BMC awarded NIDDK grant to study outcomes of minority women receiving diabetes self-management education

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has awarded a $783,906 grant to Suzanne Mitchell, MD, a family physician at Boston Medical Center (BMC), to study health outcomes of minority women with type 2 diabetes who participate in group medical visits to help them manage their diabetes. Participants will receive diabetes self-management (DSM) education and medical advice from BMC physicians either in the online virtual world Second Life or an in-person classroom setting. The study aims to determine the efficacy of virtual world and classroom groups in teaching DSM, to increase all participants' physical activity levels, and to measure technological development milestones of the virtual group.

'Shared' or 'group' medical visits have proven not only to be an effective way to deliver care to patients, but they also provide an interactive forum to educate patients on care management for medical conditions, especially chronic diseases like type 2 diabetes. The prevalence of diabetes in the U.S. is disproportionately high among minority women. According to the U.S. Department of Health and Human Services Office of Women's Health, a quarter of African-American women over age 55 has type 2 diabetes.

"We know that in order to actively participate as partners in healthcare, patients with diabetes need self-management support," said Mitchell, who also is an assistant professor of family medicine at Boston University School of Medicine. "What is remarkable about this study is we'll be educating and interacting with some of the patients, and they'll be interacting with each other, all through group visits in a virtual world."

Patients will be placed in either the control group (classroom education) or asked to join Second Life. To use Second Life, patients create an avatar -- a virtual representation of themselves -- to interact with other patients' avatars, places or objects in the virtual world. Using the avatars, patients attend group medical visits led by BMC physicians and learn the same DSM techniques as those who participate in the classroom experience.

"A previous study by BMC researchers showed that African-American women were willing to actively engage in DSM education through group visits in Second Life, which produced similar, if not better outcomes than the face-to-face classroom experience," Mitchell said. "They endorsed their desire to share their new knowledge, mastered self-care behaviors, and truly enjoyed the peer-derived social support while using Second Life."

A unique aspect of the virtual world experience is the opportunity to experiment with and simulate new behaviors, such as exercise or healthy cooking.

"There's an established theory called the Proteus Effect that explains how virtual world experiences and the process of changing an avatar's physical appearance can have an effect on a patient's real life. For example, when a patient engages her avatar in exercise activities in the virtual world, she is more likely to exercise in her real life," Mitchell said. Additionally, some participants in the pilot study reported joining their local gym after they watched, and were encouraged by, their avatar's use of Second Life's virtual gym.

An obvious but significant perk for patients randomly selected to participate in the virtual world DSM education is that those patients can attend the group medical visits from the comfort of their own home and do not have to worry about traveling to a physical location. The only requirement: A computer with Internet access, Mitchell said.