The Personalized Creation of Immersive Virtual Environments to Promote Emotional Well-being

A Proof-of-Concept Study: The Personalized Creation of Immersive Virtual Environments to Promote Emotional Well-being in Older Adults

Background: Virtual Reality (VR) technology has seen a growing adoption in clinical and healthcare settings. VR applications are both effective and acceptable, with a great potential for populations with mobility restrictions, such as older adults receiving home-based care or in long-term care facilities. However, creating head-mounted display virtual reality (HMD-VR) environments still faces considerable challenges.

Aim: The aim is to create three HMD-VR environments and to carry out a proof of concept to verify their impact on older adults.

Methods: This research uses mixed methodology to design three immersive environments with human-centred design and verify its impact with a study sample consisting of 31 people; 18 women and 13 men, of whom 16 were over 89 years old, 11 were between 79 and 89 years old, and 4 people were between 66 and 77 years old. Each participant viewed the three virtual reality environments and answered the Positive and Negative Affect Schedule (PANAS) scale, the Slater-Usoh-Steed (SUS) Presence Questionnaire, and the Simulator Sickness Questionnaire (SSQ).

Phase I was based on observational, cross-sectional, and mixed-method (quantitative and qualitative) approaches. Phase II was based on a multicentre pre-post quasi-experimental pilot study (proof-of-concept feasibility study) with a cross-sectional design and used a mixed methodology approach combining quantitative and qualitative data.

Phase I was conducted with users of the Home-Based Care (HBC) of the Manlleu City Council, located in the province of Barcelona (Spain). Initial contact and recruitment took place in September 2023, during which potential participants were informed about the aims and procedures of the study. Data collection among eligible HBC users was conducted in November 2023. The inclusion and exclusion criteria were applied jointly with the HBC technical staff to ensure the suitability and safety of the participants.

Phase II was implemented in five residential centres for older adults: La Bona Mar, Vida per l'Avi, Sant Marc, Llar per l'Avi, and Vida als Anys, located in the municipalities of Vilassar de Mar and Mataró (Spain). The centres were first contacted in December 2023, followed by a coordination meeting with the multidisciplinary teams (including social workers, social educators, psychologists, and physiotherapists). Participant selection and recruitment were performed in January 2024, in collaboration with the professional staff of each centre. All eligible residents were considered, considering the clinical criteria. Data collection with residents took place in January and February 2024. In March 2024, additional data were collected from the multidisciplinary teams to obtain their perceptions of the intervention's impact.

Phase I followed a standardized protocol designed to ensure the safe and comfortable use of the HMD-VR device by participants with personal vulnerability factors. The protocol was developed in accordance with recommendations for HMD-VR use in vulnerable populations and considering social and mental health aspects described in recent research.

The protocol was briefly described as follows: an HMD-VR acclimatization period was included, and assistance was provided for properly fitting the HMD-VR headset. A technician provided continuous supervision throughout the session. To ensure immersion and prevent distraction, participants always remained seated within a closed room to block out external sounds during the HMD-VR exposure.

A questionnaire was developed to collect information on participants' preferences, experiences, and relevant elements for the creation of the VR environments. Its structure and content were based on previous work evaluating VR experiences in vulnerable groups.

Participant selection was performed by the management team of the Home Care Service, in collaboration with each participant's reference professional, ensuring full adherence to the inclusion and exclusion criteria.

Data collection took place in participants' homes. Each participant was exposed to four HMD-VR environments presented in random order (alternating order), followed by completion of the questionnaire. The complete session lasted approximately 60 minutes. The technician continuously monitored participants throughout the session for adverse effects (e.g., dizziness, eye strain).

In Phase II, the standardized protocol was also followed. An HMD-VR acclimatization period was included with assistance from the technician to fit the headset correctly. VR Adverse effects (e.g., dizziness, eye strain) were continuously monitored throughout the session. Participants remained seated in a closed room that blocked external noise during the entire VR exposure to guarantee immersion and avoid distractions.

First, a meeting was held with the management and multidisciplinary teams (e.g., social workers, psychologists, physiotherapists) to determine the sample and schedule. Individual data collection sessions were conducted in a designated room at each of the five centers, using the Oculus Quest 2 HMD-VR system.

Each participant completed a questionnaire (10-15 minutes) and was then randomly assigned to one of the three HMD-VR environments. All participants experienced the three HMD-VR environments in alternating order. The total participation time was approximately 60 minutes per individual.

Finally, center staff completed a 10-minute electronic questionnaire (Microsoft Forms) to assess the study's impact on residents, providing sociodemographic, role-related, and impact feedback after providing informed consent.

Inclusion Criteria:

• Gender (preference for equality between men and women).
• Users of the Home Care Service (SAD) and elderly people from the five residential centres.
• Age (first phase over 18 years old and second phase over 65 years old).
• Participation in this study was completely voluntary, and all participants signed an informed consent form before taking part in the research.

Exclusion Criteria:

• People who suffer from any anomaly in binocular or auditory vision.
• People with physical or mental disabilities, or pre-existing psychiatric disorders, with serious medical conditions.
• People who suffer from any cardiovascular disease are susceptible to being affected by HMD-VR technology.
• People who suffer from symptoms related to epilepsy.
• People who have any electronic device, such as a cardiac pacemaker or other implanted medical device susceptible to being altered by HMD-VR technology.