An immersive virtual reality behaviour change intervention to support retired and non-working adults to reduce prolonged bouts of sedentary activity
Healy, David
Healy, David
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Publication Date
2024-01-25
Type
Thesis
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Abstract
Background. It is currently understood that prolonged daily sedentary behaviour is independently associated with multiple morbidities and mortality across the adult lifespan. Epidemiological evidence suggests that older adults in particular are spending prolonged periods of time sedentary each day. However, many retired and non-working adults report that they ascribe meaning to sedentary activities, which appears to be one of the primary motivators for prolonged sedentarism in this cohort. It is therefore proposed that alternative non-sedentary activities are offered to retired and non-working adults that they can also ascribe meaning to in order to break up sedentary bouts. Immersive virtual reality is a novel digital technology that recent empirical research suggests older adults enjoy using. However, it is not yet well understood whether and how a technology such as this should be integrated into retired and non-working adults’ lives, and what conditions are necessary for it to be accessible, usable, safe, and meaningful for them. Aims. This thesis aimed to (1) identify factors influencing prolonged sedentary behaviour in retired and non-working adult populations (2) understand if older adults would be interested in using immersive virtual reality and, if so (3) develop and explore a behaviour change intervention prototype to support retired and non-working adults to take part in non-sedentary activities that they can ascribe meaning to in immersive virtual reality. Methodology. Following the person-based approach to digital health intervention development, a general examination of how meaningful non-sedentary immersive virtual reality activities could be co-created with retired and non-working adults was completed. The behaviour change wheel guide to intervention development was used to develop the intervention content. Four studies were completed. Study 1 involved a systematic review and thematic synthesis exploring older adults’ experiences and perceptions of immersive virtual reality. Study 2 followed the behaviour change wheel guide to translate evidence into intervention options to support retired and non-working adults to reduce their time spent sedentary using immersive virtual reality. Study 3 was a reflexive thematic analysis exploring the intervention content developed during Study 2 with 12 retired and non-working adults through semi-structured qualitative interviews. In line with the person-based approach, guiding principles were then developed to direct the design of a health behaviour change intervention prototype. Furthermore, a logic model was created to visualise the logical flow of the intervention and to guide the integration of intervention content into the mode of delivery. Finally, Study 4 involved optimising the intervention prototype (STAND-VR) informed by the knowledge generated during Studies 1-3, through a rapid analysis and reflexive thematic analysis. Five focus group interviews were completed with 12 retired and non-working adults to develop a refined iteration of the STAND-VR intervention prototype. Findings. The systematic review and thematic synthesis reported that with a few improvements to its existing hardware and software, as well as how it is first presented to older adults, immersive virtual reality could offer new opportunities for older adults to take part in meaningful activities tailored to their needs and preferences. Stages 1-3 of the behaviour change wheel were followed to develop intervention content that would offer retired and non-working adults additional, meaningful non-sedentary activities to take part in. The qualitative interview study exploring the content of the proposed intervention content reported how retired and non-working adults perceived immersive virtual reality before and after use, how they would like to learn to use immersive virtual reality, the content and people they would like to interact with and finally, their beliefs about their sedentary activity and using immersive virtual reality. Amendments were made to the intervention content based on this feedback and a logic model was developed, organising the content into intervention components that could be delivered using immersive virtual reality. Finally, results from the analysis of the focus group interviews reported that a number of improvements to the immersive virtual reality experience should be made, offering more instructions and practice time, minimising invasions of personal space, and a range of minor improvements to the functionality and appearance of the prototype. Themes relating to participants’ thoughts on immersive virtual reality as an experience as well as how immersive virtual reality compares to reality, and in what contexts they would use immersive virtual reality were also reported. A final iteration of the intervention prototype was developed and summarised through this final study. Conclusions. This thesis has generated formative evidence to support the further optimisation, evaluation, and implementation of a health behaviour change intervention that seeks to support retired and non-working adults to reduce their time spent sedentary through engagement with virtual non-sedentary activities they can find meaningful. Through a synthesis of qualitative studies exploring older adults’ experiences and perceptions of immersive virtual reality, and the development and refinement of intervention content to achieve the proposed target behaviour, a working prototype of the proposed intervention was developed and optimised in collaboration with key stakeholders and retired and non-working adults. By working with retired and non-working adults throughout the design process, the knowledge generated during this thesis offers important implications for intervention development, immersive virtual reality use in older cohorts, and sedentary behaviour research.
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NUI Galway