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Virtual reality (VR), a simulated experience that can be similar to or completely different from the real world, has become increasingly useful within the psychiatric and medical fields. This VR technology has been applied in medical school trainings, exposure therapy for individuals with posttraumatic stress disorder (PTSD), and reminiscence therapy associated with mood disorders for older adults. Perceptions of VR through the lens of the health care provider require further exploration. VR has grown in popularity; however, this modality continues to be underused in most Veterans Affairs (VA) hospitals.
A web-based survey was used to explore health care provider perceptions of immersive VR availability and use for older adults and identify potential barriers for immersive VR use in older adults with cognitive impairment.
An 8-item web-based survey was developed to obtain health care provider feedback. This survey was disseminated throughout a single Veterans Integrated Services Network (VISN). The VR survey was developed via the Survey Monkey platform and distributed through the secure VA email network. Providers were asked to voluntarily participate in the brief, anonymous survey and offer their perceptions of immersive VR use within their patient population. Survey data were reviewed and interpreted using descriptive statistics.
A total of 49 respondents completed the survey over a 15-day period. Of them, 36 respondents (73%) had heard of a VR device, though the majority (n=44, 90%) had never used or prescribed a VR device. Respondents identified several potential barriers to immersive VR use in older adults with cognitive impairment (eg, hearing difficulties, perceptions of technology, cognitive concerns, access to resources, and visual impairment). Despite the barriers identified, providers (n=48, 98%) still reported that they would feel comfortable prescribing immersive VR as an intervention for their patient population.
Survey findings revealed that health care providers within this VISN for VAs have heard of VR, although they may not have actively engaged in its use. Most of the providers reported that they would prescribe the use of an immersive VR intervention for their older adult patients. This key point highlights the desire to implement VR strategies for patient use by their providers. If underlying barriers can be addressed and relatively resolved, this technological intervention has the potential to create substantial breakthroughs in clinical care.
Nonpharmacological interventions in health care are an alternative approach to pharmacological therapies and are recommended as a first-line treatment prior to introducing medications. This is especially important for older adults due to the increased risk for adverse outcomes. One nonpharmacological intervention with increasing recognition and application among health care providers involves the use of virtual reality (VR) devices. For the purposes of this survey, health care providers include any licensed independent provider or clinician who provides health care to older adults (eg, physicians, nurses, and psychologists). These VR devices use technology to create a simulated environment. VR is a computer-generated simulation in which one can interact with the surrounding environment by using various devices such as computers, smartphones, or head-mounted devices that can be immersive or nonimmersive [
The medical education field has also used VR to educate providers on various medical conditions [
Ways to seamlessly integrate the use of technology in older adults has been a topic of interest since the late 1980s [
Although there is strong evidence to support the use of VR in older adults, it is important to understand if health care providers support the use of immersive VR in their patient populations. This survey was developed as preparatory to a funded research study to examine the use of immersive VR in older veterans with cognitive impairment. The aim was to use a web-based survey to explore health care provider perceptions of immersive VR availability and use in older adults as well as to identify potential barriers for VR use in older adults with cognitive impairment. Through analysis of the responses, possible obstacles or stigma were identified to better understand current perceptions and advise future directions for immersive VR use with older adults.
All health care providers from a single Veterans Affairs (VA) Veterans Integrated Services Network (VISN) were invited to participate in a web-based, anonymous, closed survey. Health care providers were selected from one VA VISN that included 8 VA medical centers to better understand views from this specific population. The Veterans Affairs Health Administration is divided into 18 VISNs (or regional systems) across the nation. These regional divisions are meant to increase access to care and resources for veterans throughout the United States.
The survey, included in
The Institutional Review Board of the Central Arkansas Veterans Health Care System deemed the survey as nonresearch and preparatory to research activity and therefore exempted it from ethics review.
Descriptive statistics were used to analyze, summarize, and present the survey data findings. Frequency distribution was used to depict the frequency or count of different outcomes in the sample. The frequency distribution was presented in a table format to summarize the health care disciplines and potential VR barriers in older adults with cognitive impairment. Each entry in the table was accompanied by the count or frequency along with associated percentages.
A total of 49 participants completed the survey.
Percentage of health care providers by discipline (N=49).
Provider disciplines | Values, n (%) |
Social worker | 14 (29) |
Nursing | 10 (21) |
Physician | 10 (20) |
Psychologist | 6 (12) |
Administration | 3 (6) |
Chaplain | 2 (4) |
Physical therapist | 1 (2) |
Recreation therapist | 1 (2) |
Neuropsychologist | 1 (2) |
Research health specialist | 1 (2) |
Perceived barriers to virtual reality use by health care providers (N=12).
Barriers | Values, n (%) |
Cognitive issues | 36 (74) |
Perceptions of technology | 36 (74) |
Hearing loss | 35 (71) |
Vision problems | 33 (67) |
Access to resources | 28 (57) |
Frailty | 10 (20) |
Mood issues | 8 (16) |
Other | 5 (10) |
Our data yielded results highlighting that health care providers agreed that VR devices can be used with older adults, and furthermore, with older adults who have cognitive impairment. This information matches previous data in studies where older adults engaged in VR-based research [
Results of this project are consistent with literature in the field addressing provider acceptance of VR use for patients. Additionally, social barriers identified by providers regarding the use of VR devices in practice have been reported [
Chung et al [
One major limitation of our study is the small sample size reported; the project yielded results from 49 respondents. Second, we included only 8 items for the total survey. It is possible that additional information was unable to be analyzed due to the low item number. The third limitation includes the restriction of sending the survey to only one VA VISN and only VA health care providers. Some health care providers may have other roles in different care settings, though they would have required a VA affiliation to have access to this project survey.
Future areas of consideration include understanding the perception of health care providers toward using VR or referring patients to engage in immersive VR-based interventions. Similarly, research can explore perceptions of technological use, specifically immersive and nonimmersive VR use, in older adults with cognitive impairment. Identifying additional barriers for both forms of VR use and brainstorming possible solutions to these barriers are also required in the future.
Immersive VR continues to emerge as a viable option for a myriad of clinical presentations and medical education purposes. Various uses of this technology are being identified and researched. Although systemic, professional, and individual barriers have been highlighted, the field continues to address these obstacles with the hopes of improving the overall VR experience.
Veterans Affairs health care providers perceptions of virtual reality survey.
posttraumatic stress disorder
Veterans Affairs
Veterans Integrated Services Network
virtual reality
AMP would like to thank LB, KPP, and PRP for their guidance and assistance throughout the project. The authors would also like to thank the Veterans Affairs (VA) Veterans Integrated Services Network (VISN) participants.
This article was supported by the Department of Veterans Affairs Rehabilitation Research and Development Services (RR&D) by grant RX-002638-03. KPP was supported by the Department of Veterans Affairs RR&D merit grant I01 RX002961. PRP was supported by the Department of Veterans Affairs RR&D merit grant 1I01RX002638 and VA’s Health Services Research and Development Service (grant C19 20–398).
The deidentified data sets generated and analyzed for this study are available from the corresponding author upon reasonable request.
None declared.