The Elderly Perceived Meanings and Values of Virtual Reality Leisure Activities: A Means-End Chain Approach

Experiences and perceptions of palliative care patients receiving virtual reality therapy: a meta-synthesis of qualitative studies

BACKGROUND

The combination of virtual reality (VR) and palliative care potentially represents a new opportunity for palliative care. Many previous studies have evaluated the application of VR therapy to patients with advanced disease receiving palliative care. However, patient-perspective reviews to comprehensively understand the actual experiences and feelings of patients and provide practical guidance for designing future studies are currently lacking. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in palliative care.

METHODS

This study was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement guidelines. Ten databases, namely, PubMed, Web of Science, EBSCO, OVID MEDLINE, Scopus, John Wiley, ProQuest, CNKI, WANFANG DATA, and SinoMed, were searched, and qualitative and mixed studies from the establishment of each database to June 30, 2023 were included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes.

RESULTS

The nine selected studies altogether included 156 participants from seven hospice care facilities of different types and two oncology centers. Three key themes were identified: experiences of palliative care patients in VR therapy, the perceived value that palliative care patients gain in VR therapy, and perspectives of palliative care patients toward using VR therapy.

CONCLUSIONS

The patients' feedback covered discomfort caused by VR devices, good sense of experiences, and situations that affected the interactive experience. Some patients were unable to tolerate VR therapy or reported newer forms of discomfort. The findings indicated that VR therapy may be an effective approach to relieve patients' physical and psychological pain and help them gain self-awareness. Moreover, patients showed a preference for personalized VR therapy.

Self-assessment of the health status and leisure activities of individuals on haemodialysis

Self-assessment of health status is an important marker of social and health aspects. Haemodialysis is an option for renal replacement therapy that alters daily life and impacts social participation and the performance of tasks that give the subject a socially accepted role. In this scenario, leisure activities have the potential to generate well-being and are associated with several aspects of daily life, but few studies have analysed their relationship with the self-assessment of health status. This is a cross-sectional, census study with 1024 individuals from haemodialysis units of a Southeast Brazilian region, with the application of a questionnaire in 2019. We calculated the difference between the proportions of self-assessment of health status (positive and negative) and the two logistic regression models. The chances of individuals on haemodialysis negatively evaluating their health increase when they do not perform artistic leisure activities (OR 2.15; 95% CI 1.35-3.43), physical and sports activities (OR 3.20; 95% CI 1.86-5.52), intellectual (OR 2.21; 95% CI 1.44-3.41), manuals (OR 1.82; 95% CI 1.22-2.72), social (OR 2.74; 95% CI 1.74-4.31), tourist (OR 2.08; 95% CI 1.37-3.17) and idleness and contemplative (OR 1.92; 95% CI 1.29-2.85). Negative health self-assessment is associated with not practicing artistic, manual, physical and sporting, social, intellectual, tourist, and contemplative leisure activities, which have the function of providing social participation and giving meaning to life.

Applicability of an immersive virtual reality system for assessing route learning in older adults

Spatial orientation is defined as the ability to find one’s way around an environment, follow familiar routes, recognize places, and learn new routes. Spatial disorientation is one of the early symptoms of Alzheimer’s disease (AD), and traditional cognitive evaluation lacks ecological validity. Therefore, new assessment methods are needed for the early identification of this cognitive impairment.

A Performance Evaluation Matrix for Measuring the Life Satisfaction of Older Adults Using eHealth Wearables

eHealth wearables can track users’ state of health, record their physiological data, and facilitate self-care. In this study, we examined whether they enhance older adults’ casual exercise willingness and life satisfaction. After reviewing the related literature, the performance and satisfaction of elements for older adults to use eHealth Wearables were determined. The elements were derived from the means–end chain analysis. Three dimensions, product attributes, beneficial consequences, personal values, and responding elements, were identified first. The Performance Evaluation Matrix (PEM) was then established to determine the elements to be improved. A total of 250 questionnaires were distributed, out of which 206 valid questionnaires were completed and returned. In the proposed PEM, the product attributes that were in the priority improvement zone were accessibility, learnability, usability, affordability, positioning, pedometer, heart rate monitor, and data feedback. These elements are the most essential properties in need of improvement.

Cycle more with virtual reality: a proof of concept study in an institutionalised able-bodied geriatric population

BACKGROUND/OBJECTIVES

Physical activity (PA) has significant benefits for older adults. However, the recommended PA is rarely achieved in nursing homes. In this proof of concept study, we assessed whether virtual reality (VR) could help to increase spontaneous PA during a stationary cycling session.

DESIGN

Prospective crossover proof of concept study.

SETTING

Nursinghome.

PARTICIPANTS

Twelve participants (10 men) aged 63-88, able-bodied but with moderate cognitive impairment.

INTERVENTION

TWO stationary cycling sessions with and withoutVR.

MEASUREMENTS

Cycling distance, pedalling duration, average speed, mean pedalling cadence and the modified Borg rating of perceived exertion scale.

RESULTS

Cycling distance and duration were significantly higher in the VR condition. Most participants would rather repeat cycling sessions with VR than without.

CONCLUSION

The use of VR seems feasible to help achieve PA recommendations for able-bodied people living in nursing homes, even with moderate cognitive impairments.

How Do Location-Based Augmented Reality Games Improve Physical and Mental Health? Evaluating the Meanings and Values of Pokémon Go Users' Experiences through the Means-End Chain Theory

New technology has dramatically changed online games and blurred the boundary between active and passive activities. This study aims to explore the meanings and values of augmented reality online games by examining users’ Pokémon Go experiences through the means-end chain theory. Using data from interviews with 34 Pokémon Go users, this study adopts the soft laddering method to identify Pokémon Go’s potential attributes, consequences, and values, and to construct a hierarchical value map. The results indicated that Pokémon Go users pursue social relationships through play, and these relationships are triggered by the benefits of making new friends, maintaining current relationships with friends and family, and the attributes of prevalence, childhood memory, game design, and augmented reality. Subsequently, this study describes how Pokémon Go can be considered an active leisure activity because of its social, mental, and physical benefits and assesses the implications of its findings.

Getting into a "Flow" state: a systematic review of flow experience in neurological diseases

BACKGROUND

Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Being in flow during physical/cognitive rehabilitation may have a considerable impact on functional outcome, especially when patients with neurological diseases engage in exercises using robotics, virtual/augmented reality, or serious games on tablets/computer. When developing new therapy games, measuring flow experience can indicate whether the game motivates one to train. The purpose of this study was to identify and systematically review current literature on flow experience assessed in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Additionally, we critically appraised, compared and summarized the measurement properties of self-reported flow questionnaires used in neurorehabilitation setting.

DESIGN

A systematic review using PRISMA and COSMIN guidelines.

METHODS

MEDLINE Ovid, EMBASE Ovid, CINAHL EBSCO, SCOPUS were searched. Inclusion criteria were (1) peer-reviewed studies that (2) focused on the investigation of flow experience in (3) patients with neurological diseases (i.e., stroke, traumatic brain injury, multiple sclerosis and/or Parkinson's disease). A qualitative data synthesis was performed to present the measurement properties of the used flow questionnaires.

RESULTS

Ten studies out of 911 records met the inclusion criteria. Seven studies measured flow in the context of serious games in patients with stroke, traumatic brain injury, multiple sclerosis and Parkinson's disease. Three studies assessed flow in other activities than gaming (song-writing intervention and activities of daily living). Six different flow questionnaires were used, all of which were originally validated in healthy people. None of the studies presented psychometric data in their respective research population.

CONCLUSION

The present review indicates that flow experience is increasingly measured in the physical/cognitive rehabilitation setting in patients with neurological diseases. However, psychometric properties of used flow questionnaires are lacking. For exergame developers working in the field of physical/cognitive rehabilitation in patients with neurological diseases, a valid flow questionnaire can help to further optimize the content of the games so that optimal engagement can occur during the gameplay. Whether flow experiences can ultimately have positive effects on physical/cognitive parameters needs further study.

Analyzing Older Adults' Perceived Values of Using Smart Bracelets by Means-End Chain

To cope with the demands for medical care in an aging society, smart healthcare wearable devices that can measure physiological signals are being regarded as the primary tools in medical care programs, allowing the users to acquire basic health data. Although the smart healthcare wearable devices could be applied to disease management and prevention that could help older adults control their health, older adults must be willing and able to use and continue to use them. In this research, interviews conducted through means–end chain (MEC) and laddering were used to guide the older adults step-by-step by explaining abstract ideas and emphasizing value in their perceptions of specific attributes. A “hierarchical value map” was further constructed to confirm the perceived value of smart healthcare wearable devices to older adults. The research results showed that, in terms of attribute functions, seniors believed that smart bracelets in mobile health devices should have the attributes of safe use, real-time information feedback, correct data, comfortable wear, and clear screen. In terms of consequent benefits, older adults can use smart bracelets in mobile health devices to gain benefits in learning about smart products, understanding technology applications, increasing health awareness and relaxation, and satisfying curiosity. In terms of value goals, older adults want to achieve the value goals of a sense of social belonging, improved quality of life, and healthier bodies. Health is the most important thing for older adults, but previous research has often focused on the use of equipment for physical examinations; relatively few studies have allowed older adults to experience the equipment personally. The device can provide the ultimate value of long-term health promotion for older adults.

Acceptance and Influencing Factors of Social Virtual Reality in the Urban Elderly

In the stage of aging society and population aging, the social needs of the elderly are widely discussed by researchers. Especially driven by the demand of tele-medical treatment and tele-rehabilitation therapy, it is vital for the elderly to integrate into virtual communities by combining social virtual reality (VR) with different medical services and entertainment needs. In addition, affected by the COVID-19 epidemic, it is more difficult for people to have face-to-face contacts. With more remote consultation, entertainment and virtual social connectivity, the application of social VR is more urgent and valuable. However, there is little discussion on the acceptability and influencing factors of social VR among the elderly at present. Therefore, in order to get further data, we used (1) early stage semi-structured interviews and then (2) Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaires for investigation. One hundred fourteen elderly people aged 60–89 living in the metropolitan area of Taipei were taken as the subjects. To help them understand the situation and state of using social VR, these elderly people were asked to use a head-mounted display (HMD) to experience social VR games. The preliminary results showed that the elderly had obvious preference for entertainment (32.4%) and medical treatment (31.3%). The interview showed that this was related to the physiological condition or medical needs of the age range. In order to further understand how social VR would affect the social life of the elderly, we proposed the further demand structure of UTAUT Model based on the interview of both experts and the elderly. The model structures include (1) Performance Expectancy, (2) Perceived Enjoyment, (3) Social Influence, (4) User Attitude, (5) Behavioral Intention, and so on. These structures were applied to conduct interviews and questionnaires to find out the influence extent and relevance of the elderly on different structural needs, and suggestions were given accordingly. The results of the above interviews showed that (1) the elderly thought that the functions of entertaining and interacting of social VR could increase their social opportunities, and also meet medical needs (teleconference, cognitive decline, etc.), (2) the closeness of social relations (between family members, friends, doctors, and places), and also affect the relevance of Perceived Enjoyment (β = 0.77, p = 0.000 < 0.05). The results of these phenomena and interviews showed the interplay between the demand structures and their special relevance. They also indicated that as to social VR technologies, various demands and functional issues of the elderly need to be considered, and these demands would appear in the subtle usage, and different social VR interfaces and functions would emerge based on their special living ways and physical and psychological demands.

Using the Importance–Satisfaction Model and Service Quality Performance Matrix to Improve Long-Term Care Service Quality in Taiwan

The present study integrates the importance–satisfaction (I-S) model and service quality performance matrix (SQPM) to examine long-term care (LTC) service demands and satisfaction improvement. Many scholars have used a single model to explore project improvement. Each model has advantages, but we think they are too subjective and suggest that it is best to integrate models to determine what should be improved. We established quality attributes of service demands based on more than two sessions of discussions and expert consultations with LTC service users (older adults). The final questionnaire was divided into three parts: a demand survey, satisfaction survey, and demographics survey, and 292 valid questionnaires were collected. The questionnaire items were summarized with means and standard deviations. In this study, if only the I-S model was used to examine LTC in Taiwan, then seven service elements of the system would need to be improved. However, if only the SQPM method was used, then 16 service elements would need to be improved. Only seven service elements were identified by both methods. When time and resources are limited, it is not feasible to take comprehensiveness into account. When many projects must be improved and it is impossible to implement them at the same time, improvement priorities need to be developed. Taiwan lacks sufficient LTC resources, so it is impossible to provide enough resources for all those who need care. To use resources efficiently, the I-S model and SQPM were integrated in this study to identify areas for improvement.

Reconstructing Personal Stories in Virtual Reality sas a Mechanism to Recover the Self

Advances in virtual reality present opportunities to relive experiences in an immersive medium that can change the way we perceive our life stories, potentially shaping our realities for the better. This paper studies the role of virtual reality as a tool for the creation of stories with the concept of the self as a narrator and the life of the self as a storyline. The basis of the study is the philosophical notion of the self-narrative as an explanatory story of the events in one’s life that constitutes the notion of one’s self. This application is suitable for cases when individuals need to recreate their self, such as during recovery after traumatic events. The analysis of the effects of virtual reality shows that it enables a person to engage in a process of deeper self-observation to understand and explain adverse events and to give meaning to these events to form a new story, which can complement the therapeutic outcomes of exposure treatments. This study proposes concrete examples of immersive scenarios used to reconstruct personal stories. Several possible levels of experience are proposed to suggest that recovery can be achieved through the gradual retelling of the self-narrative, addressing all of the underlying narratives. Considering the ethical challenges that might arise, this paper explores the ways in which immersion in virtual reality can benefit a person’s view toward life as a story and his or her self as its author, comparing this idea with previous research on the application of virtual reality for trauma treatment. The analysis also emphasizes the perception of narrative authorship in virtual reality as an essential method for recovering the self-narrative and improving a patient’s mental health during self-actualization.

Influence of Leisure Activity Participation Between Genders Among Korean Older Adults

The current study examined and compared the effect of male and female older adults' participation level in leisure activities on their perceived health status, psychological well-being, levels of depression, levels of loneliness, and successful aging. A cross-sectional descriptive study design was used. Study participants comprised 197 older adults (women: n = 108, men: n = 89) ages 65 and older who were living in Gyeonggi Province, South Korea. Measures were the perceived health status scale, Geriatric Depression Scale Short Form-Korea, psychological well-being scale, loneliness scale, and successful aging scale. Based on level of participation in leisure activities, male older adults experienced a significant difference in perceived health status and loneliness. Female older adults experienced a significant difference in psychological well-being and successful aging. Health professionals should encourage higher participation in leisure activities to improve psychological well-being and successful aging of older adults. [Journal of Gerontological Nursing, 44(11), 51-58.].