Older Adults’ Experiences and Perceptions of Immersive Virtual Reality: A Systematic Review and Thematic Synthesis (Preprint)

BACKGROUND Immersive virtual reality (IVR) can be defined as fully computer-generated environments that are displayed through a head-mounted display. Existing research suggests that key features of IVR can assist older adults in their everyday lives–providing opportunities in health promotion and tackling social isolation and loneliness. There has been a surge in the number of qualitative studies exploring older adults’ experiences and perceptions of IVR. However, there has been no systematic synthesis of these studies to inform the design of new, more accessible IVR technologies. OBJECTIVE The objective of this study was to systematically review and synthesize qualitative studies exploring older adults’ experiences and perceptions of IVR. METHODS A systematic review and thematic synthesis was conducted following the ENTREQ guidelines. Two reviewers completed title and abstract screening, full-text screening, data extraction and quality appraisal. Thematic synthesis is derived from the qualitative method, thematic analysis. It involves three key steps: initial coding and grouping of these codes, the formation of descriptive themes from these codes and finally, going beyond the data to form novel insights and theories known as analytical themes. Confidence in the evidence was assessed using the GRADE-CERQual approach. RESULTS Thirteen studies were included in the final synthesis, consisting of 224 participants ranging across nine countries and five continents. Confidence in the evidence ranged from high to moderate. Four descriptive themes were generated: (1) facilitating IVR interactions, (2) experiencing unique features of IVR, (3) perceptions of IVR and (4) accounts of agency in IVR. The findings from the descriptive themes suggested that there are several improvements that need to be made to existing IVR devices to greater facilitate older adults’ use of this technology. However, despite this, older adults’ responses to IVR were generally positive. Three analytical themes were then generated: (1) tolerating the bad to experience the good, (2) buying in to IVR: don’t judge a book by its cover and (3) “it proves to me I can do it”. The analytical themes illustrated that older adults were willing to tolerate discomforts that accompany existing IVR technologies to experience features such as immersive social networking experiences, there was a discrepancy between older adults’ perceptions of IVR prior to use–which were generally negative–and after use–which were generally positive–and, IVR provided a platform for older adults to access certain activities and environments more easily than in the real world due to limitations caused by ageing. CONCLUSIONS This review highlights the need to overcome initial negative views of IVR and perceived barriers to use by emphasizing the unique ability of IVR to increase older adults’ agency through features such as presence, immersion, and embodiment, which in turn offer new opportunities to take part in meaningful activities tailored to their needs and preferences. INTERNATIONAL REGISTERED REPORT RR2-10.1177%2F16094069211009682

Designing Conversational Agents to Support Self-Regulated Learning for Older Adults

The rapid growth of the off-the-shelf smart speakers (such as Amazon Alexa and Google Home), also called Conversational Agents (CAs), creates potential to deliver everyday life support to users at home (such as checking weather, listening to news, scheduling events). Literature demonstrated the technology acceptance of CAs among older adults (including novice users) given the low barriers to use CAs. The natural conversations among CAs and users enable the opportunities to build deeper understandings about a topic through theory-driven guided dialogues. Our study has designed the metacognition strategies in the guided dialogues of CAs to support informal self-regulated learning of health information among older adults. The study has shown the feasibility and acceptance of CAs to help older adults learn new health information on their own through these guided dialogues. Additional analyses on the feasibilities to implement different metacognitive strategies in guided dialogues in the off-the-shelf CAs were also conducted.

Access and Barriers to Use of Long Term Services: Contextual Issues

The challenges that some older adults face in accessing both health and social services is a topic of continuing concern. This panel will focus on contextual issues that often shape specific challenges. These contextual issues usually emerge either from issues of diversity among the older persons themselves (for example, minority status or foreign born) and diversity between the ways in which services are offered (usually established at the national or in the case of the United States, at the state level). The intersection of these two forms of diversity often define the specific challenges faced by older persons in accessing health and social services. Further, unexpected events, such as the COVID pandemic, can affect both types of diversity (greater challenges for persons who do not speak the dominant language; inability of services to quickly adapt to radically changed environment). Our panel will address these issues through four presentations, each taking a different look at the ways in which diversity affects access. Our first paper, by Torres, will place this discussion in wider context by presenting results from a scoping review. Our second paper, by Diederich looks at access to services by immigrant generation (that being another source of diversity) in Germany. The third paper, by Thiamwong looks at how the COVID crisis affected older Hispanic women. Finally, Ring will examine how a national policy, here the definition of poverty, affects outcome and access for older person in the United States.

The Final Mile: Evaluating eHealth and mHealth Utilization Among Older Adults

While health endures as a term to describe looking after oneself, looking after loved ones, and receiving care, the added component of electronic technology has emerged to affect all levels of health care delivery. Despite the prevalence of digital health and empirical evidence strongly supporting improved outcomes--the final mile--as it is sometimes called, is the sustained patient engagement with eHealth and mHealth we have yet to achieve. This research identifies a gap in the literature for understudied characteristics of digital health adoption, use affecting the aging population in the U.S., and contributes a deeper understanding of the key barriers to use of health-related technology. A mixed-methods research approach explores prevalent barriers to digital health utilization by older adults through a pre-post data collection strategy to empirically test an educational health-related intervention rooted in the Technology Acceptance Model. This validated analytic framework represents a decision ‘core’ as a user pathway for actual use. Evaluation of score data utilized a quantitative test of group means while thematic coding was employed for qualitative analysis. The results from this study are two-fold. The work strongly suggests specific barriers to adoption and use, confirming a distrust and reluctance to engage. However, additional evidence, both quantitative and qualitative illuminates substantive skills, positive perceptions, hopeful attitudes, as well as the rationale for use of available digital resources. Findings suggest future research would benefit from expanded use of the two-pronged approach to foster health-related technology engagement.

Screening Practices for Disordered Eating in Paediatric Type 1 Diabetes Clinics

Background: Type 1 Diabetes (T1D) is associated with increased risk of eating disorders. This study aimed to (1) assess adherence of Australasian paediatric T1D clinics to international guidelines on screening for disordered eating and (2) identify barriers and enablers to the use of screening tools for the identification of disordered eating. Methods: A 24-item survey covering five content domains: clinic characteristics, identification of disordered eating, screening tool use, training and competence, and pathways for referral, was sent to Australasian clinics caring for ≥150 children and adolescents with T1D. Results: Of 13 eligible clinics, 10 participated. Two reported rates of disordered eating of >20%, while eight reported rates < 5%. All clinics used the routine clinical interview as the primary method of screening for disordered eating. Only one used screening tools; these were not diabetes-specific or routinely used. Barriers to use of screening tools included shortage of time and lack of staff confidence around use (n = 7, 70%). Enablers included staff training in disordered eating. Conclusions: Screening tools for disordered eating are not utilised by most Australasian paediatric T1D clinics. Overall, low reported rates of disordered eating suggest that it may be undetected, potentially missing an opportunity for early intervention.

Dual-energy computed tomography: Survey results on current uses and barriers to further implementation

Objective: To gauge the current availability of dual-energy computed tomography (DECT) scanners in the UK, establish available technologies, look broadly at current clinical uses in adults and paediatrics, and identify barriers to implementation and potential ways to increase use. Methods: A survey was distributed amongst 10 radiology departments and shared on two national professional co-operation mail bases; the survey ran from 20th July to 9th December 2020. It explored current DECT utilisation in adults and paediatrics as well as barriers to use and suggestions to overcome those barriers. Results: The survey demonstrated DECT availability on 39 (40%) of the 98 CT scanners, but there was limited clinical use in adults and paediatrics. Eighteen (72%) of the 25 respondents had access to at least one DECT scanner, with 14 (56%) having adult DECT protocols in clinical use; <10% head examinations and <50% for other anatomical areas. Only two (8%) respondents had DECT paediatric protocols in clinical use; <10% examinations for all anatomical areas. The main barriers to implementation identified were lack of experience with DECT (8 (44%) users (adult) and 10 (56%) users (paediatric)) and no clinical protocols available (6 (33%) users (adult and paediatric)). Understanding DECT benefits and establishing suitable protocols were the most popular suggestions for increased implementation (10 (40%) of 25 respondents). Conclusion: DECT scanners are available, but clinical use is limited for both adults and paediatrics. The main barriers identified were lack of experience with DECT and the availability of suitable protocols. Further work identified to help implementation included better education on the benefits of DECT, provision of clinical protocols and ensuring a multidisciplinary approach. Advances in knowledge: Barriers to implementation of clinical DECT protocols were identified, together with potential solutions to overcome these and enable further implementation.

Modular fluorescent nanoparticle DNA probes for detection of peptides and proteins

Fluorescently labeled antibody and aptamer probes are used in biological studies to characterize binding interactions, measure concentrations of analytes, and sort cells. Fluorescent nanoparticle labels offer an excellent alternative to standard fluorescent labeling strategies due to their enhanced brightness, stability and multivalency; however, challenges in functionalization and characterization have impeded their use. This work introduces a straightforward approach for preparation of fluorescent nanoparticle probes using commercially available reagents and common laboratory equipment. Fluorescent polystyrene nanoparticles, Thermo Fisher Scientific FluoSpheres, were used in these proof-of-principle studies. Particle passivation was achieved by covalent attachment of amine-PEG-azide to carboxylated particles, neutralizing the surface charge from − 43 to − 15 mV. A conjugation-annealing handle and DNA aptamer probe were attached to the azide-PEG nanoparticle surface either through reaction of pre-annealed handle and probe or through a stepwise reaction of the nanoparticles with the handle followed by aptamer annealing. Nanoparticles functionalized with DNA aptamers targeting histidine tags and VEGF protein had high affinity (EC50s ranging from 3 to 12 nM) and specificity, and were more stable than conventional labels. This protocol for preparation of nanoparticle probes relies solely on commercially available reagents and common equipment, breaking down the barriers to use nanoparticles in biological experiments.

Willingness, preferred ways and potential barriers to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in China

ObjectiveTo explore willingness and preferred ways to use HIV pre-exposure prophylaxis (PrEP), factors associated with willingness, and potential barriers to PrEP use among men who have sex with men (MSM) in Changsha, China.DesignA cross-sectional survey was conducted from 25 June to 31 August 2019. Two hundred and fifty-five MSM were recruited from three community-based organisations (CBOs) in Changsha City. Willingness and potential barriers to use PrEP were examined using researcher-created scales. Univariate and multivariate logistic regression was used to analyse the factors associated with willingness to use PrEP. P values <0.05 were considered significant.SettingThree MSM inclusive CBOs in Changsha, Hunan Province, China.Participants255 HIV-negative MSM were recruited through their CBOs with snowball sampling.ResultsLess than half of the participants (43.1%) had heard of PrEP and 15.3% were willing to use PrEP. The participants reported higher willingness to use event-driven PrEP (3.70±0.07) than daily PrEP (2.65±0.07). Higher self-rated risk and fear of contracting HIV (OR: 14.47, 95% CI 2.19 to 95.53), awareness of PrEP (OR: 4.20, 95% CI 1.64 to 10.73), sharing one’s own sexual orientation with parents or siblings (OR: 2.52, 95% CI 1.54 to 7.20) and having a university education or above (OR:0.29, 95% CI 0.12 to 0.72) were associated with willingness to use PrEP. Only 12.2% of the sample was concerned about potential barriers to PrEP use.ConclusionEfforts to improve awareness and knowledge of PrEP, teach self-evaluation of HIV infection risk and provide social and emotional support for MSM are needed to scale up PrEP implementation in China.

Oncologists’ knowledge and perspectives on the use of biosimilars.

35 Background: Despite the increasing availability of biosimilar cancer treatments, little is known about oncologists’ knowledge and concerns about biosimilar use in the United States. We conducted a survey of oncologists to examine their knowledge, attitudes, and experience with biosimilars. Methods: Using the ASCO Survey Research Pool (10-6-20 to 11-16-20), clinical oncologists completed a 29-question survey designed with structured input from clinical and health care system experts and literature review. Results: Of the 269 respondents, most ( n= 236, 88%) treated with biosimilars and reported that biosimilars were required at their institution. The table summarizes participants’ knowledge, barriers to use, preferences for and access to information around biosimilars, and interest in training. Conclusions: Despite high uptake of biosimilars, knowledge about basic features of biosimilars was low, and oncologists in community and private practice settings were more often concerned about safety and efficacy than those in academic practices. This information provides targets for future education about biosimilars.[Table: see text]