The Impact of a Virtual Reality Training Programme on Health Professional Knowledge, Understanding and Empathy in relation to Dementia

Background
The provision of compassionate, responsive and empathetic caring is interconnected to professional knowledge, critical understanding and increased awareness of the importance of the persons lived experiences of ill health or illness. This is extremely important in ensuring effective care for a person living with dementia. Providing empathetic care enables health professionals to promote care standards, which in turn will lead to less stressful and distressing situations for the person experiencing the effects of dementia. Achieving true empathetic understanding can be elusive in many complex caring situations. However, the emergent literature on the utilisation and emergence of virtual reality training programmes indicates significant positive steps in this direction.

Aim
The overall aim of this study was to explore and examine the impact of a Virtual Dementia Training (VDT®) Programme on participants in terms of their professional knowledge, understanding and empathy in the provision of person-centred care.

Design and Methods
The overall design for this study was a mixed methods exploratory research design, consisting of two phases. Phase one involved a quasi-experimental one-group pretest- posttest repeated measures design which was used to measure quantitative data and changes across three time points; time point 1 was prior to intervention; time point 2 was immediately after the intervention; and time point 3 was measured at 3-months follow up. The Empathy and Understanding in Dementia Index, (Slater et al. in press), a 19-item, valid and reliable tool was administered pre and post intervention to a census of multi-health professionals (93%, n=223) participating in the study. This tool measured four constructs; previous training, empathy, understanding of behaviours and person- centred practice. All items were measured on a 5-pont scale (1- strongly disagree to 5 – strongly agree). Inferential statistics will be used to examine change over time; and the impact of demographic details. The intervention delivered was a 2-hour immersive virtual reality programme, followed by a debriefing session. The virtual reality programme was designed to mimic stage 4 moderate dementia and all participants were then involved in phase two.

Phase two involved an extensive qualitative component, comprising of a series twenty focus groups consisting of 223 participants sampled from phase one cohort, representing health care practitioners across the Trust and carers for a person living with dementia. Focus groups were undertaken to evaluate the views of the opinions of participants in the VDT® programme and to gain an insight into the perceived impact of the training on practice. A discussion schedule based on the aims and objectives of the study and a review of the literature was developed and with consent, discussions were digitally recorded. Prior to focus groups beginning all participants completed a demographic and dementia training questionnaire. Data from the discussion groups were analyzed using thematic analysis. Full ethical approval was sought and granted, for both phases, from both the University and the Trust Quality and Improvement Governance Team.

Results
Analysis of phase one data revealed that prior intervention awareness to empathy levels, understanding of the symptoms of dementia, its impact on behaviour and its role in the provision of person-centred practice were all scored as neutral, irrespective of health care role, gender, age or setting. Statistically significant positive changes were reported on all items and the three constructs they represented. The changes were noted across all demographic details.

Five themes emerged from the thematic content analysis of the qualitative data: (1) immersive learning; (2) VDT ® experience; (3) empathy related responses; (4) authenticity and transferability and (5) suggestions for improvement. Overall the participants believed the VDT® experience enabled immersive learning through the senses of vision, sound and touch to occur. This enabled them to step into the shoes of a person with dementia through body ownership illusion, increasing cognitive and affective empathy. Many participants found the experience difficult which led to calls for greater psychological support being available at the end of the programme. However, questions regarding the authenticity and the transferability of the learning were raised.

Conclusion
The virtual reality programme had an impact on participants who reported significant increases ‘in feeling in touch with the world of the person with dementia’, ‘understanding of the emotions and the role they play in the presentation of many behaviours displayed by a person living with dementia’. Whilst questions regarding the authenticity and transferability of the learning were raised, overwhelmingly participants valued the experience which stimulated reflection-on-action and reflection-in-action to occur. Such approaches helped to embed the learning and understand the often isolated, fragmented and confusing world of the person living with dementia.