Healthcare Providers’ Perspectives of 360-Degree Cinematic Virtual Reality (Cine-VR): A Qualitative Study (Preprint)

BACKGROUND The global market for medical education is projected to increase exponentially over the next five years. One mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in three-dimensional (3D) multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, the majority of this research has been conducted with health professional students and not current providers. Thus, more research is needed to explore how healthcare providers’ experience VR with role-playing and clinical encounters. OBJECTIVE The purpose of this study was to explore healthcare providers’ and educators’ experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-video with the narrative storytelling of cinema to create an engaging educational experience. METHODS We conducted in-depth telephone interviews with healthcare providers and educators who participated in the cine-VR training. Interviews were audio-recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. RESULTS We conducted 20 in-depth interviews with healthcare providers and educators (age=43.8±11.8 years; 90.0% female; 95.0% white, 20.0% nurses) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: 1) Feeling Immersed in the Virtual World: Seeing a 360-sphere allowed participants to immerse themselves in the virtual world. 2) Accurate Portrayal of Appalachian Culture: All of the participants, including those born and raised in Appalachia, stated that the cine-VR storyline was an accurate depiction of Appalachian culture. 3) Contextualizing Barriers and Beliefs about Diabetes in Appalachian Culture: All of the participants were able to recall the social determinants of health addressed in the cine-VR training as well as the fatalistic attitudes about diabetes. 4) Empathizing with Multiple Perspectives: The cine-VR provided a glimpse into the real life of the main VR character; participants described thinking and feeling the character’s frustrations, disappointments, and being torn between competing responsibilities. Participants felt that the cine-VR helped them empathize with the different characters in the cine-VR. 5) Perceived Value of Cine-VR as a Teaching Tool: Participants described cine-VR as an effective teaching tool because of the realism in the simulations. CONCLUSIONS Participants described feeling immersed in the cine-VR environment. They attributed the value of the training to the realistic portrayal of diabetes, social determinants of health, and Appalachian culture. Further, participants expressed empathy for the characters in the VR. More research is needed to confirm the significance of immersion and empathy in cine-VR training for healthcare providers. CLINICALTRIAL N/A

Housing Insecurities and Homelessness Among Children and Unaccompanied Youth in Rural Appalachian Communities

Homelessness may have a profound impact on a child's physical, socio-emotional, and/or cognitive development. Cultural context may further exacerbate the impact of such circumstances. Past literature confirms that the Appalachian culture is distinct from mainstream America, suggesting that various interventions, including mental health treatment, may not be received similarly or have the same impact as they would in other communities. This chapter addresses how to support children and unaccompanied youth facing homelessness or housing insecurity within rural Appalachian communities. Existing research addresses the developmental consequences of homelessness; however, there is limited literature dedicated to understanding how the unique context of the Appalachian culture may affect these conditions. The aim of this chapter is to provide educators, counselors, and similar professionals with an overview regarding how to best support homeless children and unaccompanied youth within Appalachian communities.

Bluegrass Music and Urban Appalachian Identity in Cincinnati

Neighborhood cultural and political development in 1960s and 1970s Cincinnati coalesced around music, a positive expression of urban Appalachian culture. United Appalachian Cincinnati embraced folk-revival bluegrass and established new advocacy. Mike Maloney, Ernie Mynatt, and Stuart Faber helped Appalachians receive federal money via agencies addressing urban issues. Main Street Bible Center, Appalachian Identity Center, and the Appalachian Heritage Room were early manifestations. The Urban Appalachian Council emerged in 1974. Earl Taylor was lionized as the “authentic” bluegrass musician. After 1960, musicians honed their skills to his music at Ken-Mill Café. In the early 1970s the Katie Laur Band played in schools. Cincinnati’s Appalachian Festival—begun in 1970—highlighted positive aspects of mountain culture, including music and crafts.

Slavery, the Civil War, and Reconstruction

Discusses Appalachia’s African American citizens during the pre- and post-Civil War years. The presence of slavery and African Americans in the region has often been obscured by myths and incorrect assertions about the relative mildness of slavery in the mountain South. Yet, the African American community was very much a part of Appalachian culture and society, both during and after the Civil War. Their stories and the stories of Appalachian abolitionists seek to correct these myths and correctly inform of the region’s role during this tense time in American history.

Housing Insecurities and Homelessness Among Children and Unaccompanied Youth in Rural Appalachian Communities

Homelessness may have a profound impact on a child's physical, socio-emotional, and/or cognitive development. Cultural context may further exacerbate the impact of such circumstances. Past literature confirms that the Appalachian culture is distinct from mainstream America, suggesting that various interventions, including mental health treatment, may not be received similarly or have the same impact as they would in other communities. This chapter addresses how to support children and unaccompanied youth facing homelessness or housing insecurity within rural Appalachian communities. Existing research addresses the developmental consequences of homelessness; however, there is limited literature dedicated to understanding how the unique context of the Appalachian culture may affect these conditions. The aim of this chapter is to provide educators, counselors, and similar professionals with an overview regarding how to best support homeless children and unaccompanied youth within Appalachian communities.

Diabetes in Appalachia: providers’ perspectives

Background: Southeastern Appalachian Ohio has more than double the national average of diabetes and a critical shortage of healthcare providers. Paradoxically, there is limited research focused on primary care providers’ experiences treating people with diabetes in this region. This study explored providers’ perceived barriers to and facilitators for treating patients with diabetes in southeastern Appalachian Ohio. Methods: We conducted in-depth interviews with healthcare providers who treat people with diabetes in rural southeastern Ohio. Interviews were transcribed, coded, and analyzed via content and thematic analyses using NVivo 12 software (QSR International, Chadstone, VIC, Australia). Results: Qualitative analysis revealed four themes: (1) patients’ diabetes fatalism and helplessness: providers recounted story after story of patients believing that their diabetes was inevitable and that they were helpless to prevent or delay diabetes complications. (2) Comorbid psychosocial issues: providers described high rates of depression, anxiety, incest, abuse, and post-traumatic stress disorder among people with diabetes in this region. (3) Inter-connected social determinants interfering with diabetes care: providers identified major barriers including lack of access to providers, lack of access to transportation, food insecurity, housing insecurity, and financial insecurity. (4) Providers’ cultural understanding and recommendations: providers emphasized the importance of understanding of the values central to Appalachian culture and gave culturally attuned clinical suggestions for how to use these values when working with this population. Conclusions: Evidence-based interventions tailored to Appalachian culture and training designed to increase the cultural competency and cultural humility of primary care providers may be effective approaches to reduce barriers to diabetes care in Appalachian Ohio.

Out of Eden: Old South, Post-South and Ur-South in Sara Taylor’s The Shore

Sara Taylor’s The Shore is ex-centric in many ways. As for the setting, it geographically and socially depicts a fringe of the already-peripheral Appalachian culture, shedding a new and interesting light on the Southern “sense of place” through the use of magical-realistic elements that actually connect characters and landscape. Geography, though, is but the palimpsest. The book’s liminality is further reinforced by the fact that The Shore’s long and violent familiar history is chiefly narrated through the voices of six generations of women struggling not to be silenced by the all-embracing southern patriarchy. Considering both the psycho-geographical and socio-historical dimensions described by Taylor, this essay will show how The Shore stands as a counter-dynastic novel giving a voice to those who were excluded from the South’s self-projected image-in-place. Also, through its comprehensive outlook on southern history, the novel chronicles the (frustrated) effort to overcome postmodern placelessness via an-other way of constructing southern identity.

“Rise and Shine”

This chapter examines the use of dance to promote community development at Hoedown Island, Eastern Kentucky, with particular emphasis on the role played by the Natural Bridge State Resort Park in Powell County. It begins with an overview of the Natural Bridge State Resort Park and the efforts of civic leaders like Richard Jett to make life better for Powell and other nearby counties. It then considers Natural Bridge's role in the promotion of dancing at Hoedown Island under Jett's leadership, along with the importance of an intergenerational community and a spirit of cooperation in making dance a key part of his vision for Hoedown and for the entire Appalachian region more generally. It also discusses the ways that individual expression was encouraged in dancing such as freestyle clogging and how Jett's goal of promoting the region and its talents intersected with the national interest in Appalachian culture. The chapter concludes with an assessment of the Hoedown Island Cloggers's performance in 2000 as well as Jett's legacy and future prospects for dance at Hoedown Island.