title: A Virtual World Versus Face-to-Face Intervention Format to Promote Diabetes Self-Management Among African American Women: A Pilot Randomized Clinical Trial.
abstract: BACKGROUND
  Virtual world environments have the potential to increase access to diabetes self-management interventions and may lower cost.
  
  
  OBJECTIVE
  We tested the feasibility and comparative effectiveness of a virtual world versus a face-to-face diabetes self-management group intervention.
  
  
  METHODS
  We recruited African American women with type 2 diabetes to participate in an 8-week diabetes self-management program adapted from Power to Prevent, a behavior-change in-person group program for African Americans with diabetes or pre-diabetes. The program is social cognitive theory-guided, evidence-based, and culturally tailored. Participants were randomized to participate in the program via virtual world (Second Life) or face-to-face, both delivered by a single intervention team. Blinded assessors conducted in-person clinical (HbA1c), behavioral, and psychosocial measurements at baseline and 4-month follow-up. Pre-post differences within and between intervention groups were assessed using t tests and chi-square tests (two-sided and intention-to-treat analyses for all comparisons).
  
  
  RESULTS
  Participants (N=89) were an average of 52 years old (SD 10), 60% had ≤high school, 82% had household incomes <US $30,000, and computer experience was variable. Overall session attendance was similar across the groups (6.8/8 sessions, P=.90). Compared to face-to-face, virtual world was slightly superior for total activity, light activity, and inactivity (P=.05, P=.07, and P=.025, respectively). HbA1c reduction was significant within face-to-face (-0.46, P=02) but not within virtual world (-0.31, P=.19), although there were no significant between group differences in HbA1c (P=.52). In both groups, 14% fewer patients had post-intervention HbA1c ≥9% (virtual world P=.014; face-to-face P=.002), with no significant between group difference (P=.493). Compared to virtual world, face-to-face was marginally superior for reducing depression symptoms (P=.051). The virtual world intervention costs were US $1117 versus US $931 for face-to-face.
  
  
  CONCLUSIONS
  It is feasible to deliver diabetes self-management interventions to inner city African American women via virtual worlds, and outcomes may be comparable to those of face-to-face interventions. Further effectiveness research is warranted.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01340079; http://clinicaltrials.gov/show/NCT01340079 (Archived by WebCite at http://www.webcitation.org/6T2aSvmka).
authors.affiliation: University of Massachusetts Medical School, Division of Preventive and Behavioral Medicine, Worcester, MA, United States. milagros.rosal@umassmed.edu.
authors.forename: Milagros C
authors.identifier: http://orcid.org/0000-0001-8497-5558
authors.initials: MC
authors.lastname: Rosal
authors.forename: Robin
authors.identifier: http://orcid.org/0000-0001-9964-6095
authors.initials: R
authors.lastname: Heyden
authors.forename: Roanne
authors.identifier: http://orcid.org/0000-0002-6980-9321
authors.initials: R
authors.lastname: Mejilla
authors.forename: Roberta
authors.identifier: http://orcid.org/0000-0002-6540-7405
authors.initials: R
authors.lastname: Capelson
authors.forename: Karen A
authors.identifier: http://orcid.org/0000-0003-4503-1583
authors.initials: KA
authors.lastname: Chalmers
authors.forename: Maria
authors.identifier: http://orcid.org/0000-0001-9199-0430
authors.initials: M
authors.lastname: Rizzo DePaoli
authors.forename: Chetty
authors.identifier: http://orcid.org/0000-0003-1074-5981
authors.initials: C
authors.lastname: Veerappa
authors.forename: John M
authors.identifier: http://orcid.org/0000-0003-4525-9283
authors.initials: JM
authors.lastname: Wiecha
keywords: African Americans; clinical trials; feasibility; health behavior; health disparities; minority health; randomized clinical trial; technology; type 2 diabetes; virtual systems