Social Virtual Reality, Patients, and Providers: Not Ready for Primetime

Background. Social virtual realities (SVRs) continue to receive interest, funding, and occasional hype as solutions to public health training and, more recently, patient communication and support problems, primarily because they are “social”: people can meet and congregate, role-play can become untied from physical location, as can patient-provider interactions. Purpose. To separate the virtual from the reality, by reflecting on our experiences with two large-scale, multi-year NIH-funded projects that explored SVR use with two quite different public health problems: improving healthcare provider education, in this case, related to SBIRT; and, second, improving patient management of diabetes. From design to evaluation, both projects were grounded in respected behavior and professional development theories, and guided by an established, iterative, user-centered design and development methodology. Results. We developed two virtual worlds: a primary care clinic for providers and residents to learn about and practice SBIRT and a Diabetes Guidance Center for diabetes patients to interact with experts and providers, and to engage learning materials and support tools. For both worlds, we were generally able to implement, to varying degrees of fidelity, what we wanted to support the project objectives. However, numerous limitations and challenges emerged, and although participants frequently found the SVR usable and innovative, noting the technology's potential, numerous interface and cognitive overhead issues were also identified. Discussion. We will argue that while it is possible to create SVR experiences that accomplish key provider training or patient support goals, and that there are some significant benefits to doing so, the costs, especially in terms of production and implementation complexity as well as user overhead, simply do not justify the benefits. Quite simply, there is no single thing that can be done in a social virtual world that cannot be done as well, and quite likely more elegantly and effectively, through other methods...yet....