Papers
The Growth and Direction of Healthcare Support Groups in Virtual Worlds
John Robert Norris
Development of a Virtual Reality Coping Skills Game to Prevent Post-Hospitalization Smoking Relapse in Tobacco Dependent Cancer Patients
Paul Krebs, Jack Burkhalter, Shireen Lewis, Tinesha Hendrickson, Ophelia Chiu, Paul Fearn, Wendy Perchick, Jamie Ostroff
Does this Avatar Make Me Look Fat? Obesity and Interviewing in Second Life
Elizabeth Dean, Sarah Cook, Michael Keating, Joe Murphy
Research Papers
Development and Evaluation of Health and Wellness Exhibits at the Jefferson Occupational Therapy Education Center in Second Life
Susan Toth-Cohen, Therese Gallagher
Research-in-Brief Papers
Development of Virtual Patient Simulations for Medical Education
Douglas R Danforth, Mike Procter, Richard Chen, Mary Johnson, Robert Heller
“Think Pieces”
Virtual Worlds, Collective Responses and Responsibilities in Health
Rashid M Kashani, Anne Roberts, Ray Jones, Maged N. Kamel Boulos
Pitfalls in 3-D Virtual Worlds Health Project Evaluations: The Trap of Drug-trial-style Media Comparative Studies
Maged N. Kamel Boulos, Inocencio Maramba
Towards a virtual doctor-patient relationship: Understanding virtual patients.
Vanessa Gamboa González
Editor-in-Chief’s Corner
Cultural Identity in Virtual Reality (VR): A Case Study of a Muslim Woman with hijab in Second Life(SL)
Methal Mohammed
Shaping the ‘Public Sphere’ in Second Life: Architectures of the 2008 U.S. Presidential Election
Annabel Jane Wharton
World of Warcraft Addiction: send in the field teams
The UK’s Telegraph newspaper has run a very interesting article on the issue of addiction and World of Warcraft.
The key quote for me from the article, from Consultant Psychiatrist, Dr Richard Graham:
He has called on Blizzard Entertainment, the company that makes World of Warcraft, to waive or discount the costs associated with joining the game so that therapists can more easily communicate with at-risk players in their preferred environment.
It’s not an unusual perspective in addictions, but I have some doubts in the efficacy of it in relation to World of Warcraft. If the aim is purely initial engagement, then this could be a successful approach. It’s unlikely the intention is to provide actual treatment, As mentioned by Dr Andrew Campbell in his recent interview with me, there’s not a lot of evidence to support treatment within what is the primary stimulus for the issue.
At the end of it, it’s also hard to imagine Blizzard coughing up a bunch of free accounts for practitioners – it’d potentially be a PR nightmare. Also, the health professionals may stand out a little if they don’t understand the dynamics and social etiquettes of the game. Of course, the only way they can do that is by spending time in-game. Perhaps there needs to be a Blizzard-sponsored WoW training program for health professionals?