Developing a Virtual Reality Psychosocial Intervention for Youth on Dialysis in New Zealand: A proof of concept study.

This project will test the potential of virtual reality (VR) technology to enhance the psychosocial health of youth on dialysis. Twelve participants representing the dialysis population in New Zealand aged 18-24 years (extremities included) will be identified and invited to participate in the study. This study will evaluate the usability and acceptability of a Mindful Self-Compassion program delivered via VR by exploring dialysis youths' experiences, perceptions, and preferences. We aim to identify critical areas of improvement that can enhance user engagement and satisfaction while also providing insights into potential therapeutic benefits associated with delivering psychosocial interventions using virtual reality. Additionally, this study will investigate the logistical considerations associated with implementing a home-based Virtual Reality Psychosocial intervention by assessing logistical challenges and constraints for recruitment and participation in the study. This mixed-methods study combines quantitative questionnaires that participants complete prior to and two weeks after the VR session and open-ended questions that participants complete after the session. Methodology Study participants and recruitment The aim is to recruit 12 young dialysis patients (either haemodialysis or peritoneal dialysis). DHB staff will identify potential participants, and the University of Auckland researchers will invite them, asking the renal clinic to provide PIS and study information along with contact information for the research team. In this invitation email, eligible participants will also receive the PIS and consent forms which they can sign and return in a pre-paid envelope or via email. We plan to recruit men and women from various ethnic groups using a purposive sampling frame. Participants are invited from all age groups, from 18-24, with a wide socioeconomic/rural distribution. Youths with severe psychiatric or developmental disorders and youth with visual impairments or physical disabilities that prevent them from using VR are excluded. Participants: Purposeful sampling (i) A group of 12 participants (aged 18-24) was selected; (ii) males and females were equally represented in each group; (iii) A mix of ethnicities will be recruited, with a particular emphasis on recruiting Maori and Pasifika youth, disproportionately affected by chronic kidney disease. (iv) Peritoneal dialysis/Hemodialysis PD/HD in each group to be included. Recruitment Procedure (i) Invitations to participate will be made to potential participants by the UoA Research Team after the initial dissemination of research study information using letters, posters, and emails distributed by clinical nurses and patient support staff within the DHBs. Interested potential participants will be asked to contact the research team. (ii) Eligible participants can give informed consent by emailing/posting consent forms before or during the home visit when the VR headsets are delivered before baseline assessments are taken. Study design This mixed methods proof-of-concept study explores the usability and acceptability of a brief MSC intervention delivered via VR. Quantitative measures will be collected to assess baseline demographic and clinical characteristics. Psychosocial questionnaires will also be collected at baseline and post-intervention. Open-ended questions will be administered after the intervention and analysed qualitatively to explore the user experience of the intervention and VR technology. Study Procedure The research team will visit interested participants a week before the VR group session. At this home visit, participants will be asked to provide informed consent (if they still need to do so) and receive a demonstration of the VR tool and headset. Baseline assessments will also be carried out (by the student researcher and the research assistant). The following week, the intervention will be conducted with approximately six participants per group. Each single group session will last approximately 75 minutes: 60 minutes of intervention with a 15-minute break after 30 minutes. Participants will take part in the intervention either from their home (if they have Wi-Fi and a private room to use) or from the University of Auckland Department of Psychological Medicine, where the PhD student and the intervention facilitator will also be based when the VR session is conducted. In the home-visit participants are also introduced to a Relaxation Meditation app which comprise of 5 or 10 minutes session. They are asked to experience the meditation app in their free time at least once. The participants and the facilitator will sign into the 'Connect' VR Application developed by XRHealth, an Australian digital innovation company offering FDA-approved VR applications. 'Connect' allows people to participate in a group session via VR remotely. Participants choose an avatar to represent themselves and participate in the virtual group session with VR headsets. A postdoctoral researcher from the Department of Psychological Medicine familiar with MSC will facilitate the group session with Senior Lecturer in Health Psychology using the VR portal. At the start of the VR session, they will provide a verbal introduction to outline procedures and guidelines and answer any questions participants may have. Participants will also be encouraged to ask questions anytime during the session. During the group session, the facilitators will go through the different components of MSC (mindfulness, compassion, and shared humanity) and take the group through several exercises. After 30 minutes, the facilitators will suggest a 15-minute break and check how the participants find the session and the VR headset. The remaining session will last another 30 minutes and will cover similar topics. See below for a table of topics covered in the VR session. All participants will receive a $20 Countdown voucher during the home visit and a $50 Countdown voucher (post-study) as a koha to thank them for their time with the research. The intervention is discussed in more detail below. 1) The following questionnaires will be administered at the baseline home visit and two weeks after the intervention (over Qualtrics, a secure research website). We will also assess demographic and clinical measures at baseline, including ethnicity (using NZ census questions), age, sex, age when diagnosed, comorbidities, and treatment. The following questionnaires will be assessed at baseline and after the VR group session. • Self-Compassion Scale short form • WHO-5 Wellbeing scale • Five Facet Mindfulness Questionnaire (FFMQ-15) The following questionnaires will only be asked after the VR group session. • Modified (customised for the study) System Usability Scale (SUS) • Participants will also be asked several open-ended questions to explore what they learnt from the intervention and if they have used any of the skills or exercises (e.g., "Over the past two weeks, have you used any of the skills that you learned from the VR session?") VR Session: Components of the brief self-compassion intervention : Session One Icebreaker game: "One Truth & One Lie Statement" - 10 minutes Topic: Basic introduction on what mindful self-compassion is - 5 minutes Topic: Crossing the line Exercise: Peer discussion - 15 minutes BREAK - 10 minutes Session Two Exercise: How would I treat a friend? - 15 minutes Feedback session on the Relaxation Meditation Application - 10 minutes Summary & Closing: 5 minutes Attendance checklists and phone calls (2 hours prior) to the intervention will be carried out.