Second Life shows new promise as virtual forum for diabetes education

Participants in a Boston Medical Center study on managing diabetes danced together in the Second Life virtual world after a session.
Participants in a Boston Medical Center study on managing diabetes danced together in the Second Life virtual world after a session.

Thelma Adams, a 57-year-old Roxbury resident with diabetes, has a new grip on her condition. She now bakes dishes that she used to fry, and has committed to staying active by joining a local exercise class.

Careful diet and regular exercise are the classic lifestyle changes suggested to patients with chronic conditions like diabetes or hypertension, but patients in the US have a poor record keeping up with that regimen.

Adams, who has both conditions, chose to change after she attended a series of workshops at the Boston Medical Center a few years ago. Over the eight weeks of the course, however, Adams didn’t once visit the hospital’s facility. She met others in her group, talked, and took classes entirely online as an avatar in a virtual world called Second Life.

Launched in 2003, Second Life was among the first virtual platforms to attract a mass audience, with a onetime 36 million registered accounts and its own currency, the Linden Dollar. It led to real-life relationships and business deals, and attracted companies and organizations who tried to reach out to real people through this virtual world.

These days, Second Life has about 900,000 monthly active users and a demographic that runs largely to 30-, 40-, and 50-year olds. But it has taken on a second life of its own as a gathering space for adults meeting with a targeted purpose. A few groups of researchers are experimenting with the platform as a more formal teaching tool.

Adams was part of such a pilot study begun in 2009. The instructor was Suzanne Mitchell, a family physician at Boston Medical Center and assistant professor at the BU School of Medicine, who wanted to see if virtual group sessions about changing eating habits or exercise plans held in groups in Second Life environments could translate to real change. “We wanted to prove that the virtual world was just as good as face-to-face,” Mitchell said.

The participants were African-American women, many from low-income families, moms with jobs and busy schedules, who Mitchell reasoned might find it easier to log into the sessions from home. Half of the women were assigned to take classes at the hospital, while the other half each received a computer and a modem to join learning sessions in Second Life.

“The point was to say, is it at least as good, or is it grossly inferior,” said John Wiecha, director of the Office of Medical Education at Boston University and BMC family physician, who was Mitchell’s colleague on the study.

Some days the virtual group “met” at the Second Life BMC classroom, but the group also took field trips into the online world. Once, the course leaders led a session on diet and explained how slow, mindful eating was one way to control portions and manage diet. The participants found that when their avatars sat down to eat at the cafeteria location, their utensils moved very slowly, echoing the lesson. Another time the group met at an exercise facility within Second Life, where participants could try out the treadmill or exercise bikes, or take a swim.

In a small pilot study conducted by Boston Medical Center and BU researchers, people who attended group diabetes management sessions online in Second Life exercised more than a group that met in real life.
In a small pilot study conducted by Boston Medical Center and BU researchers, people who attended group diabetes management sessions online in Second Life exercised more than a group that met in real life.
The trial was a hit. Mitchell said the Second Life participants didn’t just sit in on the course sessions. They made friends, swapped recipes, had dance sessions, hung out. Most tellingly, participants wanted to know if they could involve their families in the game too.

For the span of the study, the diabetes of both groups improved at the same rate. Sessions online and in real life had comparable rates of attendance. But members of the Second Life group reported exercising more than the group that met in class. This was the most exciting result for Mitchell: The hint that the virtual experience might create a long-lasting lifestyle change.

These early results have drawn interest from federal agencies. This month, Mitchell received $3.5 million in funding from the National Institute of Diabetes and Digestive and Kidney Disease to recruit a larger group and do a more definitive study that determines if virtual classes really help people manage their disease — and, if they do, how effective they are compared to consults in person.

Besides the convenience factor, there’s something about the virtual space that Mitchell argues makes people more comfortable experimenting with the unfamiliar.

“I’m watching myself do something I don’t normally do. How do I feel about that, and what does that mean?” Mitchell said.

Continuous access to the new technology is key to keeping people engaged, said Alice Krueger, president of the nonprofit Virtual Ability, a 1,000-member group that hosts events and virtual outings within Second Life for people with disabilities. So Mitchell’s choice to allow study participants a computer to take home is critical.

Krueger, who has multiple sclerosis, spends about eight hours a day in Second Life as the avatar Gentle Heron, and volunteers on various Virtual Ability projects.

Of the study participants, she says, “Some of them are going to say, wow. This virtual world stuff is going to be amazing.” Those will stay on, and others will go back to interacting with their friends on platforms like Facebook. “And you can never predict ahead of time who’s going to be in which group.”

Nidhi Subbaraman writes about science and research. Email her at nidhi.subbaraman@globe.com.
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